Paradigm Freeze : Why It Is So Hard to Reform Health Care in Canada

Why has health care reform proved a stumbling block for provincial governments across Canada? What efforts have been made to improve a struggling system, and how have they succeeded or failed? In Paradigm Freeze, experts in the field answer these fundamental questions by examining and comparing six essential policy issues - regionalization, needs-based funding, alternative payment plans, privatization, waiting lists, and prescription drug coverage - in five provinces. Noting hundreds of recommendations from dozens of reports commissioned by provincial governments over the last quarter century - the great majority to little or no avail - the book focuses on careful diagnosis, rather than unplanned treatment, of the problem. Paradigm Freeze is based on thirty case studies of policy reform in Alberta, Saskatchewan, Ontario, Quebec, and Newfoundland and Labrador. The contributors assess the nature and extent of healthcare reform in Canada since the beginning of the 1990s. They account for the generally limited extent of reform that has occurred, and identify the factors associated with the relatively few cases of large reform. An insightful new perspective on a problem that has plagued Canadian governments for decades, Paradigm Freeze is an important addition to the field of health policy. Contributors include John Church (University of Alberta), Michael Ducie (Alberta Health and Wellness), Pierre-Gerlier Forest (Pierre Elliott Trudeau Foundation), Stephen Tomblin (Memorial University), Jeff Braun Jackson (Ontario Professional Firefighters Association, Burlington, ON), Marie-Pascale Pomey (Université de Montréal), John N. Lavis (McMaster University), Harvey Lazar (Queen's University), Elisabeth Martin (Université Laval),Tom McIntosh (University of Regina), Dianna Pasic (McMaster University), Neale Smith (University of British Columbia), and Michael G. Wilson (McMaster University). Cover Contents List of Tables and Figures Foreword Preface Glossary A C D E F G I L M N P R S Abbreviations Chapter 1 Why Is It So Hard to Reform Health-Care Policy in Canada? Chapter 2 Studying Health-Care Reforms Chapter 3 Health Reform in Alberta: Fiscal Crisis, Political Leadership, and Institutional Change within a Single-Party Democratic State Chapter 4 Saskatchewan’s Health-Care Policy Reform in the Romanow Era: From Restraint to Restructuring Chapter 5 Health-Care Reform in Ontario: More Tortoise Than Hare? Chapter 6 Quebec Reforms from Rochon to Couillard: The Long and Winding Road Chapter 7 Between a Rock and a Hard Place: The Difficulty of Reforming Health Care in Newfoundland and Labrador Chapter 8 Canadian Health-Care Reform: What Kind? How Much? Why? Chapter 9 Patterns in the Factors That Explain Health-Care Policy Reform Chapter 10 Verifying the Reliability of Research Results Chapter 11 Health-Care Reform: Where Things Stand Chapter 12 Prospects for Health-Care Policy Reform Annex 1 Analyzing the Nature and Extent of Health-Care Policy Reforms, 1990–2003 Annex 2 Independent Variables Referred to in 30 Case Studies That Best Help to Explain Nature and Extent of Reforms Annex 3 Some Observations on the Historical Development of Medicare References Contributors