Gregory Marchildon | University of Toronto (original) (raw)

Books by Gregory Marchildon

While almost all universal health coverage in Canada is provided under the terms of the Canada He... more While almost all universal health coverage in Canada is provided under the terms of the Canada Health Act, there is Medicare coverage that is provided outside the Act. This is the first book to explain the nature of these boundary health services and excluded populations, why they exist, and how these boundary areas are navigated. These services include workers' compensation, military personnel and veterans, and these individuals include federal prison inmates, migrants and Indigenous Peoples.

University of Toronto Press, 2021

This analysis of the Canadian health system reviews recent developments in organization and gover... more This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.

University of Toronto Press, 2019, 2019

University of Regina Press, 2018

The Great Depression of the 1930s often evokes images of the drought stricken Canadian prairies, ... more The Great Depression of the 1930s often evokes images of the drought stricken Canadian prairies, a region then in the grips of environmental and economic disaster. Between 1929 and 1932, per capita incomes fell by half in Manitoba, by 61 percent in Alberta, and by an astonishing 72 percent in Saskatchewan. The resulting political and social upheaval spread throughout the rest of the country.

This sixth volume in the History of the Prairie West Series contains a broad range of articles from the journal "Prairie Forum" about the pivotal decade in the history of Alberta, Saskatchewan and Manitoba. It features a broad range of topics including unemployment, ecology, labour strife, and the disintegration of the fabric of prairie life.

University of Toronto Press, 2018

This book is an analysis of the connection between federalism, which involves a degree of politic... more This book is an analysis of the connection between federalism, which involves a degree of political decentralization, and the organization of health care using a decision space analysis to determine the actual degree of health system decentralization. This requires an assessment of whether national or subnational governments have narrow, moderate, or broad discretion in their decisions on health system governance, access, human resources, organization and financing. This decision space analysis is applied to eight federations (Brazil, Canada, Germany, Mexico, Nigeria, Pakistan, South Africa, and Switzerland) which vary considerably in terms of geography, history, politics and constitutional development.

University of Toronto Press, 2017

Fiscal Federalism and Equalization Policy in Canada aims to increase public understanding of equa... more Fiscal Federalism and Equalization Policy in Canada aims to increase public understanding of equalization and fiscal federalism by providing a comparative and multidisciplinary perspective on the history, politics, and economics of equalization policy in Canada. The authors provide a brief history, an analysis of the politics of equalization as witnessed over the last fifteen years, and a discussion of key economic debates concerning the role of the program and its effects. They also explore the relationship between equalization and other components of fiscal federalism, particularly the Canada Health Transfer and the Canada Social Transfer. The result is an analysis that draws from the best scholarship available in the fields of economics, economic history, political science, political sociology, and public policy.

This fifth volume of the History of the Prairie West Series contains a broad range of articles sp... more This fifth volume of the History of the Prairie West Series contains a broad range of articles spanning the1870s to the present and examines the mostly unexplored place of women in the history of Canada’s Prairie Provinces. From “Spinsters Need Not Apply” to “Negotiating Sex: Gender in the Ukrainian Bloc Settlement, “women’s roles in politics, law, agriculture, labour, and journalism are explored to reveal a complex portrait of women struggling to find safety, have careers, raise children, and be themselves in an often harsh environment. Launched in 2008, the History of the Prairie West Series is comprised of the very best historical articles previously published in the scholarly journal Prairie Forum.

Bending the Cost Curve in Health Care offers domestic and international perspectives on the manag... more Bending the Cost Curve in Health Care offers domestic and international perspectives on the management of ever growing health costs. The objective of the book is to get beyond the sterile debates of the past decade and to try to determine where Canada sits, and should sit, in terms of its health care cost curve, in comparison to other OECD countries.
Leading experts from around the world and from a range of disciplines and professional backgrounds lay out the problems faced by policy-makers and provide international case studies from the UK, Norway, the United States, Australia, and Asia. Provincial experiences within Canada are explored in depth, and analyses of pan-Canadian issues such as pharmaceuticals and public-sector health spending address the question of the sustainability of health care in Canada.

A guide to 23 documented canoe routes north and south of the central trunk of the Churchill River... more A guide to 23 documented canoe routes north and south of the central trunk of the Churchill River in Northern Saskatchewan including an extensive set of planning maps.

Governance and Public Policy in Canada lays the foundation for a systematic analysis of policy de... more Governance and Public Policy in Canada lays the foundation for a systematic analysis of policy developments, shaped as they are by multiple players, institutional tensions and governance legacies. Arguing that provinces are not the most central site of governance and policy innovation, the book assesses the role of the provinces and places the provincial state in its broader economic, institutional, social, and territorial context. The aim throughout is to highlight the crucial role of provinces in policy changes that directly affect the lives of citizens.
Three key themes unify this book. First, it addresses the role of policy convergence and divergence among the provinces. Although the analysis acknowledges the enduring differences in political culture and institutions, it also points to patterns of policy convergence in specific areas. Second the book explores the push and pull between centralization and decentralization in Canada as it affects intergovernmental relations. Third, it underscores that although the provinces play a greater role in policy development than ever before, they now face a growing tension between their expanding policy ambitions and their capacity to develop, fund, implement, manage, and evaluate policy programs.

Canada is a high-income country with a population of 33 million people. Its economic performance ... more Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.

This is the revised addition of a history of the community clinics in Saskatchewan written by Sta... more This is the revised addition of a history of the community clinics in Saskatchewan written by Stan Rands, a noted social activist, public servant and community clinic administrator who died in 1985. This edition includes a new introductory chapter by Gregory P. Marchildon on primary health community clinics and Stan Rands' struggle for the transformation of health care in Saskatchewan and in Canada. This books also includes an examination of co-operatives and consumer control of health care services 50 years after the tumultuous doctors' strike of 1962 in Saskatchewan that marked the birth of universal medical care insurance in Canada.

The fifteen essays selected from the journal Prairie Forum for this volume examine the rich histo... more The fifteen essays selected from the journal Prairie Forum for this volume examine the rich history of business and early industries in the Canadian Plains before the calamity of the Great Depression. Without denying the central importance of agriculture in the development and growth of the Prairie West, these essays explore the lesser-known history of some of the first businesses in the region.

The eighteen essays selected from the journal Prairie History for this volume all focus on the ag... more The eighteen essays selected from the journal Prairie History for this volume all focus on the agricultural history of the Canadian Plains. The cover a detailed survey of First Nations agricultural practices, agriculture during the fur trade era, and ranching in its evolution from the open range to fenced-in farm settlements. The emergence of wheat as the region's premier crop after 1900 is also examined, a development which resulted in the Prairie Provinces becoming known as the "breadbasket of the world." Further studied are mechanization and adaptations to dryland farming, as well as changes to how the Prairie's cattle and crops were transported and marketed abroad. A final group of essays cover the rise of farmers' organizations and their attempts to receive fair treatment and fair prices from the grain companies and the railways.

