The Big Swing: Reforming Governance Authorities in Canadian Health Systems.

Global health governance and the World Bank

Collaborative Commissioning: regional funding models to support value‐based care in New South Wales

Due to the pandemic situation caused by COVID-19 disease, there have been tremendous efforts worldwide to keep the spread of the virus under control and protect the functioning of health systems. Although governments take many actions in fighting this pandemic, it is well known that health systems play an undeniable role in this fight. This study aimed to investigate the role of health systems and government responses in fighting COVID-19. By purposively sampling Finland, Denmark, the UK, and Italy and analyzing their health systems’ performances, governments’ stringency indexes, and COVID-19 spread variables, this study showed that high-performing health systems were the main power of states in managing pandemic environments. This study also measured relations between short and medium-term measures and COVID-19 case and death numbers in all study countries. It showed that medium-term measures had significant effects on death numbers.

A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.

Offline: Uncivil society

Health systems in an emerging economy, specifically Sub-Saharan Africa (SSA) are characterized as fragile with low implementation of Universal Health Coverage. While acknowledging that the cause of the inadequacy in emerging economies is multi-factorial, other arguments are that the root cause is inadequate political and technical leadership. Evidence reveals that visionary, imaginative, decisive, responsible, and responsive leadership is insufficient to persuade all stakeholders in low-income nations in Sub-Saharan Africa to work together to attain the constructive goal of universal coverage. On the contrary, other academics suggest that successful leadership would establish a clear national vision for universal coverage and a commitment to achieving that objective over time. These contrasting observations motivated an interrogation of the link between health system governance and Universal Health Coverage in an emerging economy taking evidence from the PHSSA programme. Through a meta-analysis of the existing literature as well as analysis of the findings from the programme, the paper explores experiences, critical success factors and recommendations for improvement of UHC through institutionalizing health system governance in an emerging economy. The research provides evidence that the governance linkages in health systems and the outcomes they produce are contingent rather than assured, due to the variety and complexity inherent in the health system governance paradigm. The situation-specific setting of a country's health system determines what can be accomplished through health governance strategy design and implementation efforts. The paper recommends a need to create a conducive environment for adoption of health systems programmes by contextualizing health governance with regard to the larger set of governance institutions that surround it. A competency framework should also be adopted in recruitment of competent health managers. The study also recommends a need for the countries in seeking to institutionalize health system governance to develop and support an organizational structure and context that sustains leadership practices through advocacy, create an enabling environment for health systems leadership, management and governance through the development of ethics and other competences specific to universal health care situations as well as provide proper financial support system so that institutionalization of leadership, management and governance can have maximum impact on the effectiveness and efficiency of health systems. There is also a need to institutionalize short courses, seminars and conferences in health leadership, management, and governance so as to entrench participatory leadership in health systems.

The WHO AFRO Regional Director candidates

BackgroundDiscriminatorypolicies, attitudes, and practices have had deleterious impacts on the health of Black, Indigenous, and other racialized groups. The aim of this study was to investigate racism as barrier to access to medicines in Canada. The study investigated the characteristics of structural racism and implicit biases that affect medicines access.MethodsA scoping review using the STARLITE literature retrieval approach and analysis of census tract data in Toronto, Ontario, Canada, were undertaken. Government documents, peer-reviewed articles from public policy, health, pharmacy, social sciences, and gray literature were reviewed.ResultsStructural racism that created barriers to access to medicines and vaccines was identified in policy, law, resource allocation, and jurisdictional governance. Institutional barriers included health care providers’ implicit biases about racialized groups, immigration status, and language. Pharmacy deserts in racialized communities represented a geographic barrier to access.ConclusionRacism corrupts and impedes equitable allocation and access to medicine in Canada. Redefining racism as a form of corruption would obligate societal institutions to investigate and address racism within the context of the law as opposed to normative policy. Public health policy, health systems, and governance reform would remove identified barriers to medicines, vaccines, and pharmaceutical services by racialized groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-023-01598-2.

BackgroundLiving donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT.ObjectiveOur objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces.MethodsThis research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question.ResultsThis project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023.ConclusionsBy investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT.International Registered Report Identifier (IRRID)DERR1-10.2196/44172

BackgroundThere are a range of perceived gaps and shortcomings in the publicly funded Canadian health system. These include wait times for care, lack of public insurance coverage for dental care and pharmaceuticals, and difficulties accessing specialist care. Medical crowdfunding is a response to these gaps where individuals raise funds from their social networks to address health-related needs.ObjectiveThis study aimed to investigate the potential of crowdfunding data to better understand what health-related needs individuals are using crowdfunding for, how these needs compare with the existing commentary on health system deficiencies, and the advantages and limitations of using crowdfunding campaigns to enhance or augment our understanding of perceived health system deficiencies.MethodsCrowdfunding campaigns were scraped from the GoFundMe website. These campaigns were then limited to those originating in the metropolitan Vancouver region of two health authorities during 2018. These campaigns were then further limited to those raising funds to allow the treatment of a medical problem or related to needs arising from ill health. These campaigns were then reviewed to identify the underlying health issue and motivation for pursuing crowdfunding.ResultsWe identified 423 campaigns for health-related needs. These campaigns requested CAD $8,715,806 (US $6,088,078) in funding and were pledged CAD $3,477,384 (US $2,428,987) from 27,773 donors. The most common underlying medical condition for campaign recipients was cancer, followed by traumatic injuries from collisions and brain injury and stroke. By far, the most common factor of motivation for crowdfunding was seeking financial support for wages lost because of illness (232/684, 33.9%). Some campaigns (65/684, 9.5%) sought help with purchasing medical equipment and supplies; 8.2% (56/684) sought to fund complementary, alternative, or unproven treatments including experimental interventions; 7.2% (49/684) sought financial support to cover travel-related costs, including in-province and out-of-province (49/684, 7.2%) travel; and 6.3% (43/684) campaigns sought help to pay for medication.ConclusionsThis analysis demonstrates the potential of crowdfunding data to present timely and context-specific user-created insights into the perceived health-related financial needs of some Canadians. Although the literature on perceived limitations of the Canadian health system focuses on wait times for care and limited access to specialist services, among other issues, these campaigners were much more motivated by gaps in the wider social system such as costs related to unpaid time off work and travel to access care. Our findings demonstrate spatial differences in the underlying medical problems, motivations for crowdfunding, and success using crowdfunding that warrants additional attention. These differences may support established concerns that medical crowdfunding is most commonly used by individuals from relatively privileged socioeconomic backgrounds. We encourage the development of new resources to harness the power of crowdfunding data as a supplementary source of information for Canadian health system stakeholders.

