John Church | Univeristy of Alberta (original) (raw)
Papers by John Church
University of Toronto Press eBooks, Jun 3, 2022
Canadian Journal of Public Health, 2008
International journal of health services : planning, administration, evaluation, Apr 1, 2017
Twenty years ago, many of Canada's provinces began to introduce regional health authorities t... more Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused s...
The Journal of the Canadian Chiropractic Association, 2012
Journal of Health Politics, Policy and Law, 2014
Although much has been written on health policy making in developed countries, the same cannot be... more Although much has been written on health policy making in developed countries, the same cannot be said of less developed countries, especially in Africa. Drawing largely on available historical and government records, newspaper publications, parliamentary Hansards, and published books and articles, this article uses John W. Kingdon's multiple streams framework to explain how the problem, politics, and policy streams converged for Ghana's National Health Insurance Scheme (NHIS) to be passed into law in 2003. The article contends that a change in government in the 2000 general election opened a “policy window” for eventual policy change from “cash-and-carry” to the NHIS.
Canadian Public Administration, 2014
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 making in this area to bureaucratic and political actors. Ontario's decision to not pursue a full-scale form of regionalization meant that key stakeholders in the acute care sector could effectively block any significant discussion of changes to how health care dollars are allocated.
Healthcare Management Forum, 2008
This paper offers a detailed historical description of the development of Alberta's population-ba... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition-in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study. Résumé Cet exposé donne une description historique détaillée de la mise au point du modèle de financement basé sur la population appliqué aux régies régionales de la santé en Alberta. Il se concentre sur les principaux facteurs politiques qui ont facilité cette transition, notamment le rôle des institutions, les intérêts organisés et les idées et valeurs. La compréhension des aspects politiques du changement des politiques, tel qu'illustrés dans ce cas, peut être utile pour évaluer les perspectives futures de la réforme du système de santé au Canada et jeter les bases d'autres études. Methods Qualitative research-"an inquiry process of understanding a social or human problem, based on building a complex, holistic picture, formed with words, reporting detailed views of informants, and conducted in a natural setting," 6-was employed for this project. Specifically, we employed case study methods because they allow the researcher to examine the "motive,
Canadian Public Administration/Administration publique du Canada, 2006
... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, ... more ... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, Stephen Tomblin, Tom McIntosh, Claudia Sanmartin, Marie-Pascale Pomey, klisabeth Martin, and Vandna Bhatia. Josh Marko, David Schaaf and Kevin Wipf provided research ...
Canadian Public Administration, 2008
In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abo... more In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with 17 regional health authorities. Consistent with the larger fiscal agenda, the intention of the government was to address the issue of efficiency of the health system through the creation of larger integrated management and governance structures. In this article, we examine why Alberta decided to create Regional Health Authorities through legislation to assume responsibility for the management and delivery of a significant range of health services? In examining the interaction of ideas, interests and institutions, we conclude that the government was partially successful in altering existing institutional and interest relationships to align with an emerging political consensus related to cost and sustainability of the health system.
Journal of Health Politics, Policy and Law, 2010
Although the costs of doctors' visits and hospital stays in Canada are covered by national pu... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' dec...
Canadian Political Science Review, 2009
Precipitated by significant expenditure reductions in health care, wait times for surgical and di... more Precipitated by significant expenditure reductions in health care, wait times for surgical and diagnostic procedures in Alberta increased significantly during the 1990s. In turn, this made access to health services a major political concern. Within this context, the interplay of ideas, interests and institutions led political decision makers to opt for the development of an Internet-based, voluntary wait times registry. Bureaucrats played a crucial role in assisting politicians to understand that the policy issue required a more nuanced response than simply throwing money at the problem.
Journal of Public Health Policy, 2002
Every couple of decades governments decide that they need to involve citizens more in public deci... more Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.
International Journal of Health Services, 1998
Since the introduction of universal health insurance in Canada in the late 1960s, the federal and... more Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.
Healthcare Management Forum, 2008
This paper offers a detailed historical description of the development of Alberta&amp... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition--in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study.
Canadian Public Administration, 2008
... Pertinent documents and public records (eg, media, Hansard) were reviewed to establish the ba... more ... Pertinent documents and public records (eg, media, Hansard) were reviewed to establish the background for the case study. ... Historical overview. ... To meet the historical expenditures of the social sector and balance the budget on the current revenue base, virtually all of the ...
Healthcare Management Forum, 2005
Over the post decade, provincial governments have embarked on ambitious plans to better integrate... more Over the post decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.
Although the costs of doctors&amp... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.
University of Toronto Press eBooks, Jun 3, 2022
Canadian Journal of Public Health, 2008
International journal of health services : planning, administration, evaluation, Apr 1, 2017
Twenty years ago, many of Canada's provinces began to introduce regional health authorities t... more Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused s...
