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Social Cohesion and Privatization in Canadian Health Care
Abstract
Résumé
Cet article traite de certains aspects du système de santé canadien qui secouent la cohésion sociale. Le plus populaire de tous les programmes sociaux, le système de santé, est régi par cinq principes définis dans la Loi canadienne de la santé . Chacun en soi et comme ensemble, ces principes contribuent à la cohésion sociale. Le système universel est cependant sous attaque de la part de différentes élites qui souhaitent privatiser certains éléments et dont la stratégie principale est appelée ici privatisation à la dérobée. Le texte aborde la rupture de la cohésion sociale par la privatisation de manière générale mais aussi en analysant le cas des centres communautaires ontariens d'accès aux soins qui sous-traitent, à travers la province, des fonds publics à des agences de soins à domicile qu'ils soient à buts lucratifs ou non.
... Scholars note the increasing commodification of care and privatization of home care in Canada and elsewhere (Armstrong 2001), and these processes are especially pronounced in direct funding arrangements (Ungerson and Yeandle 2007). Direct funding arrangements transfer public funds to individuals who then hire care workers or attendants to assist with daily needs. ...
This article enters into conversations about "care" among feminist and disability scholars through a qualitative study on the Ontario Direct Funding program. In some ways, the findings reflect Independent Living perspectives as the program and interactions between attendants and self-managers are positioned as "not care." Yet, there are areas that remain care, including associations with oppression, professionalism, medical and intimate needs, and people with intellectual disabilities. This alters theoretical conversations by demonstrating that Independent Living does not eliminate care, but rather moves it in attempt to highlight institutionalized histories, reduce oppressive potentials, and transform its meanings with varying degrees of success.
... This is most strikingly the case with the New Labour government in Britain (Pollock 2004; Player and Leys 2008), but privatization by stealth is also found in countries as diverse as Sweden (van Otter and Saltman 1991; Burgermeister 2004) and Canada (Armstrong 2001). ...
Health care has become a global industry, one that provides a revealing entry point for understanding precarious employment. Much of care work is unpaid and all of it is highly gendered. Providers and patients increasingly move around the world, creating not only precarious employment but also critical questions about the regulation and definition of care work. At the same time, the health-care sector, which includes unpaid health-care work as well as the paid work of the health-care industry, allows us to link both productive and reproductive labour through a gender lens. In this chapter, we argue that using the health-care sector as an entry point for studying precarious employment also presents important analytical and comparative challenges. Different definitions of 'health' lead to different approaches to the relationship of health care to other forms of care, both within and among countries. The fact that most care work, including heath care, is undertaken by women can result in its being undervalued in research as well as in remuneration. Indeed, it can be ignored. The blurring of public/private distinctions contributes as well to the difficulty in understanding care work and the extent of related precarious employment.
Medical crowdfunding is growing in popularity in a number of countries, including Canada. In the crowdfunding context people write and share their own stories. This activity also intersects with conventional news media practices when journalists prepare stories about these campaigns. This intersection raises the question of what are print journalists' responsibilities towards covering human interest stories based on medical crowdfunding campaigns? In this qualitative analysis we explore this question through reporting on interviews conducted with 14 Canadian news media professionals. After transcript review, emergent themes were compared and contrasted across investigators to reach confirmation on the scope and scale of emergent themes. These themes were then contrasted against the existing literature and our research goals to aid in interpreting their significance. Thematic analysis of the interviews identified three key domains of responsibility for journalists, which are: to the story, to the campaign and campaigner, and to their profession.
