ADMN 822: Selected Topics in Public Policy
PSCI 844: Politics of Health Care
HIST 890-899: Directed Reading and Research
HEALTH CARE POLICY IN POSTWAR CANADA
INTERDISCIPLINARY GRADUATE SEMINAR
FALL SEMESTER 2003
Professor Gregory P. Marchildon
Canada Research Chair in Public Policy and Economic History
Professor, Faculty of Administration
University of Regina
Overview
This course reviews the historical development of the Canadian health care system and its supporting principles, governance structures and fiscal arrangements. It then examines contemporary structures and relationships as well as the current impetus for public health care reform, including challenges related to financing, organization and delivery. Some effort is made throughout to compare Canadian health policy and programs to select OECD countries.
The course begins with an introduction to the basic concepts of health, health care and the determinants of health as well as the policy process as applied to health and health care within the Canadian federation. Part I of the course traces the evolution of the “Canadian model” in terms of the evolution of public health, hospitalization, medicare as well as the mixed and private sectors of health care. Part II is concerned with contemporary health reform issues as they relate to fiscal sustainability and the re-organization and delivery of services to achieve a more effective continuum of care.
Readings
Assigned readings should be read before the seminars. These readings have been kept to a minimum but I encourage you to explore some of the supplementary readings if possible as they are will provide you with a deeper understanding of the many, often disparate, policies and programs that make up what we call the Canadian health system. Wherever possible, course readings have been made available in electronic format on WebCT. Required readings that are not available electronically (marked by an asterisk *) have been brought together for you in a single CanCopy textbook available for purchase at the University of Regina bookstore. The one exception is the reading from C. David Naylor’s Private Practice, Public Payment (McGill-Queen’s University Press, 1986). This book is also available in the bookstore.
Evaluation
Your evaluation will be based upon: (1) the preparation and presentation of a “policy briefing” based upon an analysis of one of a selected supplementary reading; and 2) a paper of no more than 30 pages (double-spaced) in length, including bibliography, addressing a major health care policy issue. Policy briefings will be assigned to individual members of the class in advance and will be worth 30 per cent of the final mark. Paper topics will be approved in advance through the submission of a 1 page outline and bibliography worth 10 per cent. The final paper will be worth 60 per cent of your final assessment.
PART I: THE EVOLUTION OF THE CANADIAN MODEL
Seminars 1 and 2: Introduction to the “Canadian Model” and Current Challenges
* Duane Adams, “Canadian Federalism and the Development of National Health Goals and Objectives”, in Duane Adams, ed., Federalism, Democracy and Health Policy in Canada (Montreal and Kingston: McGill-Queen’s University Press, 2001): 61-105.
* Antonia Maioni, Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada (Princeton, NJ: Princeton University Press, 1998): 153-78.
Carolyn Tuohy, “Dynamics of a Changing Health Sphere: The United States, Britain, and Canada”, Health Affairs, Vol. 18, no. 3 (1999): 114-34; and “The Costs of Constraint and Prospects for Health Care Reform in Canada”, Health Affairs, Vol. 21, no. 3 (2002): 32-46.
C. David Naylor, “Health Care in Canada: Incrementalism under Fiscal Stress”, Health Affairs, Vol. 18, no. 3 (1999): 9-26.
Seminar 3: Local and Provincial Hospital Policy, 1900-1955
* Duane Mombourquette, “An Inalienable Right: The CCF and Rapid Health Care Reform, 1944-1948”, Saskatchewan History, Vol. 43, no. 3 (Autumn 1991): 101-116.
* Terry Boychuk, The Making and Meaning of Hospital Policy in the United States and Canada (Ann Arbor: University of Michigan Press, 1999): 26-48
* Naylor, Private Practice, Public Payment, 8-94.
Supplementary Reading:
Malcolm G. Taylor, Health Insurance and Canadian Public Policy: The Seven Decisions that Created the Canadian Health Insurance System and their Outcomes (Montreal and Kingston: McGill-Queen’s University Press, 2nd ed., 1987): 69-159.
Seminar 4: National Hospitalization Policy, 1955-61
* Boychuck, The Making and Meaning of Hospital Policy, 81-115.
* Naylor, Private Practice, Public Payment, 95-175.
Supplementary Readings:
Taylor, Health Insurance and Canadian Public Policy, 161-238.