Even if global warming were to be reduced substantially, the warming that has already occurred in... more Even if global warming were to be reduced substantially, the warming that has already occurred in the Canadian Plains is going to change the climate in the decades to come. Working from the best scientific evidence on the changes that are likely to occur, this book examines the ability of local communities as well as local, provincial and national institutions and governments to deal with future climate change. The thirteen chapters in this volume reflect a unique collaboration among scholars from disciplines as diverse as climatology, geography, history, hydrology, sociology, engineering, economics, law and public policy.

University of Toronto Press, 2021

University of Toronto Press, 2019, 2019

University of Regina Press, 2018

University of Toronto Press, 2018

University of Toronto Press, 2017

Journal of Aging & Social Policy, 2023

Persons living with dementia and their caregivers often face challenges in accessing support for ... more Persons living with dementia and their caregivers often face challenges in accessing support for their complex needs. This study aims to understand how program administrators, people living with dementia, unpaid caregivers, and decision-makers perceive specific dementia care programs and whether they are adequately meeting the needs of individuals living with dementia. Forty semi-structured interviews were conducted between 2018 and 2020 in five North American jurisdictions. Three main gaps were identified (1) disconnected system infrastructure, (2) lack of comprehensive services to meet diverse needs, and (3) inconsistent understandings of dementia. Despite having programs in place, there remain significant limitations in systems that could be addressed to adequately meet the needs of individuals living with dementia and their caregivers.

Canadian Journal of Health History, Vol. 40, no. 1, 2023

The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in N... more The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first considered the New Zealand policy until a final decision was made to implement the program. This article reviews the reasons for the long gestation of the policy, including the hostility of organized dentistry in Saskatchewan and Canada and the caution of the government’s bureaucracy. It would take until a social democratic government was elected in 1971 before the political stream joined with the pre-existing problem and policy streams to open the policy window. Established in 1974, the program was terminated in 1987 due to the opposition of organized dentistry combined with the pro-market ideology of a newly elected government.

CMAJ (Canadian Medical Association Journal), vol. 195, no. 4, 2023

Health Services Insights, 2023

As health service delivery shifts from institutions to the home, greater care responsibilities ar... more As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the financial risks of unpaid, homebased caregiving throughout the first year of the COVID-19 pandemic. Among 190 caregivers, salient findings include difficulties paying for care expenses after the pandemic was declared than before (P = .002); more caregivers retiring or becoming unemployed during the pandemic than before (P = .013); and a significant relationship between paying out-of-pocket for a home care worker and experiencing a decrease in the availability of such support during the pandemic (P = .029). Overall, the financial stressors of caregiving during the pandemic contributed negatively to caregivers’ mental health, with 64.2% noting could be partly offset by greater government and employment-based assistance in managing care expenses and productivity losses. Findings from this study will better inform policies that aim to protect unpaid caregivers from financial risk in pandemic recovery efforts and beyond. Results may also be useful in other welfare states where unpaid caregivers provide the majority of home care services

Health and Social Care in the Community, Vol. 30, no. 6, 2022

Despite an increase in prevalence of complex chronic conditions and dementia, longterm care servi... more Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friendsor other unpaid caregivers. Ten dementia care policy programs and service delivery
models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in New York.

Health Policy OPEN, 2022

A range of public health and social measures have been employed in response to the disproportiona... more A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries-Argentina,

Canadian Public Policy, 2022

This research note directs the attention of policy scholars to a unique and important research st... more This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of Medicare on the demand for services in Nova Scotia before and after the introduction of universal medical care insurance. Titled "The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor," this research was written up into a report delivered to the US government but was, unfortunately, never disseminated—nor did it become known in Canada. By summarizing the his tory and context of the study, the approach and methods used by Brown and Hicks, and the study’s policy significance, this research note also acts as an introduction to the study.

Cette note de recherche vise à attirer l'attention des chercheurs en politiques sur une étude originale et importante qui n'est pas assez connue et qui porte sur l'assurance-santé canadienne. Menée par Murray G. Brown et Vernon A. Hicks, cette étude a examiné l'impact de l'assurance-santé sur la demande de services en Nouvelle-Écosse avant et après l'introduction de l'assurance-santé universelle. Intitulée The Impact of Universal Medicare on the Previously Insured Poor and Nonpoor, cette recherche a fait l'objet d'un rapport qui a été soumis au gouvernement américain, mais malheureusement, ce rapport n'a jamais été diffusé, ni rendu connu au Canada. En résumant l'historique et le contexte de l'étude, l'approche et les méthodes utilisées par Brown et Hicks, ainsi que la portée politique de l'étude, cette note de recherche sert également à faire connaitre cette étude.

Health Policy, 2022

This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom an... more This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating crosscountry learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.

Health Policy, 2022

Health and Social Care in the Community, 2022

Despite an increase in prevalence of complex chronic conditions and dementia, longterm care servi... more Despite an increase in prevalence of complex chronic conditions and dementia, longterm care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid caregivers. Ten dementia care policy programs and service delivery models across five different North American jurisdictions in Canada and the U.S. are compared deductively using a comparative policy framework originally developed by Richard Rose. One aim of this research was to understand how different jurisdictions have worked to reduce the fragmentation of dementia care. Another aim is to assess, relying on the theory of smart policy layering, the extent to which these policy efforts ‘patch’ health system structures or add to system redundancies. We find that these programs were introduced in a manner that did not fully consider how to patch current programs and services and thus risk creating further system redundancies. The implementation of these policy programs may have led to policy layers, and potentially to tension among different policies and unintended consequences. One approach to reducing these negative impacts is to implement evaluative efforts that assess ‘goodness of fit’. The degree to which these programs have embedded these efforts into an existing policy infrastructure successfully is low, with the possible exception of one program in NY.

International Journal of Integrated Care, 2022

Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim t... more Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011-2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.

Social Policy & Administration, Vol. 56, no. 2, pp. 315-28, 2022

In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stand... more In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government-sponsored reports ever published. In this article, we explore how the principles and the policy proposals formulated in the report diffused to other countries and how domestic actors adapted them to their local context through policy translation processes. The social policy ideas that Beveridge put forward in his 1942 report influenced post-war policy debates in ways that varied greatly from country to country. To illustrate this claim, we analyse the reception and policy impact of this report over time in three different welfare states: Canada, Denmark, and France. This comparison shows how Beveridge's ideas influenced policy debates in different countries through translation processes that adapted these ideas to each country's institutional and political context.

