Reinvigorating Publicly Funded Medicare in Ontario: New Public Policy and Public Administration Techniques

By Fenn, W. Michael | Canadian Public Administration, Winter 2006 | Go to article overview

Reinvigorating Publicly Funded Medicare in Ontario: New Public Policy and Public Administration Techniques


Fenn, W. Michael, Canadian Public Administration


When elected in 2003, the new Ontario government faced a daunting health care reform agenda and a major fiscal and bureaucratic repositioning agenda, and both agendas were on an accelerated timetable. In response, the Ontario public service established a new mechanism both for developing and approving health care policy initiatives, and for implementing those initiatives once adopted. The health care reform agenda in Ontario was--and is--wide-ranging: from primary care and drug programs, to improved system performance (shorter wait rimes for key medical procedures) and institutional realignment. This experimental new mechanism--the Premier's Health Results Team (HRT)--appears to have achieved solid results and the Ontario health care system is showing signs of being on the road to recovery. The experience of the HRT also points to a potential cure for another persistent failing of public service reform efforts in a parliamentary system. The HRT model suggests a mechanism to enlist the increasingly important broader public sector in governments' own reform efforts, by using leverage within that wider system (human resources, technological, information, and finance) to enable the system to reform itself.

The symptoms

The evidence ... shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care ...

... For many years, the government has failed to act; the situation continues to deteriorate ... While the government has the power to decide what measures it will adopt, it cannot choose to do nothing. (1)

Who makes such incendiary comments about the lack of efficiency, integration and client satisfaction with Canadian health care services? Were they special interest advocates lobbying for even more money for health care personnel and institutions, or right-wing proponents of two-tiered medicare, or the provocative editorial gibes of a metropolitan newspaper? No, these were the views of the justices of the Supreme Court of Canada in the significant Chaoulli case, also speaking--some might suggest--as typical middle-aged Canadians and potential patients.

The diagnosis

The malaise was born, at least in part, of institutional and political neglect, heading for the political perfect storm. What were the symptoms?

--Demanding baby-boomers, who had driven public policy since the Second World War, were becoming grandparents and care-givers for elderly parents. As consumers and voters, they increasingly recognized the physiological evidence of their own impending demands on the health care system.

--The cost of remarkable new pharmaceuticals, prostheses, and medical technologies was rising exponentially, fuelled by barely sustainable government and employer drug plans.

--Direct and indirect employment in health care had become one of the largest and least fiscally constrained elements of the public sector.

With nearly half the Ontario budget devoted to health care, health expenditures were also threatening to crowd out many important social, environmental, and economic priorities. While Canadian medicare was a near-term economic advantage-in a North American context, unconstrained growth in health care costs would ultimately undermine economic performance and global competitiveness, as it was already doing in the United States.

The accumulating pressures in the system had been referred to journalistically as an "impending tsunami." One might therefore have expected at some point to have seen more urgent, focused, and collaborative action from all those within the health care system, including the governments ultimately accountable for that system. One might have anticipated a single-minded concentration on improved operational efficiency, population wellness, reduced overhead, and clinical integration. Other segments of society, and other jurisdictions, had already met the modern challenge of the demanding customer, responding with increased productivity, cost-reduction, and better use of information technology. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Reinvigorating Publicly Funded Medicare in Ontario: New Public Policy and Public Administration Techniques
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.