Maioni, Parting at the Crossroads, 92-118.
Seminar 5: Physician Services and Medicare: Provincial Initiative
* Joan Feather, “Impact of the Swift Current Health Region: Experiment or Model”, Prairie Forum, Vol. 16, no. 2 (Fall 1991): 225-48.
* Naylor, Private Practice, Public Payment, 176-213.
Supplementary Readings:
Taylor, Health Insurance and Canadian Public Policy, 239-330
S.E.D. Shortt, The Doctor Dilemma: Public Policy and the Changing Role of Physicians under Ontario Medicare (Montreal and Kingston: McGill-Queen’s University Press, 1999): 20-38.
Seminar 6: National Medicare
* Cam Traynor, “Manning Against Medicare”, Alberta History, Vol. 43, no. 1 (Winter 1995): 7-19.
* Naylor, Private Practice, Public Medicine, 214-43.
Supplementary Readings:
Taylor, Health Insurance and Canadian Public Policy, 331-37.
Antonia Maioni, Parting at the Crossroads, 119-52.
Seminar 7: The Canada Health Act
* Taylor, Health Insurance and Canadian Public Policy, 415-85.
Overview (and brief history) of Canada Health Act in Canada Health Act Annual Report, 2001-2002 (Ottawa: Health Canada, 2002): 3-8.
Monique Bégin, “Revisiting the Canada Health Act (1984): What are the Impediments to Change?” Speech delivered to the Institute for Research on Public Policy, February 20, 2002. 7 pp.
Supplementary Readings:
Monique Bégin, Medicare: Canada’s Right to Health (Montreal: Optimum, 1988).
Dale Gibson, “The Canada Health Act and the Constitution”, Health Law Journal, Vol. 4 (1996): 1-33.
Colleen Flood and Sujit Choudhry, “Strengthening the Foundations: Modernizing the Canada Health Act.” Discussion Paper (no. 13) prepared for the Commission on the Future of Health Care in Canada, August 2002. 33 pp.
Sujit Choudhry, “The Enforcement of the Canada Health Act”, McGill Law Journal, Vol. 41 (1996).
Seminar 8: Health Care Funding and Sustainability
Elias Mossialos and Anna Dixon, “Funding Health Care: An Introduction”, in Funding Health Care: Options for Europe, edited by Elias Mossialos et al. (Buckingham: Open University Press, 2002): 1-30.
Commission on the Future of Health Care in Canada, Building on Values (Final Report of the Romanow Commission (Saskatoon: Commission on the Future of Health Care in Canada, 2002): 23-44.
Supplementary Readings:
Robert G. Evans, “Raising the Money: Options, Consequences and Objectives for Financing Health Care in Canada.” Discussion Paper (no. 27) prepared for the Commission on the Future of Health Care in Canada, October 2002. 46 pp.
Institute of Intergovernmental Relations, School of Policy Studies, Queen’s University, “Federal-Provincial Relations and Health Care: Reconstructing the Relationship.” Summary Report on Fiscal Federalism and Health, prepared for the Commission on the Future of Health Care in Canada, November 2002. 29 pp.
Antonia Maioni, “Roles and Responsibilities in Health Care Policy.” Discussion Paper (no. 34) prepared for the Commission on the Future of Health Care in Canada, November 2002. 28 pp.
PART II: REFORMING HEALTH CARE IN CANADA
Seminar 9: Transforming the Hospital
* Michael. B. Decter, Four Strong Winds: Understanding the Growing Challenges to Health Care (Toronto: Stoddard, 2000), 57-74.
Barry Monaghan et al., “Through the Looking Glass: The Cardiac Care Network of Ontario 10 Years Later”, Hospital Quarterly, Vol. 4, no. 3 (Spring 2001): 30-38.
Charles B. Wilson, “The Impact of Medical Technologies on the Future of Hospitals”, BMJ, Vol. 319 (13 Nov., 1999): 1-3.
Supplementary Readings:
Phil Nolin, “The Reconfiguration of Montréal’s Hospital System”, Perspective, Vol. 9, no. 1 (1996): 14-18.
Ken Rasmussen, “Regionalization and Collaborative Government: A New Direction for Health System Governance”, in Duane Adams, ed., Federalism, Democracy and Health Policy in Canada, 239-70.