From a neoliberal perspective, governments should steer and not row; competitive markets provide effective, quality services; and individuals should take responsibility for much of their own health. These assumptions provide the basis for privatisation, a process with multiple forms that are often quite complicated and difficult to see. More of the costs of services and more of the labour are shifted to individuals and families, management in public services follows practices imported from the for-profit sector and more services are handed over to the for-profit sector while those that remain public are often managed by for-profit firms. One aspect of this for-profit provision is the contracting out of services, which we examine in nursing homes. As feminist political economists, we assume that politics, economics, discourses and ideas are integrally related. We see that the search for profit profoundly influences how we live, work, talk, reproduce and play. So do the actions of individuals and collectives. We insist that the gendered construction of social relations and the interconnections between paid and unpaid labour are critical to our understanding of how things work.
Purpose
– Canadian literature on federal correctional institutions and prison living indicate a shortage inadequate and available healthcare services to meet the needs of the prison population, despite prisoners higher rates of health challenges (e.g. mental health, addictions, HIV/AIDS) in comparison to the general population. With fewer resources, concerns arise about the delivery, quantity, and quality of penal healthcare provision. Thus, the authors examines former prisoners’ experiences of, in comparison to government reports on, wait-times, and request processes for healthcare services, as well as issues of access, quality of interactions with healthcare professionals and the regulations and policies governing healthcare provision. The paper aims to discuss these issues.
Design/methodology/approach
– The authors compare data gathered from interviews with 56 former-federal prisoners with publicly available Correctional Services Canada reports on healthcare delivery, staff-prisoner interactions, programmes and services, and overall physical and mental health to identify consistencies and inconsistencies between the government’s and former prisoners’ understandings of penal healthcare.
Findings
– Discrepancies exist between prisoners reported experiences of healthcare provision and government reports. Prisoners are dissatisfied with healthcare provision in more secure facilities or when they feel their healthcare needs are not met yet become more satisfied in less secure institutions or when their needs are eventually met.
Originality/value
– Theories of administrative control frame the analyses, including discrepancies between parolee experiences and Correctional Service Canada reports. Policy recommendations to improve healthcare provision are highlighted.
In political economy, as in everyday usage, the terms "public" and "private" are used to distinguish both between states and other organizations in the formal economy, and between households or communities and formal economies, including their state sectors. Although the terms have been useful as analytical tools, it has long been recognized by many political economists that they are not dichotomous, readily separable entities. Rather, public and private in both senses of these terms are interpenetrating and complex categories that shift over time in relation to content and degree of separation.
There is a distinct climate of anti-intellectualism in Britain today. It is important therefore, that intellectuals once more become the subject of serious sociological analysis. This paper makes a start in the re-examination of the role of intellectuals which must be sustained by further systematic research.
Many nations have undergone changes in health care financing and services. The public notices policy changes in health care and frequently bears new and unexpected costs or barriers to care unwillingly. This paper presents data from surveys of about 1,000 adults conducted during April-June 1998 in each of five countries--Australia, Canada, New Zealand, the United Kingdom, and the United States--to measure public satisfaction with health care. In no nation is a majority content with the health care system. Different systems pose different problems: In systems with universal coverage, dissatisfaction is with the level of funding and administration, including queues. In the United States, the public is primarily concerned with financial access.
THE SENSE of health care déja vu was palpable. During the Gay and Lesbian Medical Association's annual symposium this August in Chicago, Quentin Young, MD, and Rep Barney Frank (D, Mass) debated the merits of a single-payer health care system in this country.The two-man discussion echoed panels and town halltype meetings from the heyday of President Bill Clinton's ill-fated vision for national health system reform. But the debate between Frank and Young, founder and chair of the Chicago-based Health and Medicine Policy Research Group, was absent the competitive jockeying among special interests that took place during similar debates 5 years ago. On this late summer morning, both arguers agreed that a government-sponsored, single-payer system is a superior alternative to the current scenario of employer-based insurance.
Polls conducted by the CMA in 1995 indicated that most physicians favour more private funding for Canadian health care. However, new information gathered in a series of CMA-sponsored focus groups confirms earlier findings that the public does not yet share these views. In March, a polling expert told the Board of Directors that physicians must be cautious in advocating a position on the issue.
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