Gregory Marchildon

University of Toronto | U of T · Institute of Health Policy, Management and Evaluation

Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care pr...

Organized medicine in a number of advanced industrial countries resisted the post-war trend toward more state involvement in the funding and organisation of medical care. While there were eight doctors' strikes during the peak of reform efforts in the 1960s, two of the most prolonged and bitter struggles took place in Canada and Belgium. This compa...

The federal government established the Prairie Farm Rehabilitation Administration (PFRA) during the greatest environmental and economic crisis in twentieth-century Canada. While the PFRA was a logical policy response to the disaster, it was also a calculated political response by successive Conservative and Liberal administrations in Ottawa. As a r...

Bending the Cost Curve in Health Care offers domestic and international perspectives on the management of ever growing health costs. The objective of the book is to get beyond the sterile debates of the past decade and to try to determine where Canada sits, and should sit, in terms of its health care cost curve, in comparison to other OECD countrie...

The health care system in Canada is much-discussed in the international sphere, but often overlooked when it comes to its highly decentralized administration and regulation. Health Systems in Transition: Canada provides an objective description and analysis of the public, private, and mixed components that make up health care in Canada today includ...

With a population of 39 million people spread over a vast area, Canada is a highly decentralized federation. Provincial governments have most of the responsibility for the governance, organization and delivery of health services. However, the Government of Canada has a strategically significant role in maintaining broad national standards for unive...

Healthcare delivery systems in Canada are structured using three models: individual institutions, health regions, and single provincial systems, usually with smaller geographic zones. The comparative ability of these models to improve care, outcomes, and the Quadruple Aim is largely unstudied. We reviewed Canadian studies examining outcomes of prov...

For 40 years, the Canada Health Act (CHA) has not only protected universal health coverage in Canada but helped define Canada's identity as sharing and caring. Today the act not only affords less protection than often assumed, but could be in danger in the next few years. The policy choice for Canadians is either to “spring forward” with a redesign...

In this book about the Square Mile in Montreal, an elite section of the city which lay at the foot of Mount Royal, below the city's mountain and above (literally and figuratively) the city below, this chapter examines the impact and influence of Max Aitken (later Lord Beaverbrook). Although Aitken only lived in Montreal from 1907 until 1910 - when...

This presentation examines the what was added to the welfare state by the federal government of Canada during the Diefenbaker administrations first two terms of office from 1957 until 1962.

This chapter examines contemporary health policy issues facing the Progressive-Conservative government of Ontario under Premier Doug Ford, including health services integration and coordination, primary care reform, long-term care, public health, governance and structure, and emerging Indigenous health systems.

This presentation focuses the linkages between the famous Lalonde Report of 1974 entitled "A New Perspective on the Health of Canadians" with the Government of Canada's efforts to shift federal resources from Medicare to investments in health promotion and illness prevention.

Canada’s universal health system is often portrayed as a single entity internationally. The reality on the ground is more complex, however, given the constitutional division of powers between the federal government and the 13 provinces and territories. The federal government’s leadership is indeed limited to setting priorities through financing and...

Book review of "Medicare's Histories: Origins, Omissions, and Opportunities in Canada," edited by Esyllt W. Jones, James Hanley, and Delia Gavrus, published by the University of Manitoba Press in 2022.

Long before the COVID‐19 pandemic, health‐care spending became a key policy issue across the OECD. Comparing recent institutional trends in public health‐care financing in three federal countries—Canada, the United States, and Mexico—this article explores the political struggles over fiscal federalism in health care related to both vertical and hor...

Clinical networks (CNs) can promote innovation and collaboration across providers and stakeholders. However, little is known about the structure and operations of CNs, particularly in emergency care. As Canada advances learning health systems (LHSs), foundational research is essential to enable future comparisons across CNs to identify those that c...

LAY SUMMARY The historical relationship between psychedelic drugs and the military has often been characterized in terms of drug misuse or the connection between drugs like d-lysergic acid diethylamide (LSD) or psilocybin (magic mushrooms) contributing to anti-war sentiments. Recent clinical evidence, however, suggests these cultural associations m...

Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer...

This presentation examines the history of universal health coverage in Canada with a focus on the political agenda setting and interest group coalitions in Saskatchewan to draw out general policy lessons for the introduction of universal health coverage in Ireland.

