Aleksandar Džakula discusses how changes in the population, social structure, and socioeconomic conditions affect changes in the health care system; how changes in the setting affect the health behavior of citizens; what primary health care and community health means today; and how we can learn from different concepts of modern healthcare in which we strive for hospitals without walls, integrated care, community health, etc.

The United Kingdom and the United States experienced some of the world’s highest COVID-19 death rates, and are the two countries that are most frequently compared with Canada in health systems and policy studies. In this NAO Lecture, two experts – Lynn Unruh and Gemma Williams – who have been involved in tracking the range of policy and system responses to COVID in their jurisdictions will provide insights into what went on and why. We will consider what lessons we may learn from the COVID-19 policy responses taken in these two countries, including mistakes to avoid, and challenges to prepare for as we continue to deal with the direct and indirect consequences of the global pandemic.

Following the rapid development of effective COVID-19 vaccines, countries are now facing the challenge of rapidly rolling out vaccination programs to immunize the population and restore as much of normal life as quickly as possible. The example of Israel is often presented as the model for early rollout of COVID-19 vaccinations but what were the specific factors contributing to this early success? What was the contribution of existing infrastructure, organizational and health workforce capacities?

Ruth highlights three factors that have implications for the long run: availability, provision, and compliance. What are the lessons and concerns for the long run? How might Canada use this experience when swiftly scaling up its vaccination program?

Ruth Waitzberg

Researcher, Department of Healthcare Management at the Technical University of Berlin and the  European Observatory on Health Systems and Policies
Researcher Scholar – Health Policy Team, the Myers-JDC-Brookdale Institute

European Commission-funded HealthPros doctoral fellow, Erica Barbazza, presented preliminary findings of a study exploring the current and potential use of primary health care EMR data for performance measurement across Canadian jurisdictions. The study – conducted in collaboration with the Canadian Institute for Health Information, University of Toronto and the HealthPros network – investigates current use cases of EMR data identified following a pan-Canadian scan and contextual considerations enabling quality of care uses of EMR data. Erica summarizes key findings around the use cases explored and potential insights for jurisdictions at varied stages in optimizing EMR data for performance measurement, and discusses the implications of these findings for the information needs arising due to the COVID-19 pandemic.

Erica Barbazza

HealthPros fellow based at the Academic Medical Centre of the University of Amsterdam

We were fortunate to have Neil Seeman shed valuable insight on the little studied but crucial element of overlooked public perception as it relates to the pandemic. Founder and CEO of RIWI (Realtime Interactive Worldwide Intelligence) Corp, a global trend tracking, risk monitoring and prediction technology firm, Seeman is an expert in identifying and tracking “quiet voices”, or people who are otherwise not heard from, who are disinclined to share their opinions through surveys and other means. Using a range of sophisticated and highly rigorous online information-gathering techniques, Seeman’s talk explored experiences of these quiet voices regarding various aspects of the COVID-19 pandemic, such as attitudes to hygiene and social distancing protocols, and trust In public health initiatives. Our thanks to Neil for this engaging webinar lecture, and for so quickly tailoring his presentation to the COVID-19 crisis.

Neil Seeman

Founder and Chief Executive Officer, RIWI Corp.

Co-hosted by the Office of Global Public Health Education & Training

Peter discusses what universal health coverage means in a global context, how it has been interpreted and measured, what we are learning from recent measurements, and what are the challenges facing us towards the 2030 targets.

Peter Berman

Professor and Director, School of Population and Public Health, University of British Columbia
Adjunct Professor, Harvard T. H. Chan School of Public Health, Harvard University

The NAO and IHPME are delighted to partner with the European Commission, Canadian Institute for Health Information and the Amsterdam University Medical Centre to host two visiting PhD students as part of the HealthPros training program. In this NAO Lecture, Damir Ivankovic and Mircha Poldrugovac discuss this unique training program, and the two empirical studies they are leading while in Toronto.

About HealthPros

HealthPros is a Marie Sklodowska-Curie Innovative Training Network for Healthcare Performance Intelligence Professionals, running from January 2018 – 2022. HealthPros trains 13 PhD candidates (HealthPros fellows) to become the first generation of Healthcare Performance Intelligence Professionals. They are trained to make effective use of available healthcare performance data in countries to improve integrated service delivery, patient engagement, equality in access to healthcare, health outcomes, and reduce waste in healthcare. Through innovative research, HealthPros is developing tools and implementing methods to streamline healthcare performance measurement, the development and application of performance-based governance mechanisms and effective use of Healthcare Performance Intelligence by different end-users to match the different health care systems in the Netherlands, Denmark, Germany, UK, Italy, Hungary and Canada, and support the transferability of the tools and methods to other countries.

