Health Care: A Community Concern?

Developed within the context of the expansion of the Canadian welfare state in the years following the Great Depression, the present organization of Canadian health care delivery is now in serious need of reform. This book documents the causes and effects of changes made in this century to Canada's health care policy. Particular emphasis is placed on the decades following 1940, the years in which Canada moved away from an individualistic entrepreneurial medical care system, first toward a collectivist biomedical model and then to a social model for health care.

Table of Contents

Table of Contents
Health Care: A Community Concern? 1
Table of Contents 6
Charts and Lists 8
Executive Summary 10
Preface and Acknowledgments 14
Acronyms 20
Part I: Themes of the Book 24
1. An Explanation of the Approach 26
2. Canada's Publicly Financed Health Care System 30
3. The Welfare State in Canada 36
4. The Redistribution of Power Away from Local Communities and the Prospects for Its Return 42
Part II: The Context of Health Policy Development 48
5. Development of Canada's Welfare State Programs 50
6. From Welfare State to Welfare Society? 60
Part III: Canada's Publicly Financed Health Care System Evolves 68
7. Developing Federal and Provincial Organizations for Providing Collectivist Health Services 1948–66 70
8. Questioning Canadian Health Care Organizational Policies 1967–86 76
Part IV: Service Delivery Systems and Their Response to the Need for Change to a Collective Care Organization 86
9. Care in the Doctor's Office 88
10. Support Services for Physicians in General Practice 104
11. Medical Practice Organization: Alternative Medical Care Delivery Models 112
12. Evolution of Public Health Departments 140
13. Community Care for the Elderly 148
14. Rural Health Services 162
15. Four Preventive Care Programs 168
Part V: Developing Control by Formal Authorities 176
16. Developing Provincial Policies and Building Up Administrative Structures 178
17. Some Issues in Horizontal and Vertical Coordination 190
Part VI: Research on Organizational Issues 202
18. Development of Research and Planning Activities 204
19. Research on Organization Theory and its Relevance for Canadian Health Policy Development 210
20. Health Promotion: Development of a Demonstration Strategy 228
21. Economic Evaluation of Models of Community Services: A Critique of Applications of the Concept 244
Part VII: Reform and Restructuring 258
22. The Welfare State Approach is Questioned 260
23. The Impact of the Federal Deficit and Accumulating Debts 264
24. Provincial Inquiries into Health Care Organization 274
25. The Challenge of Human Rights' Policies to Traditional Health Care Structures 284
26. A New Look at Community Inputs 298
27. The Health Care System in the Welfare Society 310
Part VIII: Afterword 320
28. Continuing Cutbacks: Implications for Health Services and Health 322
29. Regionalization 328
30. Where Do We Go from Here? 340
Appendix A 346
Appendix B 356
Bibliography 364
Government Publications 408
Index 422
A 422
B 422
C 422
D 424
E 424
H 425
G 425
F 425
I 426
J 426
L 426
M 426
N 427
O 427
P 428
R 429
Q 429
S 430
T 430
U 431
V 431
W 431
About the Authors 432