Tom McIntosh - Academia.edu (original) (raw)
Papers by Tom McIntosh
This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec's particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decisi...
This paper explores how the passage of Saskatchewan's Health Facilities Licensing Act in 1996... more This paper explores how the passage of Saskatchewan's Health Facilities Licensing Act in 1996 created both a legal framework for private health facilities in the province as well as erecting significant barriers to virtually insure that no such facilities could effectively operate. This is done within the context of discovering how placing barriers to privatization has contributed to reform of the health care system and the conditions in which reform will be permitted. Data for the study were collected from a series of eleven key informant interviews including elected officials, civil servants, health care professionals, academics, members of key stakeholder organizations which both supported and opposed the legislation.
Open Federalism Revisited
Innovation in Aging
Immigrant and refugee seniors experience cultural barriers, discrimination, and limited networks ... more Immigrant and refugee seniors experience cultural barriers, discrimination, and limited networks which increase the risk of social isolation and thus hinder their active participation in the society. This paper explores social isolation among immigrant and refugee seniors in Canada based on an environmental scan of federal/provincial/territorial and community-based programs and a systematic scoping review. Findings revealed important gaps and regional disparities in opportuntiies to reduce social isolation and great active participation. Research was limited, often qualitative in nature, typically based on larger urban centres, with measurement issues related to the need for consideration beyond one's living arrangements. The results highlight the need for greater understanding Canada’s immigration and refugee system and policies, and collaboration across levels of government. Reducing issues of social isolation and enabling better active aging for vulnerable seniors require a m...
Bioarchaeology of Marginalized People
Abstract While population health as a field of research has garnered much attention in the past t... more Abstract While population health as a field of research has garnered much attention in the past two decades, health inequities between different population groups continue to rise. Globally, there has been an increasing call for the development of population health intervention research to address health inequities through action on the social determinants of health. Despite progress, there is a growing acknowledgment that challenges remain in addressing the underlying origins of health inequities. This chapter explores how a historical approach can guide our understanding of population health intervention research by addressing the underlying origins of health inequities among vulnerable populations. It begins with a brief discussion on the novel advantages of applying a historical approach to population health intervention research by highlighting the importance historical context and natural experiments embedded in the past. It then sheds light on key methodological innovations in using a historical approach to inform population health intervention research. Lastly this chapter showcases novel examples and outputs of using a historical approach to support population health intervention research.
This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec’s particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decision m...
Healthcare Management Forum, 2021
The pandemic has exposed and amplified complex and complicated health and societal challenges whi... more The pandemic has exposed and amplified complex and complicated health and societal challenges while offering immense opportunities to transform societies to improve health for all. Social isolation is a challenging and persistent issue experienced by many older adults, especially among immigrant and refugee seniors. Unique risk factors such as racism, discrimination, language barriers, weak social networks, and separation from friends and family predispose immigrant and refugee seniors to a higher risk of social isolation. The pandemic has magnified the unique risks and has highlighted the differential health and economic impacts. This article examines social isolation among immigrant and refugee seniors in Canada by focusing on the policy context, available programs and services to reduce social isolation, and the conceptualization and measurement considerations for advancing research to address social isolation among this growing population. Drawing on specific examples, we discus...
Long term Care …………………………………………………………….12 Primary Health Care ……………………………………………………….13 Policies a... more Long term Care …………………………………………………………….12 Primary Health Care ……………………………………………………….13 Policies and Legislation …………………………………………………………………..15 Intersectoral Partners …………………………………………………………………….18 Identified Gaps ………………..…………………………………………………….…….19 What We Don't Know.…………………………………………………………………….21 Recommendations and Directions for Future Research ………………………………..21 Conclusion …………………………………………………………………………………22 References …………………………………………………………………………………23 Appendix A ..………………………………………………………………………………25
HealthcarePapers
Marchildon and Sherar's (2018) "Doctors and Canadian Medicare" presents a specific ... more Marchildon and Sherar's (2018) "Doctors and Canadian Medicare" presents a specific dilemma for healthcare reform: the ability of physicians to negotiate ever-increasing incomes without reference to the consequences to healthcare costs or provincial budgeting. This commentary situates that discussion in the broader debate of the challenges to healthcare reform as exemplified by studies such as Paradigm Freeze (Lazar et al. 2013) and the ability of provincial medical associations to act as both system insiders (gatekeepers) and outsiders (with no responsibility for system finances). The resolution to this dilemma may be to follow the lead of the Alberta government by negotiating a stewardship role for physicians that requires them to take broader governmental goals into account. There is evidence to suggest that physicians may be the best actors to insist on and enforce changes in physician behaviour. Furthermore, adding physicians as stewards of the system may help create better checks and balances in the currently dysfunctional dynamics between federal and provincial stewards.
