Research

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A Research and Teaching Profile

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

In this issue we feature a research profile from Raisa Deber:

• Raisa Deber is a Professor of Health Policy in the Department of Health Policy, Management and Evaluation. Her research focuses on the public-private mix in health care and shifts from hospitals into the home and community.
  
  

+ + PROFILE OF THE MONTH + +

Raisa Deber, PhD

Health policy is an eclectic field. My research can be broadly described as 'roles and responsibilities,' focused at both the micro (providers and patients) and macro (systems) levels. As director of the M-THAC (From Medicare To Home And Community) research unit, I am collaborating with a number of colleagues, students, and community partners to examine the public-private mix and the sustainability of Canada's health care system as care shifts from hospitals into the home and community. (For more information on M-THAC, check out our website at http://www.m-thac.org/).

Education and Work Background

Born in Toronto, I temporarily became part of the 'brain drain' and went to Boston. It took four years to obtain both a bachelor's and Masters degree in political science from the Massachusetts Institute of Technology; this was followed by a PhD in political science, also at MIT. Soon after passing my comprehensive examinations, I took a job as an Assistant Professor in political science at the University of Wisconsin-Madison while trying to complete my thesis (and no, I wouldn't recommend this to my current students). I then returned to Canada (importing my biochemist spouse), and joined HPME (then Health Administration) in 1977 (the same year I successfully defended), moving to Associate Professor in 1982 and then full Professor since 1990.

In addition to my teaching and research activities, I have served on various government task forces, committees and boards, both academic and community-oriