Healthcare Policy最新文献

This is a rejoinder to an article challenging the pharmaceutical industry's claims that Canada lags in access to innovative drugs due to substandard policies. This rejoinder is in agreement with the article's main argument that Canada succeeds in attracting the new drugs that matter most, and that higher prices or stronger intellectual property protection would have a negligible impact on the timing and degree to which new drugs are launched here generally. At the same time, the rejoinder does acknowledge the legitimacy of the industry's concerns around system inefficiencies stemming from federal-provincial fragmentation but posits that national pharmacare could resolve industry and payer concerns alike. The article calls for thoughtful reform, deeper research into unmet needs and a shift in focus toward patient-relevant outcomes.

Provincial healthcare systems are experiencing significant challenges in providing timely access to publicly funded healthcare. The population is aging, increasingly comorbid (Naik et al. 2024), immigration is high (Government of Canada 2024) and public investment in additional healthcare services has not kept pace (CIHI 2024). Meanwhile, challenges to publicly funded healthcare delivery continue to mount; private and for-profit providers are making significant inroads in some provinces and eroding equity of access (Quesnel-Vallée et al. 2020). Canadians are increasingly skeptical that public administration of healthcare is affordable, accessible, effective or efficient.

The COVID-19 pandemic disrupted access to clinical services, prompting an easing of restrictions on accessing care virtually. While virtual care can substantially differ from in-person care in most specialties, this is minimally true of psychiatry, making it ideal for examining the impact of virtual delivery on access. This paper shows that those already facing access barriers faced new ones during the pandemic. The findings - based on Canadian Institute for Health Information data - highlight disparities in mental healthcare access for low-income individuals, children and adolescents, seniors and rural communities. Moreover, increased access for more patients came at the expense of fewer services per patient.

The pharmaceutical industry and its allies often claim that various aspects of Canadian pharmaceutical policy result in new drugs not being introduced into the Canadian market. These arguments ignore international evidence that shows that only a minority of new drugs offer major therapeutic gains. A corollary to the industry's message is the threat that new drugs will not be made available if governments or regulatory agencies introduce measures that threaten the profits of pharmaceutical companies. The government should not be intimidated by these threats and should continue to take actions that increase accessibility to necessary medications for all residents of Canada.

Physician billing claims are used to inform health system planning and for other secondary purposes. In most provinces/territories, diagnoses are coded using a system adopted in 1979, the International Classification of Diseases version 9 (ICD-9). This study aimed to understand the perspectives of family physicians on updating ICD-9. Canadian family physicians completed an online patient vignette coding exercise and electronic survey to capture preferences on two newer coding systems (ICD-11; International Classification for Primary Care version 3 [ICPC-3]), compared with the current ICD-9 system. The focus of this paper is the survey data, which were analyzed descriptively. One hundred and sixty-one family physicians from six provinces participated. Over half of them (58%) stated that ICD-9 should be replaced, and 86% of them felt confident learning a new coding system. After the coding exercise, most participants reported that they were very or somewhat satisfied with both newer systems (77% for ICD-11; 73% for ICPC-3). Family physicians in our study support replacing the outdated ICD-9 system to better reflect their workload and patient complexity. This paper provides recommendations for provinces/territories considering modernizing physician billing requirements.

In his introduction to the translation into French of Max Weber's famous conferences on science and politics, Raymond Aron makes the insightful suggestion that public decisions must start with two distinct conjectures (Aron 1963: 11). One concerns the risks arising from policy action, or inaction, in a situation or context that is always unique and peculiar, and the other, the uncertainty attached to the results of the action. Greatly simplified, because a decision is rarely made by only one person, outside an institution and the constraints that follow, a decision maker's first order of business is to consider the many consequences that may stem from intervening (or not) to change a situation or solve a problem (Tong 1987). In parallel, the decision maker will want evidence that the measures that are considered can succeed, based on experience or by default, on some plausible "theory" of social action (Edenhofer and Kowarsch 2019).

The recent federal election highlighted an unfortunate fact: the national political parties were not able or willing to prioritize and champion the needed health reforms to be enacted by provinces. Each of the national parties offered few innovations beyond spending more money in the same way to buy access to family physicians.

People experiencing infertility often face challenges accessing treatment, such as in vitro fertilization (IVF), especially in contexts where treatments are not funded by government or public health insurance plans. Using an original survey, this paper examines barriers to accessing IVF in British Columbia (BC), a province that recently announced that it would start funding IVF, beginning in fiscal year 2025/26. The survey findings highlight the financial, geographic and personal barriers that limit access to treatment. BC's new publicly funded IVF program should address patient challenges related to upfront costs, regional variation in the unaffordability of treatment and existing research related to embryo transfer limits in other provinces.

The line between objective advice and advocacy may be blurred for health services and policy researchers who work closely with policy makers. Our study of 22 participants' perceptions of a five-part fictional scenario in which a researcher has increasing involvement with the ministry of health found extensive variation in what participants perceived to be objective advice or advocacy. Based on this variation, we believe that health services and policy researchers cannot completely avoid the risk of being perceived as issue advocates, whether by peers or by policy makers, and suggest some possible ways to mitigate risk.

This paper examines trends in the evolution of the primary care nurse practitioner (NP) workforce in Canada. Specifically, it focuses on two linear regression models. One, unsurprisingly, shows that the number of NPs per capita is positively correlated with the proportion of people declaring having an NP as their regular provider. The second shows that the proportion of patients without a regular provider in a province is very strongly correlated with the proportion of people declaring having an NP as their regular provider. In our view, this analysis supports the hypothesis that NPs are granted more autonomy only when access to care becomes critically constrained.