Rethinking the Federal Role in Health: Revisiting the 2015 Naylor Report on Healthcare Innovation.

In 2015, the Advisory Panel on Healthcare Innovation (APHI) highlighted shortcomings in Canada's healthcare systems, including weak integration, ineffective workforce planning and deployment, uneven infostructure and misaligned incentives. Progress in the last decade has been modest, underscoring both the challenges faced by provinces/territories in effecting top-down structural reforms and the limited yield from federal attempts to "buy change." APHI anticipated that outcome and argued for a new bottom-up model of collaborative catalysis, evaluation and scaling of effective innovations in healthcare. This model also facilitates the selective commercialization of novel Canadian goods and services and bears consideration given our healthcare crisis and weak innovation indices.

The Commission on the Future of Health Care in Canada (CFHCC) is to be congratulated for addressing the tension among various levels of government regarding health-care funding. The CTHCC also took the progressive step of creating the National Health Council, a body charged with ensuring greater accountability in health care. Psychologists have argued for decades that treatment decisions should be guided by a consideration of what works for whom and under what conditions. In our response to Romanow and Marchildon (2003), we argue that funding of health services in Canada has failed to heed this recommendation and the scientific evidence in support of the efficacy of psychological interventions for a wide range of health conditions. Despite remarkable advances in healthcare delivery, Canada's health-care system continues to be funded based on an outdated model of disease and illness. Romanow and Marchildon are to be applauded for their broad conceptualization of health and the role of various health professionals in advancing the health of Canadians. Unfortunately, this recognition did not make its way into the report of the CFHCC to the extent needed to make Canada's health system truly progressive. The Commission on the Future of Health Care in Canada (CFHCC) was a very important social policy initiative. It captured the attention of the public, the health-care sector and governments. The Commission faced formidable challenges with regard to both its objectives and time frame. The focus and attention given the Commission is in no small part an indication of the degree to which support their health-care system and the urgency they feel regarding its current state. Despite the challenges, the CFHCC produced a number of key recommendations that have begun to be implemented. The federal government has made a commitment to establish funding targets so as to ensure predictable and protected revenues for health. This represents a step toward ameliorating the chronic instability and underfunding for health care that has contributed to reduced access and deterioration in the quality of health services. Governance was also addressed through the CFHCC's prescriptions regarding the respective roles of federal and provincial health ministries and the establishment of a National Health Council. The Council has been formed and is expected to hold the health-care system accountable on spending, efficiency, and effectiveness. These are positive steps. The National Health Council in particular holds the promise of serving as a catalyst that can help to transform the way in which we conceptualize and approach health and health-care delivery in Canada. Reconceptualizing Health In describing the work of the CFHCC, Romanow and Marchilclon (2003) state that the extremely short time frame meant that the recommendations could not cover the entire waterfront of longer-term issties, including the role of psychology in the health of Canadians (p. 284). The need to consider the role of a given discipline in health-care delivery is outdated. For years scientific psychology has argued that treatment decisions, and by extension, funding decisions, should be based on a determination of what works for whom under what conditions. Canada's health-care system was built, and continues to revolve, around funding specific providers and services. All too often funding decisions are made independent of scientific evidence regarding efficacy. The exclusion, and more recently the elimination, of psychological services from universal health care is a case in point. To the detriment of Canadians, there exists an artificial chasm between physical and psychological health within Canada's health-care system. Yet, there is broad recognition within the scientific community that health is more than the absence of disease; it is a state of physical, mental, and social well-being (World Health Organization, WHO, 1948). …

