Some Issues in Horizontal and
When it decided to set up a collectivist organization for delivering care the federal government introduced new programs as and when it could, so that these programs can be seen as an incremental accumulation of bits and pieces of reform and restructuring rather than parts of a well planned and coordinated policy for restructuring. In any case the emphasis in the first twenty‐ five years of the welfare state was gap filling rather than streamlining of services. The key words were ensuring access to services. This meant that many new facilities had to be opened up. Less attention was given to service integration.
The federal Minister of Finance, Mitchell Sharp, had raised the matter of the costs of commitment to the Medical Care Insurance Act in 1966 (Taylor 1978) but the government was determined to go ahead with this legislation. It felt it had to follow through on implementing this component of the health care system as recommended by the Royal Commission on Health Services (Canada 1964). However, the new Deputy Minister of Health and Welfare, Le Clair, took Sharp's warnings seriously. He initiated the process of questioning the current policies and service organization on two levels — the first was concerned with the rational organization of access to care, the second was a review of the mission. 1
Streamlining the collectivist organization of health care (rather than gap filling which had been the primary concern at the start) took a long time to become accepted by the provincial governments. It is now more than twenty years since Le Clair's questioning process was begun, but the message of____________________