School of Policy Studies, Queen’s University

2003 Spring Seminar Course Syllabus

SPS-836

HEALTH AND PUBLIC POLICY IN CANADA

Gregory Marchildon and Michael Decter

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

All required course readings, which have been brought together for you in a single Custom CourseWare textbook, should be read before the seminars. We have purposely kept these readings to a bare minimum. We encourage you to examine 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.

Evaluation

Student 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 between 15-25 pages (double-spaced) in length 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

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 Contraint 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.

Duncan Sinclair, “Rethinking Medicare: It’s Time to do it!” HealthcarePapers, Vol. 1, no. 3 (Summer 2000): 9-19.

Michael B. Decter, Four Strong Winds: Understanding the Growing Challenges to Health Care (Toronto: Stoddard, 2000): 13-54.

Supplementary Reading:

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.

Eugene Schneller, “Healthcare System and the 21st Century: Observations from South of the Border”, Hospital Quarterly, Vol. 3, no. 1 (Fall 1999).

Seminar 3: Local, Provincial and NationalHospital Policy, 1900-1960

Terry Boychuk, The Making and Meaning of Hospital Policy in the United States and Canada (Ann Arbor: University of Michigan Press, 1999): 26-48

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): 69-104.

Antonia Maioni, Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada (Princeton: Princeton University Press, 1998): 92-118.

Supplementary Reading:

Malcolm G. Taylor, Health Insurance and Canadian Public Policy, pp. 105-238.

C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911-1966 (Montreal and Kingston: McGill-Queen’s University Press, 1986), pp. 135-175.

Seminar 4: Physician Services and Medicare

C. David Naylor, Private Practice, Public Payment, 214-243

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.

Supplementary Reading:

Malcolm G. Taylor, Health Insurance and Canadian Public Policy, 239-414.

Antonia Maioni, Parting at the Crossroads, 119-52.

Seminar 5: The Canada Health Act

Overview (and brief history) of Canada Health Act inCanada 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.

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.

Supplementary Reading:

Sujit Choudhry, “The Enforcement of the Canada Health Act”, McGill Law Journal, Vol. 41 (1996).

D. Gibson, “The Canada Health Act and the Constitution”, Health Law Journal, Vol. 4 (1996): 1-33.

Seminar 6: The Funding of Health Care

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.

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.

Supplementary Reading:

Michel Grignon, Valérie Paris and Dominique Polton, “Influence of Physician Payment Methods on the Efficiency of the Health Care System.” Discussion Paper (no. 35) prepared for the Commission on the Future of Health Care in Canada, November 2002. 30 pp.

Seminar 7: Health Transfer Funding and the Federal Role

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.

Supplementary Reading:

Melissa Rode and Michael Rushton, “Options for Raising Revenue for Health Care.” Discussion Paper (no. 9) prepared for the Commission on the Future of Health Care in Canada, August 2002. 19 pp.

Gerard W. Boychuk, “The Changing Political and Economic Environment of Health Care in Canada.” Discussion Paper (no. 1) prepared for the Commission on the Future of Health Care in Canada, July 2002. 19 pp.

PART II: REFORMING HEALTH CARE IN CANADA

Seminar 8: Transforming the Hospital

Michael. B. Decter, Four Strong Winds, 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 Reading:

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 9: 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 Reading:

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 10: 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 SocialServiceCenters 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 Reading:

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 11: 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.

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.

Supplementary Reading:

World Health Report 2001 (Geneva: WHO, 2001), pp. 77-106. *

Commission on the Future of Health Care in Canada, Building on Values (Romanow Commission final report), pp. 171-188.

Seminar 12: 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.

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.

Devidas Menon, “Pharmaceutical Cost Control in Canada: Does it Work? Health Affairs, Vol. 20, no. 3 (May/June 2001): 92-103.

Supplementary Reading:

Andreas Laupacis, “Drug Policy: Making Effective Drugs Available without Bankrupting the Healthcare System”, HealthcarePapers, Vol. 3, no. 1 (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.

Seminar 13: Service Delivery

Michael B. Decter, Four Strong Winds, chapter 15 on “The Health Consumer”, 207-221.

Craig Taylor, “Tapping Disney Inspiration: Transforming Healthcare” in Hospital Quarterly, Vol. 3, no. 2 (Winter 1999/2000): 25-7.

CHSRF Issue/Survey Paper on Consumer Choice in Canada’s Healthcare System, prepared for the Commission on the Future of Health Care in Canada, June 2002: 3-9.

Supplementary Reading:

Raisa Deber, “Delivering Health Care Services: Public, Not-for-Profit, or Private?” Discussion Paper (no. 17) prepared for Commission on the Future of Health Care in Canada. 63 pp.

Doris Grinspun, “Putting Patients First: The Role of Nursing Care”, Hospital Quarterly, Vol. 3, no. 4 (Summer 2000).

Valerie McDonald, “A Parent’s Perspective: Providing Compassionate and Effective Care”, Hospital Quarterly, Vol. 3, no. 2 (Winter 1999/2000).

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