Health Economics, Policy and Law, Vol. 17, no. 1, 2022

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized ... more Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country. This accounting of the first 12 months of the pandemic highlights opportunities for a strengthened federal role in the short term, and some important lessons to be applied in preparing for future pandemics.

Home Health Care Services Quarterly, 2021

Health Policy, 2021

Outpatient technologies are important for maintaining health and overall quality of life, yet the... more Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and conditions that provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer. As such, the thirteen Canadian provincial and territorial governments make separate decisions on programs and coverage. Drawing on the WHO Universal Coverage Cube we compare who gets access, the types of technologies that can be accessed, and the level of coverage (total costs covered) in Canada. Overall, each Canadian jurisdiction had at least one publicly supported program. All relied on a ‘health assessment’ of an individual's need to determine eligibility. Income and eligibility for social assistance was used as eligibility criteria in 6 of the 13 jurisdictions. Mobility aids as well as audio, visual, and communication aids were included in all jurisdictions. While some programs offered full financial support for some technologies, forms of cost sharing were common. The results are discussed in the context of international experiences, demographic changes, and health system trends to highlight areas for policy learning.

Canadian Public Administration, 2021

Sommaire: Au Canada, les systèmes de santé dirigés par les Autochtones qui ont été initialement établis pour exprimer leur autodétermination, jouent maintenant un rôle important dans l'orientation de la prestation des programmes et services de santé. Ces systèmes de soins de santé autochtones fonctionnant dans des contextes géographiques, politiques et sociaux très variés sont extrêmement hétérogènes. Pour mieux comprendre ces différences, nous avons établi une typologie à partir de trois domaines d’entités décisionnelles : les règles de gouvernance, et les mécanismes de financement et d’imputabilité. Nous évaluons également la nature de la relation et particulièrement, le degré de contrôle exercé par les collectivités autochtones sur leurs systèmes de santé respectifs par rapport aux gouvernements fédéral, provinciaux et territoriaux. La typologie résultante à cinq niveaux organise les systèmes de santé autochtones allant d’un contrôle large et fort à un contrôle modéré et étroit. Quoique cette typologie soit fondée sur les modalités de gouvernance actuelles, elle présente néanmoins un point de comparaison pour l'étude d’innovations futures dans les systèmes de santé autochtones, ainsi que de nouveaux types d'engagement provinciaux et territoriaux par les gouvernements et organismes autochtones.

Canadian Public Administration, 2021

Governments deploy comprehensive strategies to address complex social problems with various New P... more Governments deploy comprehensive strategies to address complex social problems with various New Public Governance and horizontal initiatives. Minimal attention, however, has focused on developing evidence-informed strategy de- sign for such initiatives. Using a systematic literature review, five strategy design principles were identified: 1) proper selection of interventions; 2) system enablers; 3) a guiding purpose; 4) substantive political commitment; and 5) joined-up gov- ernance. Three case studies including document review and interviews tested strat- egy design principles. Empirical work supported, expanded, and further refined these principles. Application of these principles would likely contribute to improv- ing the success of horizontal strategy initiatives. Real-world political pressures and public administration constraints can be somewhat alleviated through learnings from well-designed strategies and experiences.

Sommaire : Les gouvernements utilisent des stratégies globales pour répondre à des problèmes sociaux complexes avec diverses initiatives horizontales et de la Nouvelles gouvernance publique. Néanmoins, ces initiatives n’ont recu que peu d’attention en ce qui concerne l’élaboration d’une conception stratégique fondée sur des données probantes. À l’aide d’un examen systématique de la littérature, nous avons identifié cinq principes de conception stratégique : 1) une sélection ap- propriée des interventions; 2) des facilitateurs du système; 3) un objectif directeur; 4) un engagement politique réel; et 5) une gouvernance conjointe. Trois études de cas comprenant un examen de documents et des entretiens ont testé les principes de conception stratégique. Ces principes ont été soutenus, élargis et affinés par des tra- vaux empiriques. L’application de ces principes contribuerait probablement à amé- liorer le succès des initiatives stratégiques horizontales. Les enseignements tirés de stratégies et d’expériences bien conçues peuvent pallier les pressions politiques du monde réel et les contraintes de l’administration publique.

Health Policy, 2021

Background: Patient registration with a primary care providers supports continuity in the patient... more Background: Patient registration with a primary care providers supports continuity in the patientprovider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Methods: 12 jurisdictions (Denmark, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Ontario [Canada], Sweden, Switzerland, United Kingdom) were selected for analysis. Information was collected by national researchers who reviewed relevant literature and policy documents to report on the estab- lishment and evolution of patient registration, the requirements and benefits for patients, providers and payers, and its connection to primary care reforms.
Results: Patient registration emerged as part of major macro-level health reforms linked to the intro- duction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments).
Conclusion: Patient registration means different things in different countries and policy-makers and re- searchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care.

Journal of Long-Term Care, 2021

The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, inclu... more The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part, because personal support work has long-existed on the fringes of what is considered health work, thereby precluding its status as a health profession. In this perspective paper, we explore how the pandemic may contribute to the semi-professionalization of personal support work based on the provision of LTC by personal support workers (PSWs) working in LTC facilities in Ontario, Canada. We first characterize personal support work to illustrate its current organization based on the logics of work control. We then speculate how the pandemic may shift control and map speculated changes onto existing checklists of professionalism and semi-professionalism in health work. We propose the pandemic will shift control away from existing market and hierarchical controls. At most, personal support work may undergo changes that are more characteristic of semi-professional control (semi-professionalism), characterized by the formation of a PSW registry that may improve role clarity, provide market shelter, and standardize wages. We do not believe this shift in control will solve all organizational problems that the pandemic has exposed, and continued market and hierarchical controls may be necessary. This perspective may provide insights for other high-income settings, where the pandemic has exposed similar fault-lines in the organization of personal support work in LTC.

Policy Success in Canada: Cases, Lessons, Challenges, 2022

In Canada, Medicare refers to universal health coverage (UHC) programs admin- istered by provinci... more In Canada, Medicare refers to universal health coverage (UHC) programs admin- istered by provincial and territorial governments under broad national standards legislated and enforced by the federal government. Established in successive steps over a quarter of a century, Medicare is the financed by the Government of Canada and the 13 provincial and territorial (PT) programs to provide full coverage for hospital, diagnostic, and medical care services. Since its inception, Medicare as an ideal has become an important dimension of the Canadian identity as well. Medicare has been a programmatic policy success based on the policy’s origi- nal objectives as conceived by successive federal governments and the originating provincial governments. Medicare has also been successful in establishing and maintaining a single-tier of hospital and medical care services, even though there have been numerous attempts to introduce a second private tier of services re- served for a minority of wealthier Canadians. Politically, it has been able to attract broad and steadfast support among the public. Over its life course, Medicare should be seen as a success in terms of endurance, too: it has preserved univer- sal access to necessary physician, hospital, and diagnostic services for no cost at the point of service for all Canadians. Moreover, it has done so through a decen- tralized system in which provincial and territorial governments pay the bills while preserving the portability of coverage for Canadians within the country. This chapter begins with a summary of the evolution of Medicare with a focus on the contingency of historical events during the discrete stages of Medicare’s evolu- tion, initially an against-the-odds accomplishment but one that eventually became a path-dependent policy norm in Canada. This historical section is followed by an analysis of the various components of Medicare’s enduring accomplishments as a program, as a policy process with public support, and as a contested political suc- cess. The chapter ends with a reflection on the policy lessons that can be drawn from Medicare’s success.