Seminar 10: Health Human Resources
Canadian Policy Research Networks (CPRN), “Health Human Resource Planning in Canada: Physician and Nursing Work Issues.” Summary Report on Health Human Resources prepared for the Commission on the Future of Health Care in Canada, October 2002. 23 pp.
Gail Tomblin Murphy and Linda O’Brien Pallas, “How Do Health Human Resources Policies and Practices Inhibit Change? A Plan for the Future.” Discussion Paper (no. 30) prepared for the Commission on the Future of Health Care in Canada, October 2002. 23 pp.
Supplementary Readings:
Advisory Committee on Health Human Resources, The Nursing Strategy for Canada, October 2000.
B. Chan, The Perceived Surplus to Perceived Shortage: What Happened to Canada’s Physician Workforce in the 1990s? (Ottawa: Canadian Institute for Health Information, 2002).
Pat Armstrong and Hugh Armstrong, “Planning for Care: Approaches to Health Human Resource Policy and Planning.” Discussion Paper (no. 28) prepared for the Commission on the Future of Health Care in Canada, October 2002. 23 pp.
Angela C. Cybulski, Karen Bell and Jean M. Reader, “Management Strategies for Nursing Recruitment and Retention”, Hospital Quarterly, Vol. 2, no. 4 (Summer 1999).
Seminar 11: Primary Care Reform
* Brian Hutchinson, Julian Abelson and John Lavis., “Primary Care in Canada: So Much Innovation, So Little Change”, Health Affairs, Vol. 20, no. 3 (2001): 116-31.
* François Béland, “Preventive and Primary Care Access Systems: CLSCs as Neighborhood and Social Service Centers in Quebec”, in Health Care Systems in Transition: An International Perspective, edited by Francis D. Powell and Albert F. Wessen (Thousand Oaks, CA: Sage, 1999): 173-198.
Supplementary Readings:
Walter Rosser and Jan Kasperski, “Organizing Primary Care for an Integrated System”, and Mary Ellen Jeans, “Primary Care and Primary Health Care for an Integrated System”, in HealthcarePapers, Vol. 1, no. 1 (Winter 1999): 5-22 and 33-36.
Fitzhugh Mullan, “The ‘Mona Lisa’ of Health Policy: Primary Care at Home and Abroad”, Health Affairs, Vol. 17, no. 2 (1998): 119-126.
Seminar 12: Home Care and Mental Health
* Patricia M. Baranek, Raisa Deber and A. Paul Williams, “Policy Trade-Offs in ‘Home Care’”: the Ontario Example”, Canadian Public Administration, Vol. 42, no. 1 (Spring 1999): 69-92.
* John Hunsley, “Cost-Effectiveness and Medical Cost-Offset: Considerations in Psychological Service Provision”, Canadian Psychology, Vol. 44, no. 1 (2003): 61-73.
Commission on the Future of Health Care in Canada, Building on Values (Romanow Commission final report), pp. 171-188.
Supplementary Readings:
World Health Report 2001 (Geneva: WHO, 2001): 77-106.
CHSRF Issue/Survey Paper on Home Care in Canada, prepared for the Commission on the Future of Health Care in Canada, May 2002: 2-9.
Seminar 13: Prescription Drugs: Regulation, Utilization and Cost
* Joel Lexchin, “Pharmaceuticals, Patents, and Politics: Canada and Bill C-22”, International Journal of Health Services, Vol. 23, no. 1 (1993): 147-160.
* Devidas Menon, “Pharmaceutical Cost Control in Canada: Does it Work? Health Affairs, Vol. 20, no. 3 (May/June 2001): 92-103.
Commission on the Future of Health Care in Canada, Building on Values (Romanow Commission final report), pp. 189-210.
Supplementary Readings:
Andreas Laupacis, “Drug Policy: Making Effective Drugs Available without Bankrupting the Healthcare System”, HealthcarePapers, Vol. 3, no. 2 (2002): 12-30.
Robin Tamblyn, “Evidence-based Utilization of Prescription Drugs: Challenges and Directions for the Future in Canada.” Paper from IRPP Conference “Towards a National Strategy on Drug Insurance”, September 23, 2002.
Robert Elgie, “Drug Pricing: A Comparison between Canada and other Countries.” Paper from IRPP Conference “Towards a National Strategy on Drug Insurance”, September 23, 2002. 11 pp.
1