Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholder... more Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholders. However, little is known about the structure and operations of CNs, particularly in emergency care. As Canada advances learning health systems (LHSs), foundational research is essential to enable future comparisons across CNs to identify those that contribute to positive system change. Drawing from the results of our international survey, we provide a description of 32 emergency care CNs worldwide, including their structure, operations and sustainability. Future research should consider the context of such networks, how they may contribute to an LHS and how they impact patient outcomes. Les réseaux cliniques (RC) peuvent favoriser l'innovation et la collaboration entre les fournisseurs et les intervenants. Cependant, on en sait peu sur la structure et le fonctionnement des RC, en particulier dans les soins d' urgence. Alors que le Canada s'intéresse aux systèmes de santé apprenants (SSA), la recherche fondamentale est essentielle pour permettre d'éventuelles comparaisons entre les RC afin de déterminer ceux qui contribuent au changement positif dans un système. À partir des résultats de notre enquête internationale, nous fournissons une description de 32 RC de soins d' urgence dans le monde, y compris leur structure, leurs activités et leur durabilité. Les recherches futures devraient tenir compte des contextes de ces réseaux, de la façon dont ils peuvent contribuer à un SSA et de leur incidence sur les résultats pour les patients.
Background Oral health is an important component of general health and healthy aging, yet financi... more Background Oral health is an important component of general health and healthy aging, yet financial protection for the costs of oral health care is often limited. Methods We systematically compare dental care coverage in Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We populated data collection templates to provide detailed and comparable descriptions of dental care coverage in 8 jurisdictions. Results Overall there were four general types of coverage models: 1) deep public coverage for a small subset of the population based on strict eligibility criteria jurisdictions: Canada, Australia and Italy; 2) universal but shallow coverage of the population, combined with deeper coverage for a sub-set of the population meeting eligibility ...
Oral health is an important component of general health, yet there is limited financial protectio... more Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia
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?
The respondents all raised valuable, informative points in response to our Invited Essay. There w... more The respondents all raised valuable, informative points in response to our Invited Essay. There was convergence around the need to alter governance structures at the same time as payment arrangements for physicians to achieve higher-performing health systems within Canada. At the same time, there were different views on how best to address the disconnect between levels of physician remuneration and accountability for healthcare performance and delivery. In addition to ongoing efforts to improve governance, such as the recent amendments to the government-physician agreement in Alberta, individual provincial governments can and should take the lead in initiating and evaluating further payment and governance experiments.
In the article, the authors discuss the absence of population health policy in the 2016 U.S. pres... more In the article, the authors discuss the absence of population health policy in the 2016 U.S. presidential election campaign because of its complexity, resulting in phantom policies. Also cited are the universal health coverage program introduced by Saskatchewan Premier Tommy Douglas in the 1940s, as well as the proposals by U.S. Senator Bernie Sanders and his Democratic presidential nomination rival Hillary Clinton on public health.
The federal government established the Prairie Farm Rehabilitation Administration (pfra) during t... more The federal government established the Prairie Farm Rehabilitation Administration (pfra) during the greatest environmental and economic crisis in twentieth-century Canada. While the pfra was a logical policy response to the disaster, it was also a calculated political response by successive Conservative and Liberal administrations in Ottawa. As a result of intergovernmental and constitutional conflicts between the federal government and the respective Prairie provincial governments, the pfra program was introduced at different times in the Prairie provinces while the community pasture program was never allowed to be established in Alberta. The pfra was headquartered in Saskatchewan, the province most supportive of the federal initiative.
Healthcare delivery systems in Canada are structured using three models: individual institutions,... more Healthcare delivery systems in Canada are structured using three models: individual institutions, health regions, and single provincial systems, usually with smaller geographic zones. The comparative ability of these models to improve care, outcomes, and the Quadruple Aim is largely unstudied. We reviewed Canadian studies examining outcomes of provincial healthcare delivery system restructuring. Across models, results were inconsistent, and quality of evidence was low. For all provinces, primary care sits outside healthcare delivery systems, with limited governance and integration. The single provincial model can reduce costs of non-clinical support functions like finance, human resources, and analytics. This model may also be best at reducing variations in care, improving electronic information integration that enables clinical decision support and reporting, and supporting the provincial spread and scale of innovations, but further refinements are required and existing studies have major limitations, limiting definitive conclusions.
