HealthcarePapers最新文献

Appropriate training data are a prerequisite for health AI tools. Policy makers, clinicians and patients can assess the datasets used to train AI models as a practical step in determining whom health AI tools are likely to benefit. Analyses of training datasets can help prioritize which health AI tools to validate and help identify where changes are needed to improve the equity of health AI.

Artificial intelligence (AI) deployed into healthcare settings is touted as an exciting approach for improving health equity. However, several issues need to be addressed before this could be achieved, including improving the collection and use of the social determinants of health data, enhancing data interoperability, closing the digital divide and conducting rigorous assessment and evaluation of AI applications to ensure that they achieve fair and equitable outcomes in real-world settings. Importantly, we should not neglect evidence-based strategies that will truly advance health equity, such as adequate housing, poverty reduction, accessible mental healthcare, food security and many other structural and social determinants of health.

The series of papers in this issue discusses artificial intelligence (AI) for healthcare in Canada, including key milestones and efforts, current trends and future needs for Canada to progress from being a leader in AI development to responsible and ethical AI adoption that advances the quintuple aim. Three key discussion themes to support this bridge include: datasets, generalizability and equity; efficiency and evaluation; and focusing on the system rather than the product. Partnerships and interdisciplinary teamwork are essential, and the commentaries highlight perspectives from patients, providers and educators. AI for healthcare poses immense potential for both benefit and harm, and Canada has the essential building blocks and shared values to start pushing the balance toward benefit and improve health and well-being across its diverse geography and populations.

In responding to the Canada Health Act reforms proposed in Medicare Makeover, our peers provide valuable insights and suggestions. We appreciate, for instance, underscoring complexities inherent in implementing our call for evidence-based processes to define publicly-funded services and concerns regarding variation in accessibility and coverage standards across Canada. While some responses advocate for greater federal direction, we argue that fractured accountabilities have contributed to current challenges. It is essential that reforms establish a clear line of accountability: the federal government must ensure provinces, territories and Indigenous governments implement transparent processes to set standards for reasonable access and coverage and, in turn, provincial, territorial and Indigenous governments must be accountable for delivering on those standards to their voters.

Should oral healthcare be part of Canada's universal healthcare system? If so, how? To effectively deal with oral healthcare within broader healthcare policy, we must first gain clarity on what comprehensiveness and access should mean for oral healthcare. To do this, we will need a fair process of deliberation to determine what Canadians think is a reasonable level of oral health and what oral healthcare services go alongside it, irrespective of how that ultimately becomes organized, financed and delivered.

The 40th anniversary of the Canada Health Act (CHA) (1985) comes at an auspicious time in healthcare history, having just experienced a major global pandemic that tested both the foundations and the flexibility of Canadian medicare. Several services suffered under the pressure of the pandemic, including mental health. Despite its historic position as a public or charitable service, mental health and addiction care has been pushed to the edges of our publicly funded health system. On this anniversary of the CHA, the author reflects on this historical trajectory by revisiting the origins of medicare and the impact of psychiatric deinstitutionalization.

A new book, by Greg Marchildon, of interest to all health system leaders, provides a riveting and detailed account of the origins of our health system by tracing the life and influence of arguably one of the greatest Canadians.

This commentary responds to Flood and Thomas (2025) by focusing on the often-overlooked principle of portability in the Canada Health Act (1985). It argues that Canada's healthcare system remains essentially the sum of its parts: provincial and territorial health plans, guided by similar values, adhering to principles that have financial strings attached and bound together by portability and the spirit of reciprocity. To strengthen this sense of shared purpose and responsibility, we need to allow space for the federal government to encourage such reciprocity and to find ways of allowing intergovernmental relationships between the provinces/territories to be enhanced.

The Canada Health Act (CHA) (1985) stands as a symbol of Canada's commitment to universal healthcare. However, there remain critical gaps that undermine the original vision of equity in healthcare. In this rejoinder to Flood and Thomas's (2025) analysis, we recommend a fundamental reinterpretation of the CHA to address persistent inequities. While the CHA has succeeded in removing financial barriers to medically necessary services, it has not fully achieved vertical or horizontal equity. A broader understanding of equity, extending beyond income, is necessary to address deeper, structural determinants of health. We provide theoretical reflections on equity and applied examples to advance our policy recommendations.

In "Medicare Makeover: Reimagining the Canada Health Act at 40," Flood and Thomas (2025) study access and comprehensiveness in the Canada Health Act (1985). They note a decline in timely access to care and advocate for the establishment of benchmarks for access, suggesting provinces should meet those standards in exchange for federal funding. They call for a re-evaluation of what constitutes "medically necessary" services, proposing a broader list of supports while ensuring equitable access regardless of financial status. Building on their recommendations, we argue for deeper systemic reform to Canadian medicare. Collaborative care models and decision making by local teams will enhance service delivery and outcomes. We also expand on the process for determining insured services, including a multi-government task force and public consultation. We suggest that proactive measures should be implemented immediately while advocating for a stronger legislative framework as proposed by Flood and Thomas to ensure the sustainability of Canadian medicare.