BackgroundssssHealth system performance is a multifaceted concept that encompasses various dimensions of a nation’s healthcare infrastructure. This study aims to assess and rank the performance of health systems across different regions of the world.MethodologyWe employed the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method in 2023 to evaluate and rank the health system performance of 31 countries across six geographical regions. Our evaluation included six general categories and twelve indicators related to health, finance, and the COVID-19 pandemic. The final weights for these indicators were determined using the Three-scale method and the Entropy-weighting method. Additionally, we categorized health system performance into three groups: high, moderate, and low. Hierarchical clustering of health system performance scores was conducted using SPSS software (version 26).ResultsLuxembourg emerged as the only high-performing health system, while Qatar and the Netherlands fell into the moderate-performance group. Other countries exhibited low-performing health systems. Notably, within the low-performance group, the United States of America, Australia, Singapore, Canada, England, and Germany achieved relatively better rankings. Conversely, Yemen, Egypt, Afghanistan, and Bolivia ranked lowest in terms of health system performance.ConclusionContrary to the assumption that higher health spending guarantees improved performance, the experience of COVID-19 among high-income countries revealed mixed results. Strengthening resilience, investing in public health systems, and ensuring sustainable financial resources are crucial for enhancing health system performance.

Health Systems Need to Transform Data Collection to Advance Health Equity.

The Canadian and Australian health systems have evolved in very similar ways. Recent policy changes in each country, however, suggest a growing divergence with respect to governance. This paper traces the origins and key milestones in the evolution of governance models, with a selective focus on two provinces in Canada (Saskatchewan and Alberta) and the state of New South Wales in Australia. While divergent models seem to be manifesting, many similar underlying features remain. We assess these developments and comment on the current patterns of organization and governance, both to provide insights on future directions and to suggest what the two countries might learn from each other.

ssssHealth system performance is a multifaceted concept that encompasses various dimensions of a nation's healthcare infrastructure. This study aims to assess and rank the performance of health systems across different regions of the world. We employed the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method in 2023 to evaluate and rank the health system performance of 31 countries across six geographical regions. Our evaluation included six general categories and twelve indicators related to health, finance, and the COVID-19 pandemic. The final weights for these indicators were determined using the Three-scale method and the Entropy-weighting method. Additionally, we categorized health system performance into three groups: high, moderate, and low. Hierarchical clustering of health system performance scores was conducted using SPSS software (version 26). Luxembourg emerged as the only high-performing health system, while Qatar and the Netherlands fell into the moderate-performance group. Other countries exhibited low-performing health systems. Notably, within the low-performance group, the United States of America, Australia, Singapore, Canada, England, and Germany achieved relatively better rankings. Conversely, Yemen, Egypt, Afghanistan, and Bolivia ranked lowest in terms of health system performance. Contrary to the assumption that higher health spending guarantees improved performance, the experience of COVID-19 among high-income countries revealed mixed results. Strengthening resilience, investing in public health systems, and ensuring sustainable financial resources are crucial for enhancing health system performance.

BackgroundDespite having a high healthcare need, persons with complex conditions are less likely to receive comprehensive care. Individuals with SCI experience difficulties accessing services 2-4 times more than the general population. There is little agreement concerning the factors that influence these access restrictions. Few studies focus on health system impact on characteristics on access.ObjectiveTo outline barriers and facilitators to service access among persons with SCI across 22 countries in terms of health system characteristicsMethodsInSCI(2017): 1st community survey on experience of persons with SCI, 12591 participants, 22 countries (Australia, Brazil, China, France, Germany, Greece, Indonesia, Italy, Japan, Lithuania, Malaysia, Morocco, the Netherlands, Norway, Poland, Romania, South Africa, South Korea, Spain, Switzerland, Thailand, USA).Data analysis1. Hierarchical cluster analysis based on Gower distance (to group systems by access restrictions: Acceptability, Approachability, Availability, Affordability, Appropriateness).2. Generalized linear mixed-effects decision tree (to explore the association of system characteristics and access, including WHO and OECD system indicators (e.g. UHC index, expenditure, human resources). Missing values were imputed with missforest.Results12% of persons with SCI reported having an access restriction, most of them (7%) with Availability. By country, the highest unmet needs were reported in Poland (25%), Germany, Lithuania, and Romania (13).1. Cluster analysis: 7 health systems clusters (groups) were identified.2. By June 2022, we will have the results of the second analysis: the association of system characteristics with access and how it is modified by socio-demographic and medical factors.Expected conclusionsThe study identifies factors a country could modify in order to improve access and strengthen the system for persons with SCI/disability, that might be relevant to general population as well.Key messages• Persons with SCI often experience similar access restrictions across countries, incl. those with high-performing health systems. System strengthening in this area is further required in all countries.• Health systems are fragmented, e.g. healthcare quality and access inside a country differs by region, urban/rural setting etc., hence, the systems are challenging to classify.