Innovation in Aging
In Canada, numbers of older adults are considered to be increasing, and by 2036, it is expected t... more In Canada, numbers of older adults are considered to be increasing, and by 2036, it is expected that seniors will reach 25% of the total population. Since 2009, the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) has developed an interdisciplinary approach to a community-based research program focused on rural older adults. The world café approach is recognized as collaborative and ideal for encouraging dialogue, sharing knowledge, and developing action plans. Set up like a café, four to six participants at each table engage in a series of three conversational rounds lasting approximately 20 minutes each. At the end of each round, participants move to different tables while the facilitator(s) remain at their original tables. We incorporated a world café approach in three distinct research projects, facilitating a total of five world café events. For each of these events, we also engaged with graduate and undergraduate students who were trained to serve as table ...
Innovation in Aging
Although there is significant stigma attached to dementia, there is a paucity of knowledge on sti... more Although there is significant stigma attached to dementia, there is a paucity of knowledge on stigma reduction interventions. Guided by a strength-based approach, this presentation consists of two objectives: 1) to identify the literature on interventions to reduce dementia-related stigma; and 2) to recognize the strength-based components of existing anti-stigma interventions. A five-stage scoping review process was used to examine peer-reviewed literature of anti-stigma interventions of dementia from 2008 to 2018. From 744 initial records, 21 articles matched our inclusion criteria and were reviewed. A stigma reduction framework was used for classifying interventions: education (to dispel myths with accurate information), contact (to provide interaction with people with dementia), mixed (education and contact interventions), and protest (to challenge negative attitudes of dementia). A range of education, contact, and mixed interventions were identified. Strength-based components of...
Innovation in Aging
This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaborati... more This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaboration of three organizations that have implemented nine projects to address social isolation for rural and urban older adults in Saskatchewan, Canada. A survey was completed with the purpose of identifying community-level awareness, knowledge and perspectives on the extent of social isolation of older adults in their communities. Key variables of interest included contributors to social isolation of older adults, barriers to overcoming social isolation, and community efforts and promising assets for addressing social isolation of older adults in their own communities. To develop an understanding of the extent to which respondents are involved with older adults, the survey asked respondents to report how often they supported, observed, advocated for, and/or interacted with seniors. The 271 respondents identified their roles in the community as human service professionals, healthcare professi...
International Journal of Migration, Health and Social Care
Purpose Social isolation and loneliness are global issues experienced by many seniors, especially... more Purpose Social isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada. Design/methodology/approach The authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services s; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria. Findings Based on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict. Research limitations/implications Given the increasing demographic of aging immigrants ...
The Governance of Health Care in Canada, 2004
The twelve papers in this third volume of the research program for the Romanow Commission offer a... more The twelve papers in this third volume of the research program for the Romanow Commission offer a detailed analysis of the governance of health care in Canada from the perspective of constitutionalism, intergovernmental relations, and societal context. In the first section, the authors deal with the formal division of powers regarding health care as outlined in the Canadian constitution and the Charter of Rights and Freedoms. The second section outlines the strengths and weaknesses of the intergovernmental governance of health care. Finally, the third section focuses on governance of health care outside of the governmental sphere. The theme that resonates throughout the contributions - and which is in itself a call for deeper analysis - is that health care governance has become locked in a cycle of mutual recrimination, blame assigning, and blame avoidance from the federal and provincial levels right down to the level of the individual citizen.
Health Reform Observer - Observatoire des Réformes de Santé, 2016
This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec's particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decisi...