J.B. Collip and the Development of Medical Research in Canada: Extracts and Enterprise. By Alison Li. McGill-Queen's/Associated Medical Services Studies in the History of Medicine, Health, and Society no. 18. Kingston: McGill-Queen's University Press, 2003. 256 pp. $55.00 (cloth) ISBN 9780773526099. Women, Health, and Nation: Canada and the United States since 1945. Ed. Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson. McGill-Queen's/ Associated Medical Services Studies in the History of Medicine, Health, and Society no. 16. Kingston: McGill-Queen's University Press, 2003. 448 pp. $80.00 (cloth) ISBN 9780773525009. $29.95 (paper) ISBN 9780773525016. An Element of Hope: Radium and the Response to Cancer in Canada, 1900-1940. By Charles Hayter. McGill-Queen's/Associated Medical Services Studies in the History of Medicine, Health and Society no. 22. Kingston: McGill-Queen's University Press, 2005. 288 pp. $70.00 (cloth) ISBN 9780773528697. The Struggle to Serve: A History of the Moncton Hospital, 1895-1953. By W.G. Godfrey. McGill-Queen's/Associated Medical Services Studies in the History of Medicine, Health, and Society no. 21. Kingston: McGill-Queen's University Press, 2004. 256 pp. $75.00 (cloth) ISBN 9780773525122. Nutrition Policy in Canada, 1870-1939. By Aleck Ostry. Vancouver: University of British Columbia Press, 2006. 160 pp. $85.00 (cloth) ISBN 9780774813273. $34.95 (paper) ISBN 9780774813280. Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives. 2nd ed. By James B. Waldram, D. Ann Herring, and T. Kue Young. 2006. Toronto: University of Toronto Press, 2006. 352 pp. $70.00 (cloth) ISBN 0802087922. $29.95 (paper) ISBN 0802085792. The social history of medicine in Canada is healthy and fit, judging by the new titles published in the past few years. Scholars have developed important new work that widens and deepens the historiography. Moreover, these new books also address the history of some of the most pressing health concerns today: medical research, transnational studies of women's health, cancer and its treatment, hospitals and health-care funding, diet and nutrition, and the history of Aboriginal health. Historians of medicine in Canada are fortunate to have solid publishing support from the partnership of McGill-Queen's University Press and Associated Medical Services (Hannah Institute) in their Studies in the History of Medicine, Health, and Society series, which published all but two of the titles under consideration. The Hannah Institute also provides generous research funding for students and scholars in the history of medicine. Such substantial assistance is rare for scholars in Canada and bodes well for the continued strength of the field. The books reviewed below all address the historic roots of contemporary health-care issues. Although historians are generally cautious about applying the lessons of the past to current concerns, they will agree that understanding something about how things came to be may indeed illuminate how things might be changed. Medical research in Canada today is a multi-million dollar enterprise, but its roots are humble. Alison Li's J.B. Collip and the Development of Medical Research in Canada charts this history by linking the major events in one man's career to the bigger story of the development of institutional research in Canada. Frederick Grant Banting and Charles Best, as the developers of insulin, are familiar to most Canadians, but the other member of the team, J.B. Bert Collip is not so well-known. Collip was the young biochemist who purified the extract and made the development of insulin possible. Alison Li's book is not so much the biography of a man as it is the story of a career that spanned the most important developments in medical research in Canada. Collip was one of the few who were able to earn a PhD in Canada at the University of Toronto before the First World War. …

Innovation in Health Care: Time for a Gut Check

Can Canada reckon with its health costs?

Current concerns over escalating health care costs and the sustainability of the Canadian health care system are based on analytical concepts and models that have their own limitations and deficiencies. Measuring health care costs across subsectors over the long-term period, the authors argue that Canada's health care costs, especially those under the direct control of provincial governments, are relatively stable. Using appropriate measures of sustainability, there is no indication that Canada's public health care expenditure is unsustainable. Nor is there any indication that Canada's public health care expenditures are out of line with those of its main trading competitors, including the United States.

