Restructuring Canada's Health Systems: How Do We Get There From Here? : Proceedings of the Fourth Canadian Conference on Health Economics

Is the Canadian health care system becoming a victim of its own success? It has done what it set out to do – provide universal access to all medically necessary health services without financial barriers to patients – but expanding technology, an aging population, and escalating costs strain its ability to continue. It is time to explore ways to reorient and restructure the health care system and the services it provides. At the Fourth Canadian Conference on Health Economics, contributors of international reputation addressed these concerns. Their papers, collected in this volume, consider a wide range of fundamental issues related to health care policies and structures. They discuss new developments in health care delivery, assess implications of such new policies as home care and health promotion, and propose concrete alternatives for restructuring the present system to sustain universal medicine. Contents 5 Foreword 9 Preface 11 What Happens If We Don’t Restructure the System? 15 Ontario’s Health Care System at the Crossroads 15 Discussion 21 Utilization: The Doctors Dilemma 25 The Effects of Medical Care Policy in B.C.: Utilization Trends in the 1980s 25 Who Has Seen the Wind? Examining the Evidence and Exploring the Policy Options Pertaining to the Effect Changes in Physician Supply Have Had on Influencing Medical Utilization and Costs in Alberta 31 Physician Remuneration: Fee-for-service Must Go, But Then What? 47 Discussion 51 Reports and Commissions: Looking for Directions 61 A Great Canadian Prescription: Take Two Commissioned Studies and Call Me in the Morning 61 Report of the Pharmaceutical Inquiry of Ontario: An Overview 75 Redefining the Globe: Recent Changes in the Financing of British Columbia Hospitals 85 Discussion 97 There’s No Place Like Home 101 Cost-Effectiveness of Home Care 101 There’s No Place Like Home 111 Discussion 117 What Gains Can We Expect from Promotion and Disease Prevention, Or ‘Whither Oat Bran’? 123 Evaluation of Federal Health Promotion Initiatives 123 Health Promotion/Disease Prevention: What Do We Think We Know? 127 Cholesterol Screening: The Costs and Benefits of Various Programs 135 Discussion 147 South of the Border 155 U.S. Influences on Canada: Can We Prevent the Spread of Kuru? 155 Canadian Influences on the U.S.: Immune System Responses? 161 Discussion 165 Yankee Influences: Playing in the Bush Leagues? 171 Managed Care: What Is It, and Can It Be Applied to Canada? 171 The American Experience with a Prospective Payment System: Some Lessons for Canada 177 Riverview/Fraser Valley Assertive Outreach Program 197 Discussion 203 Hospitals: Changing Prescriptions 207 Changing Patterns of Governance for Hospitals: Issues and Models 207 Innovative Fund Raising: The St. Michael’s Hospital Health Centre 219 Purchasing Hospital Capital Equipment: What Role for Technology Assessment? 225 Discussion 235 Quality Time 241 Assessing the Quality of Medical Care 241 Assessing the Quality of Medical Care 247 Discussion 251 Methodology for Economic Evaluation: Give Us the Tools 257 Implications of Basing Health Care Resource Allocations on Cost-utility Analysis in the Presence of Externalities 257 Conducting Comprehensive Cost Assessments: A Case Study of an Assertive Mental Health Community Treatment Program 275 Discussion 281 Economic Evaluations of Health Programs: Costs and Consequences 285 Determinants of Medical Malpractice: The Canadian Experience 285 Preliminary Findings of the Economic Evaluation of an Ontario Geriatric Day Hospital 297 Economic Costs of Self Sufficiency in Blood Products: The Case of Albumin 313 Discussion 319 Marketing Change: How Can We Get Anywhere from Here? 325 Marketing Change: How Can We Get Anywhere from Here? 325 The Empire Strikes Back 329 Hospital Competition in the U.K.: A (Possibly) Useful Framework for the Future 329 Hospital Competition in the U.K.: A Prospective 343 Discussion 345 Hospitals Revisited 351 Hospital Resources in Metropolitan Toronto: The Reality versus the Myth 351 Redirecting Incentives in the British Columbia Health System: Creating a Consequence 359 Collaborative Arrangements for Service Delivery: The Example of Two New Brunswick Hospitals 363 Discussion 373 Where Else Might We Go? Alternative Approaches and Models 377 Co-operative Health Service Delivery in Canada 377 The Independent Health Facilities Act: A First for North America 389 Models for Integrating and Coordinating Community-based Human Service Delivery: An Analysis of Organizational and Economic Factors 399 Discussion 405 Closing Remarks 409 List of Participants: Fourth Canadian Conference On Health Economics 411