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on Health Systems and Policies

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Comparing health systems across North America: Learning from reforms to expand coverage, improve quality and recover from COVID-19

The NAO’s trademark wide-perspective and comparative approach to health system analysis is on full display in this joint talk by NAO Director Sara Allin and NAO Associate Directors Miguel González-Block and Tom Rice as part of UC Davis Health Services Research Seminar Series.

Book Launch: Understanding the Boundaries of Medicare and the Canada Health Act

While almost all universal health coverage in Canada is provided under the Canada Health Act, there is Medicare-like coverage that is provided outside of the act. Based on a newly published book, this presentation explores health care services and coverage arrangements that predate or have developed alongside the Canada Health Act. There are parallel arrangements for workers’ compensation beneficiaries, military personnel, inmates in federal prisons, and certain classes of migrants. There are also border-spanning services for Indigenous health, one of the least understood areas. Finally, the dramatic increase in virtual health care services since the onset of the COVID-19 pandemic and their relationship to the Canada Health Act is examined.

The Boundaries of Medicare: Public Health Care Beyond the Canada Health Act is co-authored by Katherine Fierlbeck (Dalhousie University) and Gregory P. Marchildon and is published by McGill-Queen’s University Press.

Longwoods Leadership Discussion: Health System Sustainability and Resilience

Panelists discuss the response of Canada’s healthcare system to the pandemic, and considers the path forward to build a more resilient and sustainable health system in the face of long-term stresses. This discussion emerges out of the NAO’s report with the London School of Economics’ Partnership for Health System Sustainability and Resilience (PHSSR) that provides a comprehensive assessment of Canada’s health system as it relates to issues of sustainability and resilience.

Trouver un équilibre entre la décentralisation et la centralisation dans les systèmes de santé publique

Ce webinaire s’inscrivait dans le cadre d’un projet de recherche intitulé Platform to Monitor the Performance of Public Health Systems dirigé par Sara Allin, Andrew Pinto et Laura Rosella de l’Université de Toronto qui vise à comparer et à apprendre des variations des systèmes de santé publique entre les provinces et territoires du Canada. Le CCNPPS s’est joint au groupe de travail du projet de recherche dans les premiers mois de la pandémie de COVID-19.

Striking a Balance Between Decentralization and Centralization in Public Health Systems

This webinar, hosted by the National Collaborating Centre for Healthy Public Policy (NCCHPP), is part of a research project called Platform to Monitor the Performance of Public Health Systems, led by Sara Allin, Andrew Pinto, and Laura Rosella from the University of Toronto, and aimed at comparing and learning from variations in public health systems across Canadian provinces and territories.

Comparative Study Abroad Program in London, England

The Comparative Study Abroad Program is an exciting study abroad program offered next year in London, England. Co-led by Dr. Allie Peckham and Dr. Barret Michalec, Director of the Center for Advancing Interprofessional Practice, Education and Research, this program offers health policy students the enviable chance to study in one of the world’s most amazing cities. Over three weeks (June 6 – 27, 2022), students learn not just the fundamentals of the US, Canadian, and UK health systems, but in an immersive socio-historical and cultural perspective. This program is supported through ASU’s Global Education Office. Non-ASU students are welcome to apply too!

Come explore the vibrant and cosmopolitan global center while applying knowledge through outstanding and engaging cultural excursions and experiences.

Mexico Health Systems in Transition (HiT) Book Launch

To mark NAO’s newest Health Systems in Transition (HiT) publication, the authors and founding director Greg Marchildon gave a public virtual presentation at the Seminario Institucional in Mexico City. The new volume on Mexico completes the North American trilogy, accompanying Canada (3rd ed) and the USA (2nd ed). Dr. Marchildon discussed the project’s origins in the European Observatory on Health Systems and Policies HiT series, which relies on a rigorous template to define and structure the information to allow for insightful comparison across jurisdictions. The aim of these studies is to both document and conceptualize the various national and subnational components of a country’s health system, as well as to facilitate in-depth assessments of their governance, accessibility, financing, quality, outcomes, and efficiency. Dr. Marchildon expressed gratitude for the years of effort and leadership from NAO Associate Director (Mexico) Dr. Miguel Á. González Block and his co-authors, Hortensia Reyes Morales, Lucero Cahuana Hurtado, Alejandra Balandrán, and Edna Méndez.

COVID-19 in Norway: Timeline and Response

Professor Torbjørn Wisløff provided an overview of Norway’s response to the Covid-19 pandemic. Professor Wisløff noted that Norway has weathered the pandemic better than most jurisdictions, due to a mix of its relatively quick and strict initiatives, generally cooperative population, low population density, and good fortune. However, there were also some challenges and mistakes related to travel and health recommendations (e.g., the use of masks). There is also some inconsistency in public messaging across jurisdictions, which together with a perhaps over-abundance of information sources available to Norwegians, has caused some conflicting reports and confusion. The lecture was recorded for our NAO community and is available below.

Examining the Governance, Organization, and Financing of Public Health Across Canada

Dr. Sara Allin presented some preliminary findings about Canada’s health system as part of the Dalla Lana School of Public Health’s Collaborative Specialization in Public Health Policy program.