While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada's health care system has emerged as a notable option. In the USA, meaningful discussion of the advantages and disadvantages of the Canadian system has been thwarted by ideological mudslinging on the part of large insurance companies seeking to preserve their ultra-profitable turf and backed by conservative political forces stirring up old fears of 'socialised medicine'. These distractions have relegated the possibility of a 'public option' to the legislative dustbin, leaving tens of millions of people to face uninsurance, under-insurance, bankruptcy and unnecessary death and suffering, even after passage of the Obama health plan. While South Africa appears to experience similar legislative paralysis, there remains room for reasoned health reform debate to address issues of equity, access, and financing. Our aim is to contribute to the debate from a Canadian perspective, setting out the basic principles of Medicare (Canada's health care system), reviewing its advantages and challenges, clarifying misunderstandings, and exploring its relevance to South Africa. We periodically refer to the USA because of the similarities to the South African situation, including its health care system, which mirrors South Africa's current position if left unchanged. While Medicare is neither flawless nor a model worthy of wholesale imitation, we contend that open discussion of Canada's experience is a useful component in South Africa's current policy and political efforts.

Canada's healthcare system faces a critical choice between two futures: "Cyborgville," driven by advanced medical technologies and AI, or a wellness-focused approach inspired by Blue Zones, which emphasize healthy lifestyles and environments. This commentary paper explores the benefits and challenges of each path. Blue Zones promote longevity through natural practices like plant-based diets and physical activity but face adaptation challenges in Canada's diverse climate and culture. Cyborg technologies offer cutting-edge healthcare but raise ethical concerns and high costs. Health informatics is key to both models, supporting personalized care, data-driven health interventions, and population management. A balanced, hybrid approach combining Blue Zone principles with technological advancements could provide a sustainable, equitable healthcare system, positioning Canada as a leader in global health innovation.

Canada has a history of innovative pilot projects that have failed to spread and scale to achieve transformative change in the organization and delivery of healthcare. Past experience suggests four essential dimensions of sustainability: funding, including incentives to adopt new working methods and longer-term program funding; strong policy guidance and/or legislation and regulation; sustained focus on addressing a particular problem or issue; and accountability for results. Had the Naylor Panel recommendations been implemented a decade ago, Canada's healthcare system would now be on a much stronger footing to confront today's challenges. The Naylor blueprint offers pertinent, practical solutions for issues such as improving access to primary care, improving digital health and contending with artificial intelligence.

Canada and the United States have much in common, including the world’s longest undefended border, but when it comes to health care, they have taken strikingly different paths in the last 40 years. The education and training of providers, including physicians and nurses, is similar, but major differences are seen in the organization and financing of health care. The net results of these differences are substantial and can be compared by examining specific measurements: costs, access, and health outcomes such as mortality, as well as less-easily quantified patient or provider satisfaction. I write from several perspectives; first, as a career academic neurologist and until 2003 Chair of a leading Canadian Department of Clinical Neurosciences, and now as Vice-President of Capital Health in Edmonton and Associate Dean Clinical Affairs at the University of Alberta. I have also lived, trained, and experienced the health care systems in the United States and England. The Canadian and American health care systems began to diverge in the late 1950s when Canada developed universal hospital insurance. Insurance for physician services was added a decade later. The overall system is guided by the Canada Health Act of 1984, which set out five principles: 1) public administration and payment; 2) comprehensiveness—must cover all medically necessary health services provided by hospitals and physicians; 3) universality—all insured services must be provided on “uniform terms and conditions,” to all citizens and residents; 4) portability—insured services must be paid for even if the patient is treated in another province; 5) accessibility—the plan must provide “reasonable access” to services and “reasonable compensation” to medical practitioners. This act defines Canadian “medicare,” a system where all citizens and residents are covered by the government for the direct costs of hospital and medical services, anywhere in the country. However, Canadians are not permitted to purchase “medically …

