School of Policy Studies, Queen’s University
2003 Spring Seminar Course Syllabus
SPS-836
HEALTH AND PUBLIC POLICY IN CANADA
Gregory Marchildon and Michael Decter
Overview
This course reviews the historical development of the Canadian health care system and its
supporting principles, governance structures and fiscal arrangements. It then examines
contemporary structures and relationships as well as the current impetus for public health
care reform, including challenges related to financing, organization and delivery. Some
effort is made throughout to compare Canadian health policy and programs to select
OECD countries.
The course begins with an introduction to the basic concepts of health, health care and the
determinants of health as well as the policy process as applied to health and health care
within the Canadian federation. Part I of the course traces the evolution of the “Canadian
model” in terms of the evolution of public health, hospitalization, medicare as well as the
mixed and private sectors of health care. Part II is concerned with contemporary health
reform issues as they relate to fiscal sustainability and the re-organization and delivery of
services to achieve a more effective continuum of care.
Readings
All required course readings, which have been brought together for you in a single
Custom CourseWare textbook, should be read before the seminars. We have purposely
kept these readings to a bare minimum. We encourage you to examine some of the
supplementary readings if possible as they are will provide you with a deeper
understanding of the many, often disparate, policies and programs that make up what we
call the Canadian health system.
Evaluation
Student evaluation will be based upon: (1) the preparation and presentation of a “policy
briefing” based upon an analysis of one of a selected supplementary reading; and 2) a
paper of between 15-25 pages (double-spaced) in length addressing a major health care
policy issue. Policy briefings will be assigned to individual members of the class in
advance and will be worth 30 per cent of the final mark. Paper topics will be approved in
advance through the submission of a 1 page outline and bibliography worth 10 per cent.
The final paper will be worth 60 per cent of your final assessment.
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PART I: THE EVOLUTION OF THE CANADIAN MODEL
Seminars 1 and 2: Introduction to the “Canadian Model” and Current Challenges
Carolyn Tuohy, “Dynamics of a Changing Health Sphere: The United States, Britain, and
Canada”, Health Affairs, Vol. 18, no. 3 (1999): 114-34; and “The Costs of Contraint and
Prospects for Health Care Reform in Canada”, Health Affairs, Vol. 21, no. 3 (2002): 3246.
C. David Naylor, “Health Care in Canada: Incrementalism under Fiscal Stress”, Health
Affairs, Vol. 18, no. 3 (1999): 9-26.
Duncan Sinclair, “Rethinking Medicare: It’s Time to do it!” HealthcarePapers, Vol. 1,
no. 3 (Summer 2000): 9-19.
Michael B. Decter, Four Strong Winds: Understanding the Growing Challenges to
Health Care (Toronto: Stoddard, 2000): 13-54.
Supplementary Reading:
Duane Adams, “Canadian Federalism and the Development of National Health Goals and
Objectives”, in Duane Adams, ed., Federalism, Democracy and Health Policy in Canada
(Montreal and Kingston: McGill-Queen’s University Press, 2001): 61-105.
Eugene Schneller, “Healthcare System and the 21st Century: Observations from South of
the Border”, Hospital Quarterly, Vol. 3, no. 1 (Fall 1999).
Seminar 3: Local, Provincial and National Hospital Policy, 1900-1960
Terry Boychuk, The Making and Meaning of Hospital Policy in the United States and
Canada (Ann Arbor: University of Michigan Press, 1999): 26-48
Malcolm G. Taylor, Health Insurance and Canadian Public Policy: The Seven Decisions
that Created the Canadian Health Insurance System and their Outcomes (Montreal and
Kingston: McGill-Queen’s University Press, 2nd ed., 1987): 69-104.
Antonia Maioni, Parting at the Crossroads: The Emergence of Health Insurance in the
United States and Canada (Princeton: Princeton University Press, 1998): 92-118.
Supplementary Reading:
Malcolm G. Taylor, Health Insurance and Canadian Public Policy, pp. 105-238.
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C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics
of Health Insurance, 1911-1966 (Montreal and Kingston: McGill-Queen’s University
Press, 1986), pp. 135-175.
Seminar 4: Physician Services and Medicare
C. David Naylor, Private Practice, Public Payment, 214-243
S.E.D. Shortt, The Doctor Dilemma: Public Policy and the Changing Role of Physicians
under Ontario Medicare (Montreal and Kingston: McGill-Queen’s University Press,
1999): 20-38.
Supplementary Reading:
Malcolm G. Taylor, Health Insurance and Canadian Public Policy, 239-414.
