Health Care Federalism in Canada by Fierlbeck Katherine;Lahey William; & WILLIAM LAHEY

Author:Fierlbeck, Katherine;Lahey, William; & WILLIAM LAHEY
Language: eng
Format: epub
Publisher: McGill-Queen's University Press
Published: 2013-08-15T00:00:00+00:00

PLANNING FOR HEALTH SYSTEMS AND THE HEALTH WORKFORCE IN CANADA

Health systems have been organized on the basis of historical levels of service provision and have not emphasized systematic responses to the health needs of populations. There is a growing awareness, however, that health service planning, and therefore HHR planning, should be responsive to the changing needs of the population. People are any health care system’s greatest asset and greatest cost (achdhr 2007). The health care industry accounts for more than $200 billion worth of spending nationally (CIHI 2012a) and 60–80 cents of every dollar of this sum goes toward health professionals: the fraction of every dollar spent on health professionals varies by jurisdiction (achdhr 2007). Given the immense complexity and scope of health care systems and the incompleteness of the available information relating not only to current delivery but also to future estimating, gaps in HHR are inevitable in every jurisdiction.

The difficulty is that governments, academic institutions, organizational and professional policies, labour market mobility, and public institutions are not flexible enough to adapt to the changing needs of people and the constantly changing health care system. Moreover, the consequences of misallocations will only be further amplified in the future as financial challenges increase, the workload of the health care system increases because of demographic changes and changes in levels of health, the health care workforce is diminished and further strained because of the wave of expected retirements and the lack of new workers to replace the retirees, and risks of health crises such as pandemics become greater. Given that the challenges posed by these needs are well established and that it is in the provinces’ best interests to collectively address these challenges, why don’t we have mature, effective policy universally in place to meet said challenges?

Challenges

Within each Canadian jurisdiction, HHR planning is shared to varying degrees between the province or territory and a number of other stakeholders, including health sector organizations, unions, professional associations, regulatory bodies, research institutes, Aboriginal groups, and federal health partners. The level of participation by the various stakeholders in such efforts is largely at the discretion of the province or territory in question. The difficulty is that although there are benefits to collaboration, obstacles and costs can also stem from such an effort.

Historically, planning approaches have been hampered as each province and territory in Canada has worked independently to design its own service system, develop service delivery models, and plan its own HHR plan. This has often resulted in competition between jurisdictions for limited HHR. This is understandable given that decisions made by one jurisdiction can have unintended impacts on other jurisdictions. For example, a change in the design of one jurisdiction’s health care system could have a negative impact on the availability of certain health care providers for other jurisdictions. The risks are greater in the current reform environment where unilateral action by any one jurisdiction with a more attractive labour strategy could undermine system stability and affect other jurisdictions’ ability to deliver on health commitments (e.

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