This paper explores how the passage of Saskatchewan's Health Facilities Licensing Act in 1996... more This paper explores how the passage of Saskatchewan's Health Facilities Licensing Act in 1996 created both a legal framework for private health facilities in the province as well as erecting significant barriers to virtually insure that no such facilities could effectively operate. This is done within the context of discovering how placing barriers to privatization has contributed to reform of the health care system and the conditions in which reform will be permitted. Data for the study were collected from a series of eleven key informant interviews including elected officials, civil servants, health care professionals, academics, members of key stakeholder organizations which both supported and opposed the legislation.
Open Federalism Revisited
Innovation in Aging
Immigrant and refugee seniors experience cultural barriers, discrimination, and limited networks ... more Immigrant and refugee seniors experience cultural barriers, discrimination, and limited networks which increase the risk of social isolation and thus hinder their active participation in the society. This paper explores social isolation among immigrant and refugee seniors in Canada based on an environmental scan of federal/provincial/territorial and community-based programs and a systematic scoping review. Findings revealed important gaps and regional disparities in opportuntiies to reduce social isolation and great active participation. Research was limited, often qualitative in nature, typically based on larger urban centres, with measurement issues related to the need for consideration beyond one's living arrangements. The results highlight the need for greater understanding Canada’s immigration and refugee system and policies, and collaboration across levels of government. Reducing issues of social isolation and enabling better active aging for vulnerable seniors require a m...
Bioarchaeology of Marginalized People
Abstract While population health as a field of research has garnered much attention in the past t... more Abstract While population health as a field of research has garnered much attention in the past two decades, health inequities between different population groups continue to rise. Globally, there has been an increasing call for the development of population health intervention research to address health inequities through action on the social determinants of health. Despite progress, there is a growing acknowledgment that challenges remain in addressing the underlying origins of health inequities. This chapter explores how a historical approach can guide our understanding of population health intervention research by addressing the underlying origins of health inequities among vulnerable populations. It begins with a brief discussion on the novel advantages of applying a historical approach to population health intervention research by highlighting the importance historical context and natural experiments embedded in the past. It then sheds light on key methodological innovations in using a historical approach to inform population health intervention research. Lastly this chapter showcases novel examples and outputs of using a historical approach to support population health intervention research.
This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec’s particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decision m...
Healthcare Management Forum, 2021
The pandemic has exposed and amplified complex and complicated health and societal challenges whi... more The pandemic has exposed and amplified complex and complicated health and societal challenges while offering immense opportunities to transform societies to improve health for all. Social isolation is a challenging and persistent issue experienced by many older adults, especially among immigrant and refugee seniors. Unique risk factors such as racism, discrimination, language barriers, weak social networks, and separation from friends and family predispose immigrant and refugee seniors to a higher risk of social isolation. The pandemic has magnified the unique risks and has highlighted the differential health and economic impacts. This article examines social isolation among immigrant and refugee seniors in Canada by focusing on the policy context, available programs and services to reduce social isolation, and the conceptualization and measurement considerations for advancing research to address social isolation among this growing population. Drawing on specific examples, we discus...
Long term Care …………………………………………………………….12 Primary Health Care ……………………………………………………….13 Policies a... more Long term Care …………………………………………………………….12 Primary Health Care ……………………………………………………….13 Policies and Legislation …………………………………………………………………..15 Intersectoral Partners …………………………………………………………………….18 Identified Gaps ………………..…………………………………………………….…….19 What We Don't Know.…………………………………………………………………….21 Recommendations and Directions for Future Research ………………………………..21 Conclusion …………………………………………………………………………………22 References …………………………………………………………………………………23 Appendix A ..………………………………………………………………………………25
HealthcarePapers
Marchildon and Sherar's (2018) "Doctors and Canadian Medicare" presents a specific ... more Marchildon and Sherar's (2018) "Doctors and Canadian Medicare" presents a specific dilemma for healthcare reform: the ability of physicians to negotiate ever-increasing incomes without reference to the consequences to healthcare costs or provincial budgeting. This commentary situates that discussion in the broader debate of the challenges to healthcare reform as exemplified by studies such as Paradigm Freeze (Lazar et al. 2013) and the ability of provincial medical associations to act as both system insiders (gatekeepers) and outsiders (with no responsibility for system finances). The resolution to this dilemma may be to follow the lead of the Alberta government by negotiating a stewardship role for physicians that requires them to take broader governmental goals into account. There is evidence to suggest that physicians may be the best actors to insist on and enforce changes in physician behaviour. Furthermore, adding physicians as stewards of the system may help create better checks and balances in the currently dysfunctional dynamics between federal and provincial stewards.