Antonia Maioni, Parting at the Crossroads, 119-52.
Seminar 5: The Canada Health Act
Overview (and brief history) of Canada Health Act in Canada Health Act Annual Report,
2001-2002 (Ottawa: Health Canada, 2002): 3-8.
Monique Bégin, “Revisiting the Canada Health Act (1984): What are the Impediments to
Change?” Speech delivered to the Institute for Research on Public Policy, February 20,
2002. 7 pp.
Colleen Flood and Sujit Choudhry, “Strengthening the Foundations: Modernizing the
Canada Health Act.” Discussion Paper (no. 13) prepared for the Commission on the
Future of Health Care in Canada, August 2002. 33 pp.
Supplementary Reading:
Sujit Choudhry, “The Enforcement of the Canada Health Act”, McGill Law Journal, Vol.
41 (1996).
D. Gibson, “The Canada Health Act and the Constitution”, Health Law Journal, Vol. 4
(1996): 1-33.
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Seminar 6: The Funding of Health Care
Elias Mossialos and Anna Dixon, “Funding Health Care: An Introduction”, in Funding
Health Care: Options for Europe, edited by Elias Mossialos et al. (Buckingham: Open
University Press, 2002): 1-30.
Robert G. Evans, “Raising the Money: Options, Consequences and Objectives for
Financing Health Care in Canada.” Discussion Paper (no. 27) prepared for the
Commission on the Future of Health Care in Canada, October 2002. 46 pp.
Supplementary Reading:
Michel Grignon, Valérie Paris and Dominique Polton, “Influence of Physician Payment
Methods on the Efficiency of the Health Care System.” Discussion Paper (no. 35)
prepared for the Commission on the Future of Health Care in Canada, November 2002.
30 pp.
Seminar 7: Health Transfer Funding and the Federal Role
Institute of Intergovernmental Relations, School of Policy Studies, Queen’s University,
“Federal-Provincial Relations and Health Care: Reconstructing the Relationship.”
Summary report on fiscal federalism and health prepared for the Commission on the
Future of Health Care in Canada, November 2002. 29 pp.
Antonia Maioni, “Roles and Responsibilities in Health Care Policy.” Discussion Paper
(no. 34) prepared for the Commission on the Future of Health Care in Canada, November
2002. 28 pp.
Supplementary Reading:
Melissa Rode and Michael Rushton, “Options for Raising Revenue for Health Care.”
Discussion Paper (no. 9) prepared for the Commission on the Future of Health Care in
Canada, August 2002. 19 pp.
Gerard W. Boychuk, “The Changing Political and Economic Environment of Health Care
in Canada.” Discussion Paper (no. 1) prepared for the Commission on the Future of
Health Care in Canada, July 2002. 19 pp.
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PART II: REFORMING HEALTH CARE IN CANADA
Seminar 8: Transforming the Hospital
Michael. B. Decter, Four Strong Winds, 57-74.
Barry Monaghan et al., “Through the Looking Glass: The Cardiac Care Network of
Ontario 10 Years Later”, Hospital Quarterly, Vol. 4, no. 3 (Spring 2001): 30-38.
Charles B. Wilson, “The Impact of Medical Technologies on the Future of Hospitals”,
BMJ, Vol. 319 (13 Nov. 1999): 1-3.
Supplementary Reading:
Phil Nolin, “The Reconfiguration of Montréal’s Hospital System”, Perspective, Vol. 9,
no. 1 (1996): 14-18.
Ken Rasmussen, “Regionalization and Collaborative Government: A New Direction for
Health System Governance”, in Duane Adams, ed., Federalism, Democracy and Health
Policy in Canada, 239-70.
Seminar 9: Health Human Resources
Canadian Policy Research Networks (CPRN), “Health Human Resource Planning in
Canada: Physician and Nursing Work Issues.” Summary report on health human
resources prepared for the Commission on the Future of Health Care in Canada, October
2002. 23 pp.
Gail Tomblin Murphy and Linda O’Brien Pallas, “How Do Health Human Resources
Policies and Practices Inhibit Change? A Plan for the Future.” Discussion Paper (no. 30)
prepared for the Commission on the Future of Health Care in Canada, October 2002. 23
pp.
Supplementary Reading:
Advisory Committee on Health Human Resources, The Nursing Strategy for Canada,
October 2000.
B. Chan, The Perceived Surplus to Perceived Shortage: What Happened to Canada’s
Physician Workforce in the 1990s? (Ottawa: Canadian Institute for Health Information,
2002).