Part of edited book entitled Restoring the Purpose of the Canada Health Transfer published by the Evidence Network, 2014

A short policy article on the policy purpose of the Canada Health Transfer and how it can be tran... more A short policy article on the policy purpose of the Canada Health Transfer and how it can be transformed to better meet this purpose.

The Unexpected Louis St-Laurent: Politics and Policies for a Modern Canada, edited by Patrice Dutil, published by UBC Press, 2020

In this chapter, Prime Minister St-Laurent's attitude towards, and handling of, the policy of uni... more In this chapter, Prime Minister St-Laurent's attitude towards, and handling of, the policy of universal hospital coverage is examined. St-Laurent was both uncertain as to the merits of this extension of the Canadian welfare state, and tried to undermine its achievement through requiring a double majority (majority of provinces with a majority of the population) before the federal government was prepared to implement the Hospital Insurance and Diagnostic Services Act of 1957.

Is Two-Tier Health Care the Future? Edited by Colleen M. Flood and Bryan Thomas, 2020

This chapter examines the history of the regulation of private finance in Canada, in particular t... more This chapter examines the history of the regulation of private finance in Canada, in particular the key decision points that would establish medicare's regulatory regime in two key areas. The first was the active contestation among provincial governments over a single-payer design versus a multi-payer design, and the ultimate selection of the latter as the dominant design. The second key area concerns hospital user charges and physician extra-billing as part of the medicare policies of selected provincial governments and their eventual elimination.

Universality and Social Policy in Canada, 2019

The evolution of single-tier and single-payer medicare in Canada and its relationship with the co... more The evolution of single-tier and single-payer medicare in Canada and its relationship with the conceptualizations of universality.

Universality and Social Policy in Canada, 2019

The evolution of primary and secondary education in Canada in relation to the concept of universa... more The evolution of primary and secondary education in Canada in relation to the concept of universality.

Communicating the History of Medicine, 2019

This chapter examines five decades of historical writing on, and myth-making about, the origins o... more This chapter examines five decades of historical writing on, and myth-making about, the origins of Medicare, Canada’s public health-care system. It examines interpretations of the 1962 doctors’ strike in Saskatchewan, and its reception and uptake among physician and citizen audiences. Within the medical profession, academic and professional elites have vied to capture attention from Canadian citizen-audiences. A pro-Medicare consensus, emergent in the 1960s and 1970s, was replaced in the early 2000s by a newly polarized view, critical of public health care, which reinterprets the history of the strike action as a form of justified public protest.

Back to Blakeney: Revitalizing the Democratic State, edited by David McGrane, John Whyte, Roy Romanow, and Russell Isinger, 2019

In this chapter, I reflect on how social democratic goals and policies are actually achieved on t... more In this chapter, I reflect on how social democratic goals and policies are actually achieved on the ground. In particular, I examine the means used by Allan Blakeney and his cabinet government to translate his party’s intentions and goals into workable policy programs that would change the economic and social directions of the province and influence progressive political change in the rest of Canada. I isolate Blakeney’s unique contributions to the art of government and indicate why I think they succeeded in turning social democratic policy objectives into effective and sustainable programs.

In book "Party of Conscience: The CCF, the NDP, and Social Democracy in Canada" edited by Roberta Lexier, Stephanie Bangarth, and John Weir, 2018

This chapter explores the contribution of social democracy to the introduction and precise design... more This chapter explores the contribution of social democracy to the introduction and precise design of the policy of universal health coverage in Canada. The chapter was written by Erika Dyck and Greg Marchildon

25 Years of Informing the Debate, 2017

My personal reflections on the impact of the Caledon Institute of Social Policy on policy agenda ... more My personal reflections on the impact of the Caledon Institute of Social Policy on policy agenda setting and policy formulation in Canada

Federalism and Decentralization in Health Care: A Decision Space Approach, edited by Gregory P. Marchildon and Thomas J. Bossert (University of Toronto Press), 2018

Dictionary of Canadian Biography, 1998

A biography of Canadian businessman W.D. Matthews (b. 1872, d. 1919) who was considered "one of t... more A biography of Canadian businessman W.D. Matthews (b. 1872, d. 1919) who was considered "one of the shrewdest business men in Canada" in the late 19th and early 20th centuries. He was one of Toronto's most notable financiers.

Dictionary of Canadian Biography, 1998

Biography of Benjamin Franklin Pearson (b. 1855, d. 1912), a Canadian lawyer, financier and polit... more Biography of Benjamin Franklin Pearson (b. 1855, d. 1912), a Canadian lawyer, financier and politician. Pearson was heavily involved in coal interests in Nova Scotia, in particular the Dominion Coal Company, as well as street railways in the Caribbean and Halifax.

Dictionary of Canadian Biography, 1998

Graham Fraser (b. 1846, d. 1915) was a Canadian industrialist who established and directed the No... more Graham Fraser (b. 1846, d. 1915) was a Canadian industrialist who established and directed the Nova Scotia Steel and Coal Company based in New Glasgow, Nova Scotia. After his resignation from Nova Scotia Steel and Coal, Fraser went to to manage the Dominion Iron and Still Company in Cape Breton, Nova Scotia.

Dictionary of Canadian Biography, 2016

Biography of Robert Edward Harris (b. 1860, d. 1931), a Canadian lawyer, businessman and jurist. ... more Biography of Robert Edward Harris (b. 1860, d. 1931), a Canadian lawyer, businessman and jurist. Harris was one of the first corporate lawyers in Nova Scotia where he specialized in corporate finance. He was the head of a law firm in Halifax that would eventually become the largest law firm (Stewart McKelvey) in the Atlantic region in the latter part of the 20th century. Harris would eventually become chief judge of the Supreme Court of Nova Scotia.

Biography of James Drummond McGregor (b. 1838, d. 1918), a businessman and Liberal politician who... more Biography of James Drummond McGregor (b. 1838, d. 1918), a businessman and Liberal politician who an investor in, and for a short time, president of, the Nova Scotia Steel and Coal Co. based in New Glasgow, Nova Scotia.