In Canada, persons living with dementia represent a sizable number of home care recipients. Although home care is not wholly publicly funded under provincial health insurance plans, some provinces like Ontario subsidize a maximum number of hours of home care provided by a personal support worker (PSW) on the basis of need. The public subsidization...

Persons living with dementia and their caregivers often face challenges in accessing support for their complex needs. This study aims to understand how program administrators, people living with dementia, unpaid caregivers, and decision-makers perceive specific dementia care programs and whether they are adequately meeting the needs of individuals...

Canada is a laggard when it comes to providing public funding for dental care, ranking close to the bottom of OECD countries. However, the federal government's proposed $13-billion Canadian Dental Care Plan could change that. This paper calls the plan a major step forward in reforming dental care but argues that the "payer of last resort model" the...

The Saskatchewan Dental Plan in Canada was the first universal dental care plan for children in North America. Based on a similar New Zealand program, it would take over two decades from the time that the provincial government first considered the New Zealand policy until a final decision was made to implement the program. This article reviews the...

This presentation summarizes a book written by Katherine Fierlbeck and Gregory P. Marchildon on the boundaries areas of Medicare and the Canada Health Act.

With a population of 39 million people spread over a vast area, Canada is a highly decentralized federation. Provincial governments have most of the responsibility for the governance, organization and delivery of health services. However, the Government of Canada has a strategically significant role in maintaining broad national standards for unive...

En mars 1990, la Conférence des sousministres fédéral, provinciaux et territoriaux de la Santé a mandaté les économistes en santé Morris Barer et Greg Stoddart pour produire un rapport au sujet des politiques sur les ressources médicales. Face à une récession économique et à une crise de la dette publique, les ministres de la Santé cherchaient à ré...

While almost all universal health coverage (UHC) in Canada is provided under the criteria of the Canada Health Act, there is Medicare (the term for UHC in Canada) that is provided outside of the Act. This is the first book to explain the nature of these boundary health services, why they exist, and how to navigate them in practice. These boundary s...

As health service delivery shifts from institutions to the home, greater care responsibilities are being imposed on unpaid caregivers. However, gaps remain concerning how these responsibilities are contributing to caregivers’ financial risk. This study describes results from an online survey conducted in late-2020 in Ontario, Canada, about the fina...

This chapter compares health systems in North America and Europe based upon classification systems developed. Since most of these classifications are based on a subset of health services covered under national universal health coverage (UHC) laws, the common core services across different UHC systems are examined. This analysis is then applied to m...

Despite an increase in prevalence of complex chronic conditions and dementia, long‐term care services are being continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada and the United States (U.S.) live at home with support provided by family, friends or other unpaid ca...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

A review of the evolution of universal health coverage (UHC) in Canada with emphasis on the design choices selected by competing provincial governments and the values that eventually informed the national implementation of UHC, commonly known as Medicare. Some attention is paid to the continuing primary care as well as integration and coordination...

A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This...

Presentation on the work of the North American, Asia-Pacific and African Observatories on Health Systems and Policies in the context of the European Observatory of Health Systems and Policies.

A presentation concerning the health systems and policy environment determining access to mental and physical health services by public safety personnel in Canada.

A summary presentation on the history of the development of Canadian Medicare, the decentralized nature of the Canadian health system, and the different layers of health services in Canada.

This book offers 22 in-depth case studies of public policies and programs of both provincial and federal governments in Canada that have been markedly successful. Using a common analytical framework, each case study describes the history and evolution of the policy, and assesses the extent of its programmatic, process, political, and long-term succ...

This book offers 22 in-depth case studies of public policies and programs of both provincial and federal governments in Canada that have been markedly successful. Using a common analytical framework, each case study describes the history and evolution of the policy, and assesses the extent of its programmatic, process, political, and long-term succ...

This research note directs the attention of policy scholars to a unique and important research study on Canadian Medicare that is not generally known. Conducted by Murray G. Brown and Vernon A. Hicks, the study examined the impact of Medicare on the demand for services in Nova Scotia before and after the introduction of universal medical care insur...

This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating cross-country learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and...

Introduction: Accountable Care Organizations (ACOs), implemented in the United States (US), aim to reduce costs and integrate care by aligning incentives among providers and payers. Canadian governments are interested adopting such models to integrate care, though comparative studies assessing the applicability and transferability of ACOs in Canada...