For 40 years, the Canada Health Act (CHA) has not only protected universal health coverage in Can... more For 40 years, the Canada Health Act (CHA) has not only protected universal health coverage in Canada but helped define Canada's identity as sharing and caring. Today the act not only affords less protection than often assumed, but could be in danger in the next few years. The policy choice for Canadians is either to “spring forward” with a redesigned act to safeguard and improve medicare or continue to “fall back” and allow the further erosion of Medicare.
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. Résumé Les soins axés sur le patient sont une priorité clé pour les gouvernements, les fournisseurs et les intervenants, mais on en sait peu sur les préférences de soins des groupes de patients. Nous avons effectué un examen de la portée dans lequel 193 articles ont été analysés. Cinq états de santé ont été utilisés pour rendre compte de la diversité des préférences possibles en fonction des besoins en santé. Cinq grands thèmes ont été identifiés et exprimés différemment selon l'état de santé : les soins personnalisés, la navigation, le choix, les soins holistiques et la continuité des soins. Le point de vue du patient doit être pris en compte afin de répondre aux divers besoins des groupes ciblés, ce qui peut éclairer la planification du système de santé de même que les initiatives visant l' amélioration des soins ainsi que le ciblage des investissements.
Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholder... more Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholders. However, little is known about the structure and operations of CNs, particularly in emergency care. As Canada advances learning health systems (LHSs), foundational research is essential to enable future comparisons across CNs to identify those that contribute to positive system change. Drawing from the results of our international survey, we provide a description of 32 emergency care CNs worldwide, including their structure, operations and sustainability. Future research should consider the context of such networks, how they may contribute to an LHS and how they impact patient outcomes. Les réseaux cliniques (RC) peuvent favoriser l'innovation et la collaboration entre les fournisseurs et les intervenants. Cependant, on en sait peu sur la structure et le fonctionnement des RC, en particulier dans les soins d' urgence. Alors que le Canada s'intéresse aux systèmes de santé apprenants (SSA), la recherche fondamentale est essentielle pour permettre d'éventuelles comparaisons entre les RC afin de déterminer ceux qui contribuent au changement positif dans un système. À partir des résultats de notre enquête internationale, nous fournissons une description de 32 RC de soins d' urgence dans le monde, y compris leur structure, leurs activités et leur durabilité. Les recherches futures devraient tenir compte des contextes de ces réseaux, de la façon dont ils peuvent contribuer à un SSA et de leur incidence sur les résultats pour les patients.
Background Oral health is an important component of general health and healthy aging, yet financi... more Background Oral health is an important component of general health and healthy aging, yet financial protection for the costs of oral health care is often limited. Methods We systematically compare dental care coverage in Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We populated data collection templates to provide detailed and comparable descriptions of dental care coverage in 8 jurisdictions. Results Overall there were four general types of coverage models: 1) deep public coverage for a small subset of the population based on strict eligibility criteria jurisdictions: Canada, Australia and Italy; 2) universal but shallow coverage of the population, combined with deeper coverage for a sub-set of the population meeting eligibility ...
Oral health is an important component of general health, yet there is limited financial protectio... more Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia
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?
The respondents all raised valuable, informative points in response to our Invited Essay. There w... more The respondents all raised valuable, informative points in response to our Invited Essay. There was convergence around the need to alter governance structures at the same time as payment arrangements for physicians to achieve higher-performing health systems within Canada. At the same time, there were different views on how best to address the disconnect between levels of physician remuneration and accountability for healthcare performance and delivery. In addition to ongoing efforts to improve governance, such as the recent amendments to the government-physician agreement in Alberta, individual provincial governments can and should take the lead in initiating and evaluating further payment and governance experiments.
In the article, the authors discuss the absence of population health policy in the 2016 U.S. pres... more In the article, the authors discuss the absence of population health policy in the 2016 U.S. presidential election campaign because of its complexity, resulting in phantom policies. Also cited are the universal health coverage program introduced by Saskatchewan Premier Tommy Douglas in the 1940s, as well as the proposals by U.S. Senator Bernie Sanders and his Democratic presidential nomination rival Hillary Clinton on public health.
The federal government established the Prairie Farm Rehabilitation Administration (pfra) during t... more The federal government established the Prairie Farm Rehabilitation Administration (pfra) during the greatest environmental and economic crisis in twentieth-century Canada. While the pfra was a logical policy response to the disaster, it was also a calculated political response by successive Conservative and Liberal administrations in Ottawa. As a result of intergovernmental and constitutional conflicts between the federal government and the respective Prairie provincial governments, the pfra program was introduced at different times in the Prairie provinces while the community pasture program was never allowed to be established in Alberta. The pfra was headquartered in Saskatchewan, the province most supportive of the federal initiative.