The Journal of the Canadian Chiropractic Association, 2012
Journal of Health Politics, Policy and Law, 2014
Although much has been written on health policy making in developed countries, the same cannot be... more Although much has been written on health policy making in developed countries, the same cannot be said of less developed countries, especially in Africa. Drawing largely on available historical and government records, newspaper publications, parliamentary Hansards, and published books and articles, this article uses John W. Kingdon's multiple streams framework to explain how the problem, politics, and policy streams converged for Ghana's National Health Insurance Scheme (NHIS) to be passed into law in 2003. The article contends that a change in government in the 2000 general election opened a “policy window” for eventual policy change from “cash-and-carry” to the NHIS.
Canadian Public Administration, 2014
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 making in this area to bureaucratic and political actors. Ontario's decision to not pursue a full-scale form of regionalization meant that key stakeholders in the acute care sector could effectively block any significant discussion of changes to how health care dollars are allocated.
Healthcare Management Forum, 2008
This paper offers a detailed historical description of the development of Alberta's population-ba... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition-in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study. Résumé Cet exposé donne une description historique détaillée de la mise au point du modèle de financement basé sur la population appliqué aux régies régionales de la santé en Alberta. Il se concentre sur les principaux facteurs politiques qui ont facilité cette transition, notamment le rôle des institutions, les intérêts organisés et les idées et valeurs. La compréhension des aspects politiques du changement des politiques, tel qu'illustrés dans ce cas, peut être utile pour évaluer les perspectives futures de la réforme du système de santé au Canada et jeter les bases d'autres études. Methods Qualitative research-"an inquiry process of understanding a social or human problem, based on building a complex, holistic picture, formed with words, reporting detailed views of informants, and conducted in a natural setting," 6-was employed for this project. Specifically, we employed case study methods because they allow the researcher to examine the "motive,
Canadian Public Administration/Administration publique du Canada, 2006
... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, ... more ... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, Stephen Tomblin, Tom McIntosh, Claudia Sanmartin, Marie-Pascale Pomey, klisabeth Martin, and Vandna Bhatia. Josh Marko, David Schaaf and Kevin Wipf provided research ...
Canadian Public Administration, 2008
In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abo... more In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with 17 regional health authorities. Consistent with the larger fiscal agenda, the intention of the government was to address the issue of efficiency of the health system through the creation of larger integrated management and governance structures. In this article, we examine why Alberta decided to create Regional Health Authorities through legislation to assume responsibility for the management and delivery of a significant range of health services? In examining the interaction of ideas, interests and institutions, we conclude that the government was partially successful in altering existing institutional and interest relationships to align with an emerging political consensus related to cost and sustainability of the health system.
Journal of Health Politics, Policy and Law, 2010
Although the costs of doctors' visits and hospital stays in Canada are covered by national pu... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' dec...
Canadian Political Science Review, 2009
Precipitated by significant expenditure reductions in health care, wait times for surgical and di... more Precipitated by significant expenditure reductions in health care, wait times for surgical and diagnostic procedures in Alberta increased significantly during the 1990s. In turn, this made access to health services a major political concern. Within this context, the interplay of ideas, interests and institutions led political decision makers to opt for the development of an Internet-based, voluntary wait times registry. Bureaucrats played a crucial role in assisting politicians to understand that the policy issue required a more nuanced response than simply throwing money at the problem.
Journal of Public Health Policy, 2002
Every couple of decades governments decide that they need to involve citizens more in public deci... more Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.
International Journal of Health Services, 1998
Since the introduction of universal health insurance in Canada in the late 1960s, the federal and... more Since the introduction of universal health insurance in Canada in the late 1960s, the federal and provincial governments have been concerned with cost savings, efficiency of service delivery, equity in service provision, enhanced citizen participation, and increased accountability of decision-makers. A plethora of government royal commissions and task forces have recommended a similar range of options for addressing these concerns. Central to the reforms has been a proposed regionalized health system with an intermediary body responsible for functions previously assigned to local or central structures. For its supporters, regionalization offers a means of better coordinating and integrating health care delivery and controlling expenditures, and promises a more effective provision of services and an avenue for citizen participation in health care decision-making. All provincial governments except Ontario have introduced regional structures for health care, with the hope that these changes will increase efficiency, equity, and responsiveness. However, despite the alleged benefits, regionalization presents significant challenges. It faces obstacles to integrating and coordinating services in a manner that produces economies of scale; it requires an enhanced level of information that may be difficult to achieve; it is unlikely to involve citizens in health care decision-making; and it may actually lead to increased costs.
Healthcare Management Forum, 2008
This paper offers a detailed historical description of the development of Alberta&amp... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition--in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study.
Canadian Public Administration, 2008
... Pertinent documents and public records (eg, media, Hansard) were reviewed to establish the ba... more ... Pertinent documents and public records (eg, media, Hansard) were reviewed to establish the background for the case study. ... Historical overview. ... To meet the historical expenditures of the social sector and balance the budget on the current revenue base, virtually all of the ...
Healthcare Management Forum, 2005
Over the post decade, provincial governments have embarked on ambitious plans to better integrate... more Over the post decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.
Although the costs of doctors&amp... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.