From the CIHR catalyst grant project that explores provincial/territorial public health systems and the impact of recent reforms and COVID-19, Dr. Allin provides an overview of the status and role of public health within health systems across Canada, and an outline of the ongoing multi-staged and multi-jurisdictional study into the role of public health initiatives in overall health outcomes. This work began prior to the pandemic and has shifted to examine public health’s role in Covid responses. She concludes her talk with preliminary findings related to the Ontario context, including emerging insights into what has worked, and what has not. Dr. Allin’s talk, including a spirited concluding discussion with attendees, is available below.

Transforming Health Systems Towards Universal Care

Ireland has devised a ten-year plan for health reform through political consensus, spearheaded by Steve Thomas, Director of the Centre of Health Policy and Management at Trinity College Dublin. This high-level policy roadmap will transform the country’s two-tier structure into a universal, needs-based healthcare system. The keynote and panel discussion explored the components of big bang policy change and system transformation — both in Ireland and Canada — including population health, entitlements, integrated care, funding and implementation.

Speaker Bio

Steve Thomas
Director, Centre of Health Policy and Management, Trinity College Dublin

Steve Thomas is the director of the Centre for Health Policy and Management at Trinity College Dublin. He has more than 60 peer-reviewed publications and has developed policies in Ireland including free general practice medical care for under-6s and over-70s. He has worked in international health economics research and government policy for more twenty years with long-term postings in South Africa, Bangladesh, and Uganda.

Panel Info

Dr. Rueben Devlin, Special Advisor Healthcare, Chair, Premier’s Council on Improving Healthcare and Ending Hallway Medicine

Carolyn Hughes Tuohy, Professor Emeritus of Political Science and Founding Fellow in Public Policy, Munk School of Global Affairs and Public Policy at the University of Toronto

Julie Drury, Patient and Family Advisor

Challenges of International Policy Learning, and Reflections on a Career in and out of Academia

This special lunch and learn with Ellen Nolte was co-hosted by the Health Systems Performance Research Network.

Speaker Bio

Professor of Health Services and Systems Research, London School of Hygiene & Tropical Medicine

Ellen Nolte is Professor of Health Services and Systems Research at the London School of Hygiene & Tropical Medicine. She holds a PhD from London University and a Master’s degree in public health (MPH). Her expertise is in health systems research, international health care comparisons and performance assessment. Over the past decade she has developed an internationally recognised research portfolio around innovative service models that seek to better meet the needs of people with complex and long-term health problems, with a particular focus on care coordination and integration within and across sectors. She has published widely on health systems, integrated care, European health policy and population health assessments both in the international peer-reviewed literature and the wider literature. Ellen was previously head of London Hubs of the European Observatory on Health Systems and Policies and Director of the Health and Healthcare Policy programme at RAND Europe, Cambridge, UK.

Leading Edge Options to Integrate Care

The Boehm Lectures on Public Health and Healthcare (formerly the Leadership Series) aim to foster a dialogue and engage the public health and health system communities on significant issues facing the health of Canadians.

This sold-out lecture explored options to transform health systems towards a greater focus on integration and person-centredness. It examined the evidence on the range of strategies to strengthen person-centred health services and systems and how available approaches can meet the various challenges health systems are facing today and to guide the development of more informed policies and practices.

Ellen Nolte

Professor of Health Services and Systems Research, London School of Hygiene & Tropical Medicine


  • Sarah Downey, President and CEO, Michael Garron Hospital
  • Kerry Kuluski, Assistant Professor, Institute of Health Policy, Management and Evaluation; Research Scientist, Bridgepoint Collaboratory for Research and Innovation
  • Graydon Smith, Mayor, Town of Bracebridge
  • Walter Wodchis, Professor, Institute of Health Policy, Management and Evaluation; Research Chair of Implementation and Evaluation Science, Trillium Health Partners’ Institute for Better Health

Federalism and Decentralization in Health Care: A Decision Space Approach

Even though health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, it explores vital health care issues such as constitutional responsibility, national laws, and the source and organization of public revenues.

Beyond these structural features, each country case system is subjected to a “decision space analysis” to determine the actual degree of decentralization. A core question is whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations.

North American Observatory on Health Systems and Policies (NAO) Launch Event

The North American Observatory on Health Systems and Policies (NAO) is a collaborative partnership of interested researchers, research organizations, governments, and health organizations promoting evidence-informed health system policy decision-making. Due to the high degree of health system decentralization in the United States and Canada, the NAO is committed to focusing considerable attention to state and provincial health systems and to creating a foundation for more systematic health system and policy comparisons among substates.


  • The Honourable Roy Romanow, Former Premier and Chair of the Royal Commission on the Future of Health Care in Canada; Chancellor, University of Saskatchewan
  • Dr. Bob Bell, Deputy Minister of Health and Long-Term Care, Ontario
  • Maureen O’Neil, President, Canadian Foundation for Healthcare Improvement
  • Dr. Richard Saltman, Professor, Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta; Associate Director of Research Policy, European Observatory on Health Systems and Policies, Brussels


  • Adalsteinn (Steini) Brown, Director of the Institute of Health Policy, Management and Evaluation (IHPME) at the University of Toronto
  • Greg Marchildon, Ontario Research Chair in Health Policy and System Design at IHPME and the Founding Director of the NAO