Healthcare delivery systems in Canada are structured using three models: individual institutions,... more Healthcare delivery systems in Canada are structured using three models: individual institutions, health regions, and single provincial systems, usually with smaller geographic zones. The comparative ability of these models to improve care, outcomes, and the Quadruple Aim is largely unstudied. We reviewed Canadian studies examining outcomes of provincial healthcare delivery system restructuring. Across models, results were inconsistent, and quality of evidence was low. For all provinces, primary care sits outside healthcare delivery systems, with limited governance and integration. The single provincial model can reduce costs of non-clinical support functions like finance, human resources, and analytics. This model may also be best at reducing variations in care, improving electronic information integration that enables clinical decision support and reporting, and supporting the provincial spread and scale of innovations, but further refinements are required and existing studies have major limitations, limiting definitive conclusions.
For 40 years, the Canada Health Act (CHA) has not only protected universal health coverage in Can... more For 40 years, the Canada Health Act (CHA) has not only protected universal health coverage in Canada but helped define Canada's identity as sharing and caring. Today the act not only affords less protection than often assumed, but could be in danger in the next few years. The policy choice for Canadians is either to “spring forward” with a redesigned act to safeguard and improve medicare or continue to “fall back” and allow the further erosion of Medicare.
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. Résumé Les soins axés sur le patient sont une priorité clé pour les gouvernements, les fournisseurs et les intervenants, mais on en sait peu sur les préférences de soins des groupes de patients. Nous avons effectué un examen de la portée dans lequel 193 articles ont été analysés. Cinq états de santé ont été utilisés pour rendre compte de la diversité des préférences possibles en fonction des besoins en santé. Cinq grands thèmes ont été identifiés et exprimés différemment selon l'état de santé : les soins personnalisés, la navigation, le choix, les soins holistiques et la continuité des soins. Le point de vue du patient doit être pris en compte afin de répondre aux divers besoins des groupes ciblés, ce qui peut éclairer la planification du système de santé de même que les initiatives visant l' amélioration des soins ainsi que le ciblage des investissements.
How and why was universal health coverage implemented so early in a
poverty-stricken province in ... more How and why was universal health coverage implemented so early in a poverty-stricken province in Canada? Why was its design so faithfully replicated in the national standards that ultimately shaped Medicare across the rest of Canada? Seeking to answer these questions, Tommy Douglas and the Quest for Medicare in Canada explores the history of universal health care through the life of Canadian politician Tommy Douglas, identifying the pivotal moments and decisions that led to the establishment of Medicare in Canada. The book traces the origins of Medicare back to the 1930s Depression and its devastating impact on the Prairie populations. Marchildon examines how Tommy Douglas and a new generation of reformers, radicalized by the Depression, prioritized socialized health care. The book reveals how, as the provincial party leader, Douglas leveraged support from both local and external allies to rapidly implement universal hospital insurance and lay the groundwork for a new health system. Despite strong opposition from physician and business lobbies, Douglas continued to pressure the government for federal cost-sharing of universal health coverage. Drawing on archival sources including speeches, television broadcasts, and cabinet documents, Tommy Douglas and the Quest for Medicare in Canada illuminates how Douglas’s vision, leadership, and coalition-building among unions were crucial to the successful establishment of Medicare in Canada.
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poverty-stricken province in Canada? Why was its design so faithfully
replicated in the national standards that ultimately shaped Medicare
across the rest of Canada? Seeking to answer these questions, Tommy Douglas and the Quest for Medicare in Canada explores the history of universal health care through the life of Canadian politician Tommy Douglas, identifying the pivotal moments and decisions that led to the establishment of Medicare in Canada.
The book traces the origins of Medicare back to the 1930s Depression
and its devastating impact on the Prairie populations. Marchildon examines how Tommy Douglas and a new generation of reformers, radicalized by the Depression, prioritized socialized health care. The book
reveals how, as the provincial party leader, Douglas leveraged support from both local and external allies to rapidly implement universal hospital
insurance and lay the groundwork for a new health system. Despite strong opposition from physician and business lobbies, Douglas continued to pressure the government for federal cost-sharing of universal health coverage. Drawing on archival sources including speeches, television broadcasts, and cabinet documents, Tommy Douglas and the Quest for Medicare in Canada illuminates how Douglas’s vision, leadership, and coalition-building among unions were crucial to the successful establishment of Medicare in Canada.