The Canadian health care system – known as “Medicare” or “Assurance-maladie” in Quebec – was created to ensure Canadians free access to health care services and medications. The health system is both publicly funded and administered. It has been built on five principles laid out in the Canada Health Act (1984); these are: Public Administration, Comprehensiveness, Universality, Portability, and Accessibility. In sum, the right to health has been at the organizational core of the Canadian health system. Provinces and territories administer and deliver most of the health services in Canada. This is done through provincial and territorial health insurance plans which are required to follow the national principles set out in the Canada Health Act. Since its creation, the Canadian health care system has undergone important changes and reforms. However, until a few years ago each major reform of the system retained the principles of justice and equity as core values. Quebec adopted the Health and Social Services Act in December 1971. The Quebec health care system was established with a mandate to maintain, improve, and restore the health and well-being of the entire Quebec population, making health and social services accessible to all. Health and social services in Quebec are administered jointly. This specificity, which has been adopted by other health care systems, has the advantage of allowing a comprehensive response to the health and social needs of the population. Since the 80s there has been a worldwide trend towards the privatization of public services. In order to describe developments in the Quebec health care system, we interviewed Dr Marie-Claude Goulet (M-CG), chair of the organization Médecins québécois pour le régime public (MQRP) [Quebec Physicians for a Public System] , an organization campaigning against the commercialization of health care in Quebec. The MQRP is an umbrella organization made up of various groups from Quebec province; it is part of the larger Canadian Doctors for Medicare (CDM) network. CDM was created in May of 2006 because of physician concerns about the trend towards privatization of the country’s health care services. As a member of ALAMES North America, I was interested in hearing the perspective of a Latin American working in the Quebec health care system. How did the experience of privatization in a Latin American country compare to what is currently taking place in Quebec? To this end I interviewed Dr Fernando Álvarez (FA), an Argentinian pediatrician who had worked in the Children’s Hospital in Buenos Aires. For the past 18 years he has been part of the Quebec health system and is currently head of Gastroenterology, Hepatology, and Nutrition services at Montreal University’s Sainte-Justine Hospital.

With increasing economic pressures, swaying public opinion and new government policies rationing health care resources, nurses in Canada are again challenging physicians for room to practice as nurse practitioners. Although the last Canadian nurse practitioner program was discontinued in 1983, and it was argued that the death of the role was inevitable in Canada's health care system, nurse practitioners have not vanished. Social plans in the United States are drawing heavily on the Canadian model of universal access and a government-funded health care system, and dramatic changes are taking place in Ontario's health care system. Now more than ever it is important that nurse practitioners understand Canada's health care system, why the NP role in Ontario has not been highly successful, and why the time is right for reintroduction of nurse practitioners into Ontario's health care system.

It has been 10 years since the Advisory Panel on Healthcare Innovation Report (Advisory Panel on Healthcare Innovation 2015) recommended patient engagement and empowerment as one action to enhance the quality and sustainability of healthcare in Canada. Since that time, patient engagement has become internationally recognized as a key component toward improving healthcare systems. In this article, the author highlights how organizations across Canada have engaged patients in healthcare and health research planning, design and governance activities, and discusses three key areas wherein improvements are needed to leverage the potential of patient engagement: leadership and infrastructure, diversity and representation and power structures/imbalances.

Romanow, Kirby and Courchene: Canada's Health System – a Moral or a Business Enterprise?

Federal Health Minister Rona Ambrose created the Advisory Panel on Healthcare Innovation, asking them to identify five priority innovation areas that would improve accessibility, quality of care and health spending. Their 2015 report found fragmented systems, a lack of collaboration across jurisdictions to share learnings and best practices and undercapitalized technological advancements, among other barriers to spreading successful innovation. Ten years later, we review the report's main recommendations and examine progress in the key areas identified for action. Progress on many of the recommendations is lacking. The panel's main recommendations - creation of a $1-billion innovation fund to enable sustainable changes in care delivery and a national healthcare innovation agency - have gone largely unanswered. We illustrate the need for an innovation agency that spans all provinces using several examples, including ones where digital health innovation is required, including central intake and triage for specialist referrals. We discuss the conditions needed for successful implementation: An interoperable digital solution, changes to models of care and funding flows, leadership and a patient-centred culture within the health system. We also highlight how local innovation hubs enable the development of new technologies and identify the key local, provincial and national factors for success that should be considered for a new federal agency.