This presentation provides an overview of the development of Medicare in Canada from its origins in the Great Depression of the 1930s with particular emphasis on its design principles and its original objectives.

The response to an emergency, such as the COVID-19 pandemic, can be particularly complex in federated systems as the federal and subnational governments often share responsibility for public health, and the level of coordination and collaboration required to protect and preserve public health is even more acute during such emergencies. For decades,...

In the history of social policy in advanced industrial societies, the 1942 Beveridge Report stands as one of the most influential government‐sponsored reports ever published. In this article, we explore how the principles and the policy proposals formulated in the report diffused to other countries and how domestic actors adapted them to their loca...

A presentation on the history of universal health coverage in Canada and the nature of the relationship between the Canadian public and the federal-provincial-territorial program commonly known as Medicare. The moderator of the session of Colleen Flood.

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high d...

In Nepal, there has been some resistance to the new system of federalism by stakeholders and the bureaucracies within some ministries, especially in health and education, to the point that they have tried to reverse the devolution of authority and resources. The reasons for this likely go well beyond a questions of position and power but may involv...

Dementia has significant social and economic impacts for those living with dementia and their caregivers. Despite an increase in prevalence of complex chronic conditions and dementia, long-term care services are continuously pushed out of institutional settings and into the home and community. The majority of people living with dementia in Canada a...

Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous. To better understand these diff...

Governments deploy comprehensive strategies to address complex social problems with various New Public Governance and horizontal initiatives. Minimal attention, however, has focused on developing evidence‐informed strategy design for such initiatives. Using a systematic literature review, five strategy design principles were identified: 1) proper s...

Patient registration with a primary care providers supports continuity in the patient-provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Twelve jurisdictions (Denma...

Little is known about the financial risks of unpaid caregiving. This is, in part, due to challenges in identifying people who are caregivers and limitations in capturing all aspects of spending related to caregiving in existing approaches to public data collection. To fill these gaps, we developed a composite survey informed by validated instrument...

Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and condition...

As individuals are living longer, the prevalence of older adults living with dementia and other complex health and social care needs is on the rise (Alzheimer’s Association, 2020; CIHI, 2020). Correspondingly, efforts to develop supportive programming and policies for persons living with dementia (PLWDs) are of paramount importance (CIHR, 2019). Th...

This is a biography of Tommy Douglas, one of the most notable Canadian politicians of the 20th Century. In 2004 the Canadian Broadcasting Corporation took a popular poll to determine the “Greatest Canadian” as part of its television series of the same name. Tommy Douglas finished first, in a top ten that included cultural icons Terrance Stanley FOX...

A presentation on what has prevented comparison of the health systems in the United States and Canada in the past and the reasons why the systems are worthy of comparison in the present and the future. This presentation includes a description of the issues and health sectors which would benefit from comparative analysis and why.

The COVID-19 pandemic has exposed fault-lines in the organization of personal support work, including low wages, part-time employment, and risky working condition, despite its essential nature in long-term care (LTC). This is, in part, because personal support work has long-existed on the fringes of what is considered health work, thereby precludin...

This document serves as a brief introduction to this piece of research on Canadian Medicare that we think deserves to be far better known by public policy specialists, health economists as well as historians and others interested in the evolution of Canadian medicare. It constitutes one of those rare natural experiments, the opportunity for which h...

Background: High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from con- sidering reform experiences abroad, exchange is limited. This paper provides an overview of health re- form trends in 31 high-income countries in...

Virtual presentation at the Harvard T.H. Chan School of Public Health to participants enrolled in "Making Decentralization Work: Policy and Management Issues and Implications of COVID-19"

Virtual presentation at the Harvard T.H. Chan School of Public Health to participants enrolled in "Making Decentralization Work: Policy and Management Issues and Implications of COVID-19"

The coronavirus disease 2019 (COVID-19) pandemic has shifted the health policy debate in Canada. While the pre-pandemic focus of policy experts and government reports was on the question of whether to add outpatient pharmaceuticals to universal health coverage, the clustering of pandemic deaths in long-term care facilities has spurred calls for fed...

Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components...

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were id...

Background and objectives: Patient safety incidents are a leading cause of disability and death in high-income countries, with an estimated 1 in 10 patients harmed while receiving hospital care. Never events are serious patient safety incidents that are preventable through systemic efforts and therefore, “should never occur”. In this comparative st...

