scholarly journals Pharmaceutical policy reform in Canada: lessons from history

2018 ◽  
Vol 13 (3-4) ◽  
pp. 299-322 ◽  
Author(s):  
Katherine Boothe
Keyword(s):  
Health System ◽  
Private Insurance ◽  
Universal Coverage ◽  
New Drugs ◽  
System Reform ◽  
The Social ◽  
Broad Public Health ◽  
Potential Methods ◽  
Integrated Health Services

AbstractCanada is the only country with a broad public health system that does not include universal, nationwide coverage for pharmaceuticals. This omission causes real hardship to those Canadians who are not well-served by the existing patchwork of limited provincial plans and private insurance. It also represents significant forgone benefits in terms of governments’ ability to negotiate drug prices, make expensive new drugs available to patients on an equitable basis, and provide integrated health services regardless of therapy type or location. This paper examines Canada’s historical failure to adopt universal pharmaceutical insurance on a national basis, with particular emphasis on the role of public and elite ideas about its supposed lack of affordability. This legacy provides novel lessons about the barriers to reform and potential methods for overcoming them. The paper argues that reform is most likely to be successful if it explicitly addresses entrenched ideas about pharmacare’s affordability and its place in the health system. Reform is also more likely to achieve universal coverage if it is radical, addressing various components of an effective pharmaceutical program simultaneously. In this case, an incremental approach is likely to fail because it will not allow governments to contain costs and realize the social benefits that come along with a universal program, and because it means forgoing the current promising conditions for achieving real change.

A network of networks

2017 ◽  
Vol 31 (2) ◽  
pp. 223-236 ◽  
Author(s):  
Rick Iedema ◽  
Raj Verma ◽  
Sonia Wutzke ◽  
Nigel Lyons ◽  
Brian McCaughan
Keyword(s):  
Health Service ◽  
Health System ◽  
Network Governance ◽  
System Reform ◽  
System Transformation ◽  
Content Type ◽  
Multiple Networks ◽  
Network Of Networks

Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. Design/methodology/approach This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities. Findings The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system. Research limitations/implications While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced. Practical implications The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform. Social implications Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives. Originality/value This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

Learning from health system reform trajectories in seven Canadian provinces

2020 ◽  
pp. 1-17
Author(s):  
Susan Usher ◽  
Jean-Louis Denis ◽  
Johanne Préval ◽  
Ross Baker ◽  
Samia Chreim ◽  
...  
Keyword(s):  
Health System ◽  
Grey Literature ◽  
Universal Coverage ◽  
System Reform ◽  
Turn Of The Millennium ◽  
Publicly Funded ◽  
Community Based ◽  
Multiple Strategies ◽  
Canadian Provinces ◽  
Longitudinal Case Studies

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.

Institutional ethnography as a unique tool for improving health systems

2019 ◽  
Vol 32 (3) ◽  
pp. 143-147 ◽  
Author(s):  
Emily Rowland ◽  
Myuri Manogaran ◽  
Ivy Lynn Bourgeault
Keyword(s):  
Health System ◽  
Neonatal Intensive Care ◽  
Institutional Ethnography ◽  
Deep Understanding ◽  
Patient Experiences ◽  
Social Contexts ◽  
Neonatal Intensive Care Units ◽  
System Reform ◽  
Internal Structures ◽  
The Social

Qualitative research in the health system has made tremendous developments in the last decade to better understand patient experiences. What is often overlooked, are the influences that the internal structures, policies and people have on the individuals that use health services. Institutional ethnography is a qualitative approach that aims to capture the social organization of "everyday life" at various system levels. An institutional ethnographic framework was applied to two research studies exploring how families experience care in neonatal intensive care units. Data were collected to develop a deep understanding of the social contexts that exist within institutional boundaries. This paper provides evidence that how care is organized and delivered can significantly influence patient experiences, perceptions and ultimately health outcomes. Adopting institutional ethnographic techniques as a common research method is a valuable tool for health leaders seeking to understand and develop recommendations for health system reform.

Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers

Interpreting ◽  
2005 ◽  
Vol 7 (2) ◽  
pp. 167-192 ◽  
Author(s):  
Yvan Leanza
Keyword(s):  
Social Science ◽  
Health System ◽  
Cultural Differences ◽  
Outpatient Clinic ◽  
Healthcare Providers ◽  
Language Barriers ◽  
Science Literature ◽  
The Social ◽  
Social Science Literature

This paper is an attempt at defining more clearly the various roles of community interpreters and the processes implicitly connected with each of them. While the role of the interpreter is a subject that has been widely discussed in the social science literature, it is less present in the biomedical one, which tends to emphasize the importance of interpreting in overcoming language barriers, rather than as a means of building bridges between patients and physicians. Hence, studies looking at interpreted medical interactions suggest that the presence of an interpreter is more beneficial to the healthcare providers than to the patient. This statement is illustrated by the results of a recent study in a pediatric outpatient clinic in Switzerland. It is suggested that, in the consultations, interpreters act mainly as linguistic agents and health system agents and rarely as community agents. This is consistent with the pediatricians’ view of the interpreter as mainly a translating machine. A new typology of the varying roles of the interpreter is proposed, outlining the relation to cultural differences maintained therein. Some recommendations for the training of interpreters and healthcare providers are suggested.

Social Representations and Commitment

2018 ◽  
Vol 23 (3) ◽  
pp. 233-249 ◽  
Author(s):  
Eric Bonetto ◽  
Fabien Girandola ◽  
Grégory Lo Monaco
Keyword(s):  
Social Representations ◽  
Social Representation ◽  
Second Line ◽  
Review Of The Literature ◽  
First Line ◽  
Research Perspectives ◽  
The Social ◽  
Bibliographic Search ◽  
English Articles

Abstract. This contribution consists of a critical review of the literature about the articulation of two traditionally separated theoretical fields: social representations and commitment. Besides consulting various works and communications, a bibliographic search was carried out (between February and December, 2016) on various databases using the keywords “commitment” and “social representation,” in the singular and in the plural, in French and in English. Articles published in English or in French, that explicitly made reference to both terms, were included. The relations between commitment and social representations are approached according to two approaches or complementary lines. The first line follows the role of commitment in the representational dynamics: how can commitment transform the representations? This articulation gathers most of the work on the topic. The second line envisages the social representations as determinants of commitment procedures: how can these representations influence the effects of commitment procedures? This literature review will identify unexploited tracks, as well as research perspectives for both areas of research.

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