Canada's Entrepreneurs: From the Fur Trade to the 1929 Stock Market Crash, edited by J. Andrew Ross and Andrew D. Smith, 2011

One of Canada's most prominent financiers of the late 19th and early 20th centuries, W.D. Matthew... more One of Canada's most prominent financiers of the late 19th and early 20th centuries, W.D. Matthews began his career in the flour, grain and malt business. He then moved into insurance, banking and the securities business. Based in Toronto, he became known as one of Canada's shrewdest businessmen.

Dictionary of Canadian Biography., 2018

This is a biography of James Henry Plummer, banker and businessman; born 19 Feb. 1848 in Mary Tav... more This is a biography of James Henry Plummer, banker and businessman; born 19 Feb. 1848 in Mary Tavy, England, died 10 Sept. 1932 in Toronto. Plummer was heavily involved in the Dominion Steel and Coal Company before and during the First World World. After the war, Plummer opposed Dominion Steel's merger into the British Empire Steel Corporation.

The International Encyclopedia of Public Health, Jan 1, 2017

A review of the Canadian health system with some emphasis on public health stewardship at the nat... more A review of the Canadian health system with some emphasis on public health stewardship at the national level of government.

Vulnerability and Adaptation: The Canadian Prairies and South America, Jun 2016

This chapter reviews the history of drought in a region of Western Canada knowns as the Palliser ... more This chapter reviews the history of drought in a region of Western Canada knowns as the Palliser Triangle From the time that agriculture was introduced in the last decades of the 19th century, drought has been a recurring feature. Focusing on the Dust Bowl of the 1930s, this chapter reviews the policy interventions of the day to extract some lesson for the future of the region in preparing for prolonged droughts that may be exacerbated by climate change.

Evidence-based medicine, 2013

In the policy environment, the news media play a powerful and influential role, determining not o... more In the policy environment, the news media play a powerful and influential role, determining not only what issues are on the broad policy agenda, but also how the public and politicians perceive these issues. Ensuring that reporters and editors have access to information, that is, credible and evidence-based is critical for stimulating healthy public discourse and constructive political debates. EvidenceNetwork.ca is a non-partisan web-based project that makes the latest evidence on controversial health-policy issues available to the Canadian news media. This article introduces EvidenceNetwork.ca, the benefits it offers to journalists and researchers, and the important niche it occupies in working with the news media to build a more productive dialogue around healthcare.

International Journal of Integrated Care

Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim t... more Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011–2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.

Journal of Comparative Policy Analysis: Research and Practice, 2021

Abstract National responses to COVID-19 depend in part on national health care financing arrangem... more Abstract National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies.

Healthcare Policy, 2021

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is... more Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.

Canadian Public Administration, 2021

Originally established as an expression of self-determination, Indigenous-governed health systems... more Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these differences, a typology is constructed based on three areas of decision-making space: governance rules, financing and accountability mechanisms. The nature of the relationship and in particular, the degree of control exercised by Indigenous communities over their respective health systems in relation to federal, provincial and territorial governments, is also assessed. The resulting five-level typology organizes Indigenous health systems into broad and strong control to moderate and narrow control. Although this typology is based on current governance arrangements, it nevertheless presents a baseline for the study of future innovations in Indigenous health systems as well as new types of provincial and territorial government engagement by Indigenous governments and organizations. Sommaire: Au Canada, les systèmes de santé dirigés par les Autochtones qui ont été initialement établis pour exprimer leur autodétermination, jouent maintenant un rôle important dans l'orientation de la prestation des programmes et services de santé. Ces systèmes de soins de santé autochtones fonctionnant dans des contextes géographiques, politiques et sociaux très variés sont extrêmement hétérogènes. Pour mieux comprendre ces différences, nous avons établi une typologie à partir de trois domaines d’entités décisionnelles : les règles de gouvernance, et les mécanismes de financement et d’imputabilité. Nous évaluons également la nature de la relation et particulièrement, le degré de contrôle exercé par les collectivités autochtones sur leurs systèmes de santé respectifs par rapport aux gouvernements fédéral, provinciaux et territoriaux. La typologie résultante à cinq niveaux organise les systèmes de santé autochtones allant d’un contrôle large et fort à un contrôle modéré et étroit. Quoique cette typologie soit fondée sur les modalités de gouvernance actuelles, elle présente néanmoins un point de comparaison pour l'étude d’innovations futures dans les systèmes de santé autochtones, ainsi que de nouveaux types d'engagement provinciaux et territoriaux par les gouvernements et organismes autochtones.

Health Economics, Policy and Law, 2021

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characteri... more Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the cou...

Social Policy & Administration, 2021

Health Economics, Policy and Law, 2021

Patient safety is a complex systems issue. In this study, we used a scoping review of peer-review... more Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components of mandatory reporting legislation that must be in place as a part of a systems governance approach to patient safety and used this model to frame our results. Our results suggest that mandatory reporting legislation across Canada is generally designed to gather information about – rather than respond to and prevent – patient safety incidents. Overall, we found limited evidence of impact of mandatory reporting legislation on patient safety outcomes. Although legislation is one lever among many to improve patient safety outcomes, there are nonetheless several considerations for patient safety legislation to assist in broader system improvem...

Health Economics, Policy and Law, 2021

The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. ... more The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to universal health coverage, the clustering of pandemic deaths in long-term care facilities has spurred calls for federal standards in long-term care (LTC) and its possible inclusion in universal health coverage. This has led to the probability that the federal government will attempt to expand medicare as Canadians have known it for the first time in over a half century. However, these efforts are likely to fail if the federal government relies on the shared-cost federalism that marked the earlier introduction of medicare. Two alternative pathways are suggested, one for LTC and one for pharmaceuticals, that are more likely to succeed given the state of the Canadian federation in the early 21st century.

Journal of Comparative Policy Analysis: Research and Practice, 2019

Communicating the history of medicine, 2019

Health Policy, 2019

Canada is the only Universal Health Insurance country in the OECD without universal insurance for... more Canada is the only Universal Health Insurance country in the OECD without universal insurance for outpatient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federal government launched an Advisory Council on the Implementation of National Pharmacare, to report in 2019 on the best strategy to implement a national Pharmacare program that would provide all Canadians access to affordable outpatient prescription drugs. The Council was asked to consider three options: a universal public plan for all Canadians; a public catastrophic insurance plan that would kick off once spending on prescription drugs reaches a given threshold; and a more modest patching of existing gaps, providing coverage to those who are not eligible to any form of insurance. Beyond the relative consensus around the ideas that gaps in coverage should be filled to make drugs affordable to all, and that the costs of drugs are too high in Canada, the Council faces the challenge of addressing three underlying issues: 1) what amount of income redistribution will result from each of the three options; 2) how much savings would the implementation of a single payer generate? 3) what role restricting a national formulary would play in achieving those savings, and what would be the political consequences of narrowing the formulary?

