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Treating Health Care: How the Canadian System Works and How It Could Work Better    by Raisa Deber order for
Treating Health Care
by Raisa Deber
Order:  USA  Can
University of Toronto, 2017 (2017)
Hardcover, Softcover, e-Book
* * *   Reviewed by Hilary Williamson

In Treating Health Care: How the Canadian System Works and How It Could Work Better, Professor Raisa Deber of the University of Toronto Institute of Health Policy, Management and Evaluation, speaks of Canadians' pride in their health care and 'considerable discomfort when international rankings place Canadian health care in the middle, or even near the bottom, of the pack. We still look very good compared with the United States, but so does everyone else.'

She addresses a call for reform, based on 'costs, access and quality'. Her book gives an informative overview of policy in general and health policy in particular; what effects it; and the factors involved in making sound decisions, making very clear the complexity of the subject, and the trade-offs and ethical considerations involved. Deber tells us that since 1984, 2 pieces of legislation define Canadian federal-provincial arrangements for health care. 'One (currently the CHT) sets out how much money provincial and territorial governments will receive in federal transfers, and the other (the CHA) specifies what, if any, conditions need to be met to receive the money.' The CHA specifies that if a provincial health plan doesn't meet its criteria, cash transfers can be reduced or withheld.

Deber mentions a number of court battles regarding timely access to health care, and relating to the right to life, liberty and security of the person in Canada's Charter of Rights; and a Supreme Court decision that 'was seen as requiring that a province had a duty to ensure that people received timely access to insured services'. Regarding primary care access, 'Statistics Canada estimated that in 2014, 14.9% of Canadians over age 12 did not have a regular family doctor' (though half had not looked for one). Also, timely primary care 'access can still be a problem, even for people with a regular doctor' and this has not improved since 2004. These people tend to go to ER for care, which is 'expensive, unpleasant and inefficient'.

Deber suggests that key targets for policy change to improve healthcare in Canada are 'equity, access to care (including wait times), quality and patient safety, accountability, and cost control' and describes isolated innovations that have helped with timely connection to primary care. We are told that the former Health Council of Canada 'called for placing more emphasis on pan-Canadian collaboration ... It viewed leadership, at all levels, as the key lever and noted the difficulty in maintaining policy directions when governments changed' - ironically, the Council's own funding was not renewed when governments changed.

The author concludes that Canadian 'health care is not terminally ill, but there is clearly room for improvement. However, some treatment suggestions are likely to make things worse.' This volume is a must read for anyone interested in sustainable Canadian health care.

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