Presentation at a virtual research seminar on the COVID-19 Crisis: Policy and Outcomes, hosted by the Journal of Comparative Policy Analysis, Cornell University and Tsinghua University on May 14, 2021.

Tommy Douglas (1904–1986) compte parmi les dirigeants les plus influents de l’histoire du Canada. Immigrant écossais, il devint ministre baptiste en Saskatchewan, où les souffrances qu’il observa pendant la grande dépression l’incitèrent à adhérer au socialisme et à la 5 Fédération du Commonwealth coopératif (CCF) de James Shaver Woodsworth. Dougla...

Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, t...

This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large a...

National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has –through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues,...

This chapter evaluates Canadian Medicare's success based on a PPPG (policy, politics and program) assessment framework.

This presentation examines six lessons that policy makers in the United States can draw from the Canadian model of universal health coverage known as Medicare (not to be confused with Medicare in the US).

This article compares the policy achievements of the Liberal St-Laurent government (1948-57) in the health field to the current Liberal government under Justin Trudeau (2015-present).

Canada lost its edge in the ’70s when Connaught Laboratories was sold. The time has come to invest in a university-based research and production capacity to ensure that vaccines will once again be produced in Canada to prepare for future pandemics. The full text is available at: https://policyoptions.irpp.org/magazines/march-2021/canada-needs-a-uni...

Originally established as an expression of self-determination, Indigenous-governed health systems now play an important role in shaping the delivery of health programs and services in Canada. Operating in very diverse geographic, political and social contexts, these Indigenous health systems are highly heterogeneous in nature. In order to better un...

This is a book review of Charles Williams' biography of Lord Beaverbrook covering his life in Canada and Britain and his work as a financier, press baron, politician and backroom advisor. The review can be found online a: https://cbha-acha.ca/wp-content/uploads/2021/02/MarchildonRevWilliams21.R3.pdf

Clinical networks have become increasingly widespread to promote innovation, knowledge creation and exchange, and collaboration. Emergency care clinical networks (ECCNs) are specifically oriented to support emergency care providers working in emergency settings. This rapid review explores the prevalence and characteristics of 32 ECCNs worldwide to...

This commentary compares Israel's COVID-10 vaccination response to the much slower and less successful vaccination campaign in Canada. Although Canada did start with some structural disadvantages relative to Israel including less centralized and coherent emergency planning and a more complex demographic geography, there are, nonetheless, some impor...

Presentation on the basic concepts concerning the comparison of high performing health systems.

Patient safety incidents are estimated to be the third-leading cause of death in Canada - among the highest in the OECD. To tackle this problem, six indicators of never events—serious patient safety incidents that “should never occur”—were developed to standardize measurement and enable international comparisons. We describe and assess the policy i...

Latin America and the Caribbean (LAC) accounts for over a quarter of the world’s total cases, and a third of the total deaths, from the COVID-19 pandemic (1-3) (4). In the absence of a vaccine to prevent the transmission of the virus, LAC countries have introduced several public health, health system, and economic policies to reduce the spread an...

Latin America and the Caribbean (LAC) accounts for over a quarter of the world’s total cases, and a third of the total deaths, from the COVID-19 pandemic (1-3) (4). In the absence of a vaccine to prevent the transmission of the virus, LAC countries have introduced several public health, health system, and economic policies to reduce the spread an...

This article examines Prime Minister Pierre Trudeau's legacy in terms of fiscal federalism in Canada. Contrary to the conventional wisdom, Trudeau leaned in the direction of greater fiscal decentralization as demonstrated by his decisions on social (health and post-secondary education) transfers and equalization.

La présente analyse du système de santé du Canada examine les évolutions récentes dans l’organisation et la gouvernance, le financement de la santé, la prestation de soins de santé, les réformes de santé et le rendement du système de santé. L’espérance de vie est élevée, mais a atteint un plateau entre 2016 et 2017 en raison de la crise des opioïde...

Healthy system overview of Canada for the purposes of comparison as part of the Commonwealth Fund international health systems studies

En partant d’une revue rapide antérieure sur les expériences de prise en charge des cas de COVID-19 et de leurs contacts à l’étranger, nous avons mené une analyse environnementale de la littérature et consulté un échantillon de commodité de spécialistes locaux, principalement des directeurs et directrices de la santé publique ou des médecins hygién...