Health Reform Observer - Observatoire des Réformes de Santé, 2019

Healthcare Policy | Politiques de Santé, 2017

The Fiscal Sustainability of Health Care - the first of a three-volume set of selected papers fro... more The Fiscal Sustainability of Health Care - the first of a three-volume set of selected papers from the Romanow Commission - comprises the most influential discussion papers on the fiscal sustainability of public health care in the future. The subjects covered include the current and potential cost drivers of the system, the financing and delivery of health care, fiscal federalism, and international trade regimes. While some of the contributors are among Canada's best known and respected figures in the field, others are relatively new scholars from Canada and abroad who bring fresh perspectives and new insights to the issue of fiscal sustainability. Presenting divergent diagnoses and policy prescriptions, the papers collectively highlight the many factors that governments and health care sector managers must confront to keep the Canadian health care system viable in the 21st century.

Health Reform Observer - Observatoire des Réformes de Santé, 2016

Natural Hazards, 2016

This study compares climatological data for two climate extremes, severe drought and excessive mo... more This study compares climatological data for two climate extremes, severe drought and excessive moisture, to the experience and memories of agriculturalists based on extensive interviews with farmers and ranchers in the southern Great Plains of Canada. The climate data used were the Standardized Precipitation and Evapotranspiration Index. While differences are expected between these quantitative and qualitative sources due to the fact that there is often a gap between any extreme weather event and its impact, there was less difference than expected. However, these gaps are significant because politicians, policy makers and emergency preparedness planners do, or at least should, take into account the perceptions of those most directly affected by climate extremes and understand the instances. The findings confirm the importance of localized and experiential knowledge in climate change adaptation.

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.

This presentation examines six lessons that policy makers in the United States can draw from the ... more This presentation examines six lessons that policy makers in the United States can draw from the Canadian model of universal health coverage known as Medicare (not to be confused with Medicare in the US).

The Fourth International Jerusalem Conference on Health Policy: Improving Health and Health Care, edited by Bruce Rosen, Avi Israeli and Stephen Shortell, 2010

John F. Roatch Global Lecture Series on Social Policy and Practice, Arizona State University, Mar 2006

Social History of Medicine, 2023

This is a book review of "Medicare's Histories: Origins, Omissions, and Opportunities in Canada" ... more This is a book review of "Medicare's Histories: Origins, Omissions, and Opportunities in Canada" published by the University of Manitoba Press in 2002.

Canadian Business History Association website, 2021

This is a book review of Charles Williams' biography of Lord Beaverbrook covering his life in Can... more This is a book review of Charles Williams' biography of Lord Beaverbrook covering his life in Canada and Britain and his work as a financier, press baron, politician and backroom advisor. The review can be found online at: https://cbha-acha.ca/wp-content/uploads/2021/02/MarchildonRevWilliams21.R3.pdf

Canadian Public Policy, Vol. 40, no. 2, pp. 194-195, Jun 2014

Summary provincial statistics including population, gross domestic product (GDP), GDP per capita,... more Summary provincial statistics including population, gross domestic product (GDP), GDP per capita, provincial revenue, personal income per capita, provincial expenditures, and provincial debt.

Annual time series (1905-2005) of agricultural statistics drawn from various sources. These stati... more Annual time series (1905-2005) of agricultural statistics drawn from various sources. These statistics include size of farm population, size and number of farms, wheat production, prices and value, and farm incomes.

Forum of Federations Though Piece, 2021

In Nepal, there has been some resistance to the new system of federalism by stakeholders and the ... more In Nepal, there has been some resistance to the new system of federalism by stakeholders and the bureaucracies within some ministries, especially in health and education, to the point that they have tried to reverse the devolution of authority and resources. The reasons for this likely go well beyond a questions of position and power but may involve perceptions, whether accurate or not, of the ability of provincial and local levels of government to carry out their new responsibilities. Whatever the motives behind this resistance, the consequence of this has been to stall the implementation of a federalized system of healthcare. The purpose of this think piece is to propose a potential way to address the current deadlock by examining the decision space, capacity and accountability of subnational governments in Nepal.

This is the final report of the Independent Expert Panel reviewing the health and social programs... more This is the final report of the Independent Expert Panel reviewing the health and social programs and services in Yukon, Canada. The five member panel included Bruce McLennan (Chair), George Green, Greg Marchildon, Diane Strand and Jennifer Zelmer. The report contains a large number of recommended changes including a major health system inspired in party by the Nuka model of care developed in Alaska by the Southcentral Foundation.

Patient Information in 10 Countries, Jul 16, 2015

This report was prepared by the European Observatory on Health Systems and Policies in response t... more This report was prepared by the European Observatory on Health Systems and Policies in response to a request of the United Kingdom Department of Health. It provides a comparative overview of several domains of patient information in the following 10 countries: Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United States.

The report explores:
• whether there is an overall rating for quality and safety for every major hospital, every GP practice, every residential care provider and every domiciliary care provider
• whether outcomes of individual doctors are published with regard to mortality and GP outcomes
• whether data on referral to treatment times is published for every major hospital
• whether data on patient experience of hospital and GP services are published for every provider (hospital, GP practice)
• whether patients can access their medical records online and (ii) there is a single patient record across whole system (including both primary and secondary/hospital care data)

Some caution is necessary when interpreting the findings presented here. The information was collected at very short notice and may not be fully complete or accurate.

CIHI Report: Spending and Workforce, Oct 2011

The is a study of the underlying drivers of health care costs in Canada, mainly focusing on the ... more The is a study of the underlying drivers of health care costs in Canada, mainly focusing on the periods from 1998 until 2008. This report should be used as a companion to the Canadian Institute for Health Informations's annual report on national health expenditure trends.

Facteurs d’accroissement des dépenses de santé: les faits, Oct 2011

Royal Commission Report, Nov 2002

This is the final report of the Royal Commission on the Future of Health Care in Canada - commonl... more This is the final report of the Royal Commission on the Future of Health Care in Canada - commonly known as the Romanow Commission.Taken together, the 47 recommendations contained in this report serve as a roadmap for a collective journey by Canadians to reform and renew their health care system. They outline actions that must be taken in 10 critical areas, starting by renewing the foundations of Canadian medicare.