Damir Ivankovic

PhD Fellow/MD Researcher of the HealthPros Project

Mircha Poldrugovac

PhD Fellow of the HealthPros Project

Co-hosted by the Centre for Sustainable Health Systems

The hanging burden of disease requires health system to focus on promoting population health alongside their established role in treating illness. All parts of the health system must contribute by using resources more effectively and by recognizing the role of health systems as anchor institutions in their communities. Health systems also have a contribution to make in building partnerships for improving health with local governments, people and communities. This lecture will illustrate how this is being done in some jurisdictions and set out the challenges facing health system leaders in ‘turning around the oil tanker’.

Sir Chris Ham

Independent Chair, Coventry and Warwickshire STP, non-executive Director, Royal Free London, NHS Foundation Trust, Co-Chair of the NHS Assembly and Visiting Senior Fellow at The King’s Fund

Co-hosted by the Office of Global Public Health Education & Training

Situated within the context of the Sustainable Development Goals and the Astana Declaration on Primary Health Care (PHC), Aylene discusses the political, structural and organizational dimensions of PHC in different regions of Brazil.

Aylene Bousquat

Professor, School of Public Health, University of São Paulo, Brazil

As many Canadian health policy researchers have noted, the veto power of the provincial medical associations constitutes a substantial constraint on what Canadian governments can and cannot do in health policy. So, imagine a very similar system in which this constraint is absent. In New Zealand, organized medicine has not traditionally played a strong formal role in health policy processes. There are many recent examples of major policy change in New Zealand in which organized medicine did not play a large role in formulation, and could not block the features of the policy that may have adverse implications for their constituents. In this context, it is worth asking whether New Zealand has had any more success in advancing health policy projects such as primary care reform that may be unsettling for medical interests.

In this seminar, Tenbensel explores the story of New Zealand’s primary care reforms since 2001 – its successes and its unfulfilled expectations, its effects on medical and other health professions, and the lessons from this experience that may be applicable to other jurisdictions. The New Zealand primary health care reform story is one that clearly demonstrates the importance of implementation processes, and the need for policymakers to understand what work is necessary after policy decisions are made.

Tim Tenbensel 

Associate Professor, School of Population Health, University of Auckland

Stephen Peckham discusses the impact and changes of the QOF in the United Kingdom focusing on some of the recent changes and future proposals for the use of incentive payments and shared savings schemes in England.

Stephen Peckham

Professor of Health Policy and Director of the Centre for Health Services Studies, University of Kent
Professor of Health Policy, London School of Hygiene and Tropical Medicine

Chris Ham, former Chief Executive of The King’s Fund speaks to the role of the UK Think Tank, outlining how they led the debate on integrated care and population health, influenced policy makers at a national level and locally, and then worked to support implementation. How do we go beyond influencing policy to ‘making it happen’ helping practically in the development of leaders and systems?

Sir Chris Ham

Independent Chair, Coventry and Warwickshire STP, non-executive Director, Royal Free London, NHS Foundation Trust, Co-Chair of the NHS Assembly and Visiting Senior Fellow at The King’s Fund

Taiwan’s National Health Insurance is a single payer system established in 1995. At its planning stage in the late 1980s it had looked to Canada, among other nations, for insights on how to implement a universal health coverage scheme. Insurance coverage in Taiwan is universal and the system has been able to maintain overall health spending as a percent of GDP that is considerably lower than the average for OECD nations, and at the same time meet the health care needs of its population without the often seen challenges to single payer systems such as long waiting times. The presentation discusses how Taiwan’s single-payer health system works, what are its strengths and weaknesses, and challenges going forward. Where possible, some comparisons with Canada’s health system are included.

Tsung-Mei Cheng

Health Policy Research Analyst at the Woodrow Wilson School of Public and International Affairs, Princeton University

Many Americans face a daunting number of health insurance options and nearly all evidence indicates that they are not able to make choices that are in their best interests. Behavioral economics posits that limiting choices and simplifying information can improve consumer welfare. Evidence from some recent experiments are presented by Thomas Rice.