Innovation in Aging
In Canada, numbers of older adults are considered to be increasing, and by 2036, it is expected t... more In Canada, numbers of older adults are considered to be increasing, and by 2036, it is expected that seniors will reach 25% of the total population. Since 2009, the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) has developed an interdisciplinary approach to a community-based research program focused on rural older adults. The world café approach is recognized as collaborative and ideal for encouraging dialogue, sharing knowledge, and developing action plans. Set up like a café, four to six participants at each table engage in a series of three conversational rounds lasting approximately 20 minutes each. At the end of each round, participants move to different tables while the facilitator(s) remain at their original tables. We incorporated a world café approach in three distinct research projects, facilitating a total of five world café events. For each of these events, we also engaged with graduate and undergraduate students who were trained to serve as table ...
Innovation in Aging
Although there is significant stigma attached to dementia, there is a paucity of knowledge on sti... more Although there is significant stigma attached to dementia, there is a paucity of knowledge on stigma reduction interventions. Guided by a strength-based approach, this presentation consists of two objectives: 1) to identify the literature on interventions to reduce dementia-related stigma; and 2) to recognize the strength-based components of existing anti-stigma interventions. A five-stage scoping review process was used to examine peer-reviewed literature of anti-stigma interventions of dementia from 2008 to 2018. From 744 initial records, 21 articles matched our inclusion criteria and were reviewed. A stigma reduction framework was used for classifying interventions: education (to dispel myths with accurate information), contact (to provide interaction with people with dementia), mixed (education and contact interventions), and protest (to challenge negative attitudes of dementia). A range of education, contact, and mixed interventions were identified. Strength-based components of...
Innovation in Aging
This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaborati... more This presentation will discuss the Reducing Isolation of Seniors Collective (RISC), a collaboration of three organizations that have implemented nine projects to address social isolation for rural and urban older adults in Saskatchewan, Canada. A survey was completed with the purpose of identifying community-level awareness, knowledge and perspectives on the extent of social isolation of older adults in their communities. Key variables of interest included contributors to social isolation of older adults, barriers to overcoming social isolation, and community efforts and promising assets for addressing social isolation of older adults in their own communities. To develop an understanding of the extent to which respondents are involved with older adults, the survey asked respondents to report how often they supported, observed, advocated for, and/or interacted with seniors. The 271 respondents identified their roles in the community as human service professionals, healthcare professi...
International Journal of Migration, Health and Social Care
Purpose Social isolation and loneliness are global issues experienced by many seniors, especially... more Purpose Social isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada. Design/methodology/approach The authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services s; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria. Findings Based on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict. Research limitations/implications Given the increasing demographic of aging immigrants ...
The Governance of Health Care in Canada, 2004
The twelve papers in this third volume of the research program for the Romanow Commission offer a... more The twelve papers in this third volume of the research program for the Romanow Commission offer a detailed analysis of the governance of health care in Canada from the perspective of constitutionalism, intergovernmental relations, and societal context. In the first section, the authors deal with the formal division of powers regarding health care as outlined in the Canadian constitution and the Charter of Rights and Freedoms. The second section outlines the strengths and weaknesses of the intergovernmental governance of health care. Finally, the third section focuses on governance of health care outside of the governmental sphere. The theme that resonates throughout the contributions - and which is in itself a call for deeper analysis - is that health care governance has become locked in a cycle of mutual recrimination, blame assigning, and blame avoidance from the federal and provincial levels right down to the level of the individual citizen.
Health Reform Observer - Observatoire des Réformes de Santé, 2016
Saskatchewan Politics: Crowding the Centre, edited by Howard Leeson, pp. 337-353, 2009
This chapter covers health reform in Saskatchewan during successive NDP administrations from the ... more This chapter covers health reform in Saskatchewan during successive NDP administrations from the election of the Roy Romanow government in 1991 until the defeat of the NDP and the election of the Saskatchewan Party in 2007.