IRPP INSIGHT No. 46, 2023

Canada is a laggard when it comes to providing public funding for dental care, ranking close to t... more Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government's proposed $13-billion Canadian Dental Care Plan could change that. This paper calls the plan a major step forward in reforming dental care but argues that the "payer of last resort model" the government has chosen to implement falls short. It identifies four broad policy goals that should guide future reform of dental care and six possible options for achieving them. It calls for the government to move toward implementing universal dental care coverage for a limited core of essential dental services and argues that the best way to achieve it is through the creation of a federally funded arm's-length agency.

NAO Rapid Review No. 33, 2022

The response to an emergency, such as the COVID-19 pandemic, can be particularly complex in feder... more The response to an emergency, such as the COVID-19 pandemic, can be particularly complex in federated systems as the federal and subnational governments often share responsibility for public health, and the level of coordination and collaboration required to protect and preserve public health is even more acute during such emergencies. For decades, information sharing across governments in Canada has been identified as a critical constraint in ensuring optimal decision-making and citizen outcomes. Other federations face similar challenges and have achieved various levels of success with implementing national public health surveillance drawing on subnational data. This rapid review aims to draw lessons for Canada from other federations and quasi-federations (in the case of UK) on the governance of COVID-19 vaccine data, with a view of compiling and standardizing subnational data at the national level. We conducted rapid comparative case studies of four jurisdictions (Germany, Australia, Switzerland, and the UK), which included an environmental scan of the literature with validation by local experts

World Bank - North American Observatory on Health Systems and Policies, Report, 2020

Latin America and the Caribbean (LAC) accounts for over a quarter of the worldâ€™s total cases, a... more Latin America and the Caribbean (LAC) accounts for over a quarter of the worldâ€™s total cases, and a third of the total deaths, from the COVID-19 pandemic (1-3) (4). In the absence of a vaccine to prevent the transmission of the virus, LAC countries have introduced several public health, health system, and economic policies to reduce the spread and impacts of COVID-19 (4,5). However, contextual factors such as fragmented health systems, limited social safety nets, and high levels of informal employment and inequality have further challenged the response to the pandemic in many of these countries (4,6,7). Furthermore, these underlying conditions intensify the impact of COVID-19, particularly for the most disadvantaged, including the unemployed, informal, and low-income workers, many of whom live in overcrowded households (4,7). In this study, we aim to describe policy interventions in 10 LAC countries in response to the COVID-19 pandemic, to compare these responses based on the experiences in two relatively high-performing jurisdictions, South Korea and Uruguay, and to support cross-jurisdictional policy learning for pandemic preparedness in the LAC region through knowledge exchange activities.

North American Observatory on Health Systems and Policies, Rapid Review No. 27, 2020

A review of COVID-19 case and contact management strategies in Canada that examines: workforce ca... more A review of COVID-19 case and contact management strategies in Canada that examines: workforce capacity; skills and training; case identification and management; contact identification and management; and various technologies for case and contact management.

Broadbent Institutee, 2020

A report from the Broadbent Institute in Canada that makes the case for incorporating community m... more A report from the Broadbent Institute in Canada that makes the case for incorporating community mental health, long-term care and pharmacare into universal health coverage in Canada

North American Observatory on Health Systems and Policies (NAO), 2020

The North American COVID-19 policy monitor has been designed to collect and organize up-to-date i... more The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions are responding to the crisis, in this case the province of New Brunswick, Canada. It summarizes responses of health systems as well as wider public health initiatives. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO).

The North American COVID-19 policy monitor has been designed to collect and organize up-to-date i... more The North American COVID-19 policy monitor has been designed to collect and organize up-to-date information on how jurisdictions in Canada are responding to the crisis. It summarizes responses of health systems as well as wider public health initiatives. This study focuses on the province of Manitoba. The North American policy monitor is an offshoot of the international COVID-19 Health System Response Monitor (HSRM), a joint undertaking of the WHO Regional Office for Europe, the European Commission and the European Observatory on Health Systems and Policies. Canadian content to HSRM is contributed by the North American Observatory on Health Systems and Policies (NAO).

North American Observatory on Health Systems and Policies Rapid Review No. 20, 2020

The aim of this report was to summarize the review literature (e.g., systematic reviews, scoping ... more The aim of this report was to summarize the review literature (e.g., systematic reviews, scoping reviews, and literature reviews) to identify best practices for using technologies to support health care in rural communities.

North American Observatory on Health Systems and Policies Rapid Review No. 19, 2020

Patient safety in the hospital setting is a major public health challenge. Mandatory reporting le... more Patient safety in the hospital setting is a major public health challenge. Mandatory reporting legislation is key to gathering information about – and learning from – patient safety incidents. This Rapid Review highlights a gap between the gathering of patient safety data and the ability of regulators, professionals, and other stakeholders to learn from such data to prevent future harm. We provide an assessment of patient safety monitoring across Canadian jurisdictions and conclude by offering five workable proposals to improve the governance and utilization of patient safety data to best protect patients.

North American Observatory on Health Systems and Policies Rapid Review No. 18, 2020

Given that Electronic Medical Records (EMRs) and related information technologies are a large com... more Given that Electronic Medical Records (EMRs) and related information technologies are a large component of high-performing healthcare systems and there remains very little progress towards territorial, provincial, or national EMR systems, this rapid review seeks to understand the outcomes associated with EMR use, the barriers towards implementation, and strategies for encouraging adoption.

North American Observatory on Health Systems and Policies Rapid Review No. 17, 2019

The creation of Ontario Health Teams represents a major shift towards integrated care across the ... more The creation of Ontario Health Teams represents a major shift towards integrated care across the health system in the province. Integrated models of care intend to improve the care experiences of people and providers as well as the outcomes of care for populations across the care continuum. Approaches to integrate care involve a number of organizations and providers, often with an organization or a group of providers acting as the lead of the integration effort. This rapid review aims to understand the role that hospitals can play as lead integrators of care delivery models that span multiple sectors.

North American Observatory on Health Systems and Policies Rapid Review No. 14, 2019

This review compares Yukon’s health system performance with other northern regions, including: La... more This review compares Yukon’s health system performance with other northern regions, including: Labrador, Saguenay (QC), Côte-Nord (QC), Nord (QC), Nunavik (QC), Baie-James (QC), Northwestern (ON), Porcupine (ON), Thunder Bay (ON), Northern (MB), Mamawetan (SK), Keewatin (SK), Athasbasca (SK), North Zone (AB), Northwest (BC), North-Interior (BC), Northeast (BC), the Northwest Territories, Nunavut, and Yukon.

North American Observatory on Health Systems and Policies Rapid Review No. 13, 2019

This rapid review summarises and assesses the review literature to identify key attributes that a... more This rapid review summarises and assesses the review literature to identify key attributes that are associated with high-performing care provided closer to home

North American Observatory on Health Systems and Policies Rapid Review No. 12, 2019

his rapid review updates the previous rapid review (no. 9) and sets out to address three broad ob... more his rapid review updates the previous rapid review (no. 9) and sets out to address three broad objectives: to identify the key factors and mechanisms involved in ACOs that have demonstrated success; to consider lessons learned from the perspectives of providers working in ACOs; and to conduct an appraisal of the evaluative literature.

