Raisa Deber Delivers 2009 Emmett Hall Memorial Lecture

The Emmett Hall Memorial Lecture is one of Canada’s most prestigious lectureships. It commemorates Justice Hall, the father of Canadian medicare. In mid-May 2009, HPME faculty member Dr Raisa Deber was honoured to have been invited to deliver the 2009 Emmett Hall Memorial Lectureship. She gave her presentation at the Canadian Association of Health Services and Policy Research (CAHSPR) annual conference.

Raisa’s lecture was entitled Speaking Truth to Power: Some Adventures of a Policy Analyst in the Ivory Tower. In her presentation, Raisa drew extensively on her team’s study of Medical Savings Accounts (MSAs), in collaboration with Leslie Roos, Evelyn Forget, and colleagues in Manitoba. MSAs would change how health care is financed by shifting from funding providers to giving potential consumers fixed allowances with which they can purchase specified health care services. In theory, this would save money by forcing people to be “wise consumers” of health care.

Raisa noted that their studies of the distribution of health care costs in Manitoba found that “in every age–sex group, approximately 80%-90% of the population spends less than the mean of that group for physician and hospital services.” She noted that it is difficult to find savings from people who do not incur costs, and noted that their calculations suggested MSAs would both increase total spending and shift costs to the most vulnerable. Among many other points covered during her talk, Raisa suggested a better approach would be to develop strategies (1) to improve costs and outcomes for the high-spending population and (2) to keep the low-spending population healthy.

Raisa also acknowledged the controversial reception (at least in some circles) accorded to her team’s MSA-related research and publications. Far from being daunted by the sometimes vitriolic response, Raisa emphasized the fundamental importance of being in a position to “speak truth to power.” It is “essential,” she argued, “to be able to maintain programs of research, even if the particular policy issues being examined are not on the front burner at that moment.” Failure to keep such research going, she concluded, would leave researchers unable to respond when their analyses were most needed.

Sponsored by the Hall Foundation, each year a lecturer is nominated on the basis of his or her outstanding contributions to Hall’s values: equity, fairness, justice, and efficiency. With her presentation, Raisa joins an eminent roster of past Emmett Hall Memorial Lecturers: Evelyn Shapiro, Roy Romanow, Jack Boan, Morris Barer, Charles Wright, Fraser Mustard, Monique Begin, and Robert G. Evans.