The Governance of Health Care in Canada : The Romanow Papers, Volume 3

The twelve papers in this third volume of the research program for the Romanow Commission offer a detailed analysis of the governance of health care in Canada from the perspective of constitutionalism, intergovernmental relations, and societal context. In the first section, the authors deal with the formal division of powers regarding health care as outlined in the Canadian constitution and the Charter of Rights and Freedoms. The second section outlines the strengths and weaknesses of the intergovernmental governance of health care. Finally, the third section focuses on governance of health care outside of the governmental sphere. The theme that resonates throughout the contributions – and which is in itself a call for deeper analysis – is that health care governance has become locked in a cycle of mutual recrimination, blame assigning, and blame avoidance from the federal and provincial levels right down to the level of the individual citizen. Contents 5 Acknowledgments 7 Contributors 9 Introduction: Restoring Trust, Rebuilding Confidence - The Governance of Health Care and the Romanow Report 11 Part I. The Constitutional Context 35 1. Health and the Distribution of Powers in Canada 35 2. Constitutional Jurisdiction over Health and Health Care Services in Canada 60 3. How Will the Charter of Rights and Freedoms and Evolving Jurisprudence Affect Health Care Costs? 93 Part II. The Intergovernmental Context 137 4. Intergovernmental Cooperation Mechanisms: Factors for Change? 137 5. Roles and Responsibilities in Health Care Policy 179 6. Health Care Politics and the Intergovernmental Framework in Canada 209 7. The Conditions for a Sustainable Public Health System in Canada 234 Part III. The Social and Legal Context 267 8. Political Elites and Their Influence on Health Care Reform in Canada 267 9. Creating a More Democratic Health System: A Critical Review of Constraints and a New Approach to Health Restructuring 290 10. Could New Regulatory Mechanisms Be Designed after a Critical Review of Health Technology Innovations? 322 11. Strengthening the Foundations: Modernizing the Canada Health Act 356 The twelve papers in this third volume of the research program for the Romanow Commission offer a detailed analysis of the governance of health care in Canada from the perspective of constitutionalism, intergovernmental relations, and societal context. In the first section, the authors deal with the formal division of powers regarding health care as outlined in the Canadian constitution and the Charter of Rights and Freedoms. The second section outlines the strengths and weaknesses of the intergovernmental governance of health care. Finally, the third section focuses on governance of health care outside of the governmental sphere. The theme that resonates throughout the contributions? and which is in itself a call for deeper analysis? is that health care governance has become locked in a cycle of mutual recrimination, blame assigning, and blame avoidance from the federal and provincial levels right down to the level of the individual citizen