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Pat Armstrong and Hugh Armstrong, “Planning for Care: Approaches to Health Human
Resource Policy and Planning.” Discussion Paper (no. 28) prepared for the Commission
on the Future of Health Care in Canada, October 2002. 23 pp.
Angela C. Cybulski, Karen Bell and Jean M. Reader, “Management Strategies for
Nursing Recruitment and Retention”, Hospital Quarterly, Vol. 2, no. 4 (Summer 1999).
Seminar 10: Primary Care Reform
Brian Hutchinson, Julian Abelson and John Lavis., “Primary Care in Canada: So much
Innovation, so little Change”, Health Affairs, Vol. 20, no. 3 (2001): 116-31.
François Béland, “Preventive and Primary Care Access Systems: CLSCs as
Neighborhood and Social Service Centers in Quebec”, in Health Care Systems in
Transition: An International Perspective, edited by Francis D. Powell and Albert F.
Wessen (Thousand Oaks, CA: Sage, 1999): 173-198.
Supplementary Reading:
Walter Rosser and Jan Kasperski, “Organizing Primary Care for an Integrated System”,
and Mary Ellen Jeans, “Primary Care and Primary Health Care for an Integrated System”,
in HealthcarePapers, Vol. 1, no. 1 (Winter 1999): 5-22 and 33-36.
Fitzhugh Mullan, “The ‘Mona Lisa’ of Health Policy: Primary Care at Home and
Abroad”, Health Affairs, Vol. 17, no. 2 (1998): 119-126. *
Seminar 11: Home Care and Mental Health
Patricia M. Baranek, Raisa Deber and A. Paul Williams, “Policy Trade-Offs in ‘Home
Care’”: the Ontario Example”, Canadian Public Administration, Vol. 42, no. 1 (Spring
1999): 69-92.
John Hunsley, “Cost-Effectiveness and Medical Cost-Offset: Considerations in
Psychological Service Provision”, Canadian Psychology, Vol. 44, no. 1 (2003): 61-73.
CHSRF Issue/Survey Paper on Home Care in Canada, prepared for the Commission on
the Future of Health Care in Canada, May 2002: 2-9.
Supplementary Reading:
World Health Report 2001 (Geneva: WHO, 2001), pp. 77-106. *
Commission on the Future of Health Care in Canada, Building on Values (Romanow
Commission final report), pp. 171-188.
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Seminar 12: Prescription Drugs: Regulation, Utilization and Cost
Joel Lexchin, “Pharmaceuticals, Patents, and Politics: Canada and Bill C-22”,
International Journal of Health Services, Vol. 23, no. 1 (1993): 147-160.
Robert Elgie, “Drug Pricing: A Comparison between Canada and other Countries.”
Paper from IRPP Conference “Towards a National Strategy on Drug Insurance”,
September 23, 2002. 11 pp.
Devidas Menon, “Pharmaceutical Cost Control in Canada: Does it Work? Health Affairs,
Vol. 20, no. 3 (May/June 2001): 92-103.
Supplementary Reading:
Andreas Laupacis, “Drug Policy: Making Effective Drugs Available without Bankrupting
the Healthcare System”, HealthcarePapers, Vol. 3, no. 1 (2002): 12-30.
Robin Tamblyn, “Evidence-based Utilization of Prescription Drugs: Challenges and
Directions for the Future in Canada.” Paper from IRPP Conference “Towards a National
Strategy on Drug Insurance”, September 23, 2002.
Seminar 13: Service Delivery
Michael B. Decter, Four Strong Winds, chapter 15 on “The Health Consumer”, 207-221.
Craig Taylor, “Tapping Disney Inspiration: Transforming Healthcare” in Hospital
Quarterly, Vol. 3, no. 2 (Winter 1999/2000): 25-7.
CHSRF Issue/Survey Paper on Consumer Choice in Canada’s Healthcare System,
prepared for the Commission on the Future of Health Care in Canada, June 2002: 3-9.
Supplementary Reading:
Raisa Deber, “Delivering Health Care Services: Public, Not-for-Profit, or Private?”
Discussion Paper (no. 17) prepared for Commission on the Future of Health Care in
Canada. 63 pp.
Doris Grinspun, “Putting Patients First: The Role of Nursing Care”, Hospital Quarterly,
Vol. 3, no. 4 (Summer 2000).
Valerie McDonald, “A Parent’s Perspective: Providing Compassionate and Effective
Care”, Hospital Quarterly, Vol. 3, no. 2 (Winter 1999/2000).
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