North American Observatory on Health Systems and Policies Rapid Review No. 11, 2019

This report examines the experiences of the U.S., U.K., and France with respect to the use of reg... more This report examines the experiences of the U.S., U.K., and France with respect to the use of regulatory waivers or administrative agreements. This report summarizes the experience of regulatory permissiveness as a way to offer time-limited leniency from statutory or regulatory requirements to implement innovative programs and delivery models. It concludes with lessons learned for the Ontario context.

North American Observatory on Health Systems and Policies Rapid Review No. 10, 2018

This rapid review describes the current landscape of province-wide services in Canada, including ... more This rapid review describes the current landscape of province-wide services in Canada, including the following two, often distinct, categories of services: 1) health and clinical services; and (2) shared back-office administrative services, including information technology, payroll and some human resources (HR) functions. We aim to shed light on the approaches provincial governments have taken to centralize health services and administrative functions in provincial arm’s-length organizations.

North American Observatory on Health Systems and Policies Rapid Review No. 9, 2018

This rapid review intended to address three broad objectives: to characterize public ACOs, in par... more This rapid review intended to address three broad objectives: to characterize public ACOs, in particular their approach to shared savings and financial risk, accountability and monitoring, as well as funding and incentive mechanisms; to synthesize the results of evaluations of ACOs conducted between 2015-2018 in the US; and to explore initiatives across Canada with respect to implementing ACO-like models based on criteria identified in objective one.

North American Observatory on Health Systems and Policies Rapid Review No. 5, 2018

Assistive technologies or devices have been defined as any piece of equipment or products that ar... more Assistive technologies or devices have been defined as any piece of equipment or products that are used to maintain or improve an individual’s functional capabilities. Coverage of assistive technologies (ATs) has been shaped by two different policy regimes—disability policy and health policy. However, high-income jurisdictions have varying approaches to coverage for assistive technologies with differences in the eligibility, types of devices covered, and cost-sharing approaches. These rapid reviews compare coverage policies in eight countries (Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Norway, the United Kingdom) for four categories of ATs. The following rapid reviews involve an in-depth assessment of programs within each jurisdiction using a common definition of ATs and a core set of questions. In more broadly drawn universal health coverage (UHC) systems, such as the five western European countries, ATs tend to be part of UHC although patient contributions are also common albeit based on different rationales. In the more narrowly drawn UHC systems in Canada, Australia, and New Zealand, ATs tend to be part of separate extended health benefit programs and are accompanied by user fees and access restrictions. All systems have reasonably strict rules on eligibility for coverage in terms of proving disability although they vary in the requirement on the permanence of the disability.

North American Observatory on Health Systems and Policy Rapid Review No. 4, 2018

ssistive devices aim to provide individuals with tools that can support the management of their h... more ssistive devices aim to provide individuals with tools that can support the management of their health and social needs. These devices are often used to support hospital discharge, maintain independence in the home, and to support active participation at home, work, and in the community. Given that the proportion of older adults in Canada is growing (Statistics Canada, 2014) and assistive devices usage increases with age (Statistics Canada, 2015), we can expect increased pressure for public funding and/or provision of assistive devices. Despite the acknowledged value of having access to assistive devices, the degree to which provinces and territories (P/T) publicly support such access varies. How decisions are made are then a result of two imperatives: the first a consequence of the democratic process where decisions are made on the basis of unique interest group pressures, politics and historical policies within individual jurisdictions; the second on the basis more technocrat recommendations through deliberate processes (e.g. health technology assessments) based on clinical and cost effectiveness analyses. This review looks to identify all Canadian jurisdictions that offer publicly supported assistive devices programs and to identify program characteristics, including: program mandates, eligibility criteria, types of devices included/excluded, how decisions to include/exclude are made, the funding mechanisms used (private insurance, user fees, public insurance, a mix), and how the funding approaches are decided.

PhD Thesis, London School of Economics and Political Science, 1990, 1990

The existing research on the first merger waves in the United States, Britain, and to a lesser ex... more The existing research on the first merger waves in the United States, Britain, and to a lesser extent in Germany, has produced valuable information on the rise of the modern industrial enterprise. These studies reveal important similarities as well as a few significant differences in the nature of the economic development of these nations. A new merger series for Canadian manufacturing industry was generated to provide a further comparison. In addition, a large pool of information was gathered concerning the workings of promotional syndicates, corporate flotations, and secondary financial markets. This aggregate data, in conjunction with a case study of the most prominent Canadian promoter of the era and the companies he consolidated, is used to determine the relationship between security financing and the evolution of manufacturing industry in Canada. An explanation of the cause of the first Canadian merger wave, 1909-1912, is based on individual case evidence and the results of causality tests using aggregate data. The necessary pre-condition to a merger wave was the emergence of a broad market for Canadian industrial securities. Although high stock prices stimulated merger waves in Britain and the United States at the turn of the century, the first Canadian merger wave had to wait another decade until the expansion of the Canadian market and the tapping of the British market for Canadian "industrials" permitted large-scale flotations. The potential profits which were available through corporate reorganisation, rationalisation of manufacturing and distribution networks, and monopolisation, were reflected in the higher rates of return which British investors sought en masse in the new Canadian securities. This flood of British capital in turn accelerated the industrial transformation taking place in Canada and encouraged further mergers. High stock prices triggered the first merger movement as they had in Britain and the United States. Corporate financiers became merger promoters as they catapulted propositions into consolidations large enough to be listed on public stock exchanges and to be of interest to prospective investors. High-risk financial methods provided the incentive to financial intermediaries to broaden this market as quickly as possible and, therefore, to deliver the maximum amount of cash to the new industrial consolidations.

Presentation for an executive course at the Instituto Nacional de Salud Públic (National Institut... more Presentation for an executive course at the Instituto Nacional de Salud Públic (National Institute of Public Health) in Mexico. The course was led by Miguel Gonzalez-Block, Associate Director, North American Observatory on Health Systems and Policies.

This chapter evaluates Canadian Medicare's based on a PPPG (policy, politics and program) assessm... more This chapter evaluates Canadian Medicare's based on a PPPG (policy, politics and program) assessment framework.

This is a biography of Tommy Douglas (1904-86), among the most influential politicians and leader... more This is a biography of Tommy Douglas (1904-86), among the most influential politicians and leaders in Canada during the 20th century. This biography will eventually be published online by the Dictionary of Canadian Biography.