Thomas Rice

Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health
Associate Director (United States) of the NAO

The seminar provides insights on past, present and future work that the Management and Health laboratory of Sant’Anna School of Pisa has been carrying out since 2004. Sabina Nuti presents the results of the longstanding constructive research on performance evaluation systems (PES) in healthcare in Italy. In particular, she discusses the power of benchmarking, of the visualization tools and how the PES has been used across the Italian Regions. Moreover, she presents the results achieved and the governance tools adopted to improve the regional and organizational performance.

Sabina Nuti

Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health

Why is it so hard to know whether decentralization is a good policy for health systems? Many observers have made unsubstantiated claims for decentralization and federalism in part because there are many different ways to design and implement decentralization and federal policies. It is also very difficult to evaluate the impact of these policies because of the importance of different contexts and of simultaneous policies of funding, payment and service delivery changes in the health sector. We have applied a consistent approach, called “decision space”, to show the complex arrangements of decentralization and federal policies in 8 different countries and begin the process of evaluation in the hopes of providing recommendations for policy makers.

Thomas J. Bossert

Senior Lecturer and the Director of the International Health Systems Program of the Harvard T. H. Chan School of Public Health

Canada is the only country with a broad public health system that does not include pharmaceuticals. This talk considers Canadian pharmaceutical insurance policy in comparison to England and Australia, providing a historical explanation for the different paths of policy development in these three liberal welfare states. Katherine Boothe summarizes their current differences in pharmaceutical policy, and reflects on the ways our ability to “learn from abroad” is enhanced by an understanding of the historical contexts in which health policies develop.

Katherine Boothe

Associate Professor, Department of Political Science, McMaster University
Member, Centre for Health Economics and Policy Analysis

Related Publications

• Ideas and the Pace of Change: National Pharmaceutical Insurance in Canada, Australia, and the United Kingdom (2015)

Most Mexicans have gained access to a guaranteed health care package delivered through improved, pro-poor strategies. However, the health system remains segmented and inequitable, while centralization, inefficiency and even corruption limit funding and provision. In his talk, Miguel González Block addresses the progress and challenges facing universal access to needed health interventions, free at the point of service. Governance will be discussed as the biggest challenge to enable the transition from the current president-centered, segmented and vertically integrated set of social security and assistance institutions, towards person-centered, plural health funding and provider networks.

Miguel Angel González-Block

Director, EviSys Consulting
PwC Chair in Health Systems Research, Anahuac University
Associate Director (Mexico), NAO

U.S. Senator Bernie Sanders (Vermont) discusses “Medicare for All” in a lecture sponsored by the North American Observatory on Health Systems and Policies and the Dalla Lana School of Public Health. He was joined by Dr. Danielle Martin of Women’s College Hospital and the University of Toronto to discuss what the U.S. can learn from Canada’s single-payer health care system.

Australia and Canada have many similarities in health policy, starting with some of the main features of each country’s Medicare system. The workings of private health insurance provide a striking area of contrast. Australia has a duplicate system, in which private health insurance covers most of the services provided by public hospitals, constructing a parallel private system. Canada has kept the public and private separate. This talk explores the different ways private funding works in each system and the consequences for equity, quality and access.

James Gillespie

Associate Professor, School of Public Health, University of Sydney
Deputy Director, Menzies Centre for Health Policy, University of Sydney

In the 17 years since the World Health Report 2000, which controversially proposed measures of performance of 193 health systems worldwide, there have been enormous advances in the information available on health and disease worldwide, led by the Global Burden of Disease project. In this talk, Martin McKee presents new findings from the project, which have employed the concept of avoidable mortality and linked it to these new sources of data. He discusses both the remaining challenges and the implications of these findings to researchers and policy decision-makers.

Martin McKee

Professor, London School of Hygiene and Tropical Medicine
Research Director, European Observatory on Health Systems and Policy

Resources

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015. Barber, Ryan M et al. The Lancet, Volume 390, Issue 10091, 231 – 266

While provincial medicare policies currently discourage dual practices, these policies are under judicial review in the Cambie Surgeries case in British Columbia. This is an ideal time to review the origin and impact of these policies from a more international and comparative perspective.

Placing the regulation of dual practice in a health systems conceptual framework, Greg Marchildon and Bruce Rosen compare Canada and Israel. Although facing similar problems, the polities within these countries have developed different approaches to regulating dual practice in the public interest that provide useful policy lessons for each.

Bruce Rosen

Director, Smokler Center for Health Policy Research at Myers-JDC-Brookdale Institute
Co-editor, Israel Journal of Health Policy Research

Greg Marchildon

Ontario Research Chair in Health Policy and System Design at IHPME
Founding Director, North American Observatory on Health Systems and Policies