Learning from health system reform trajectories in seven Canadian provinces

Abstract

In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada?, McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian system based on physician independence and assured universal coverage only for medical and hospital services. This paper focuses on reforms since the turn of the millennium to explore the transformative capacities developed in seven provinces within this system architecture. Longitudinal case studies, based on scientific and grey literature, and interviews with key informants, trace the patterns of reform in each province and reveal five objectives that, to varying degrees, preoccupied reformers: (1) address chronic disease, (2) align health system actors with provincial objectives, (3) shift from hospital to community-based care, (4) integrate physicians, and (5) develop improvement capacities. The range of strategies adopted to achieve these objectives in different provinces is compared to identify emerging pathways of reform and extract lessons for future reformers. We find significant cross-learning between provinces, but also note an emergent dimension to reforms, where multiple strategies aggregate through time to create unique patterns, presenting their own set of possibilities and limitations for the future.

Global health and innovation: A panoramic view on health human resources in the COVID‐19 pandemic context

“…Despite Quebec's attempts over time to re‐balance the distribution of resources across sectors of care, 3 the first wave of the pandemic revealed persistent difficulties in responding to needs in LTC settings, home care and in deprived areas. A recent report by the Protecteur du citoyen 33 concluded that the government invested efforts in preparing hospitals for the pandemic, but paid little policy attention initially to other sectors of care.…”

“…Shortages in various occupational categories are a long-standing issue in Quebec's health system. [34][35][36] As in other Canadian provinces, the system developed historically around two main centres of gravity-medical and hospital care-guaranteed under the Canada Health Act, 3 which has had the effect of limiting the attention paid to emerging health priorities such as care for a growing vulnerable elderly population.…”

“…In Canada, HHR policies have been assessed and studied extensively in recent years 2 and provinces have undertaken significant reforms to adapt their health systems to emerging needs and issues. 3 However, numerous vulnerabilities persist. 4,5 Bourgeault and colleagues 6 stress the importance of national HHR strategy to address misalignment with priority health needs.…”

“…The COVID‐19 pandemic emphatically underlines the importance of health issues in the contemporary world, 1 obliging national jurisdictions to revisit their health human resources (HHR) policies. In Canada, HHR policies have been assessed and studied extensively in recent years 2 and provinces have undertaken significant reforms to adapt their health systems to emerging needs and issues 3 . However, numerous vulnerabilities persist 4,5 .…”

Canadian health emergency management professionals’ perspectives on the prevalence and effectiveness of disaster preparedness activities in response to COVID-19

“…While emergencies have increased in frequency, they may still be rare in certain regions of Canada which leads to variability in the commitment of leadership to invest in preparedness [ 10 ]. Another element of variation stems from the nature of health systems in each region of Canada [ 51 ]. Alberta has a long history of responding to natural disasters including fires and floods which has seen the development of a robust emergency planning and co-ordination capability [ 52 ].…”