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Learning from health system reform trajectories in seven Canadian provinces

Published online by Cambridge University Press:  06 August 2020

Susan Usher Open the ORCID record for Susan Usher [Opens in a new window] ,
Jean-Louis Denis ,
Johanne Préval ,
Ross Baker ,
Samia Chreim ,
Sara Kreindler ,
Mylaine Breton  and
Élizabeth Côté-Boileau
Susan Usher*
Affiliation:
PhD candidate, Public Administration, École Nationale d'administration Publique, Québec, Canada
Jean-Louis Denis
Affiliation:
Professor, School of Public Health, Université de Montréal, CRCHUM, Québec, Canada
Johanne Préval
Affiliation:
Research professional, Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Québec, Canada
Ross Baker
Affiliation:
Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
Samia Chreim
Affiliation:
Professor, Telfer School of Management, University of Ottawa, Ontario, Canada
Sara Kreindler
Affiliation:
Assistant Professor, Community Health Sciences, University of Manitoba, Manitoba, Canada
Mylaine Breton
Affiliation:
Associate Professor, Social Sciences and Medicine, University of Sherbrooke, Québec, Canada
Élizabeth Côté-Boileau
Affiliation:
PhD candidate, Health Sciences Research, University of Sherbrooke, Québec, Canada
*
*Corresponding author. Email: susan.usher@enap.ca
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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.

Keywords

Comparative analysishealth systemspolicy leverssubnational health systems

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Health Economics, Policy and Law , Volume 16 , Issue 4 , October 2021 , pp. 383 - 399
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Copyright © The Author(s), 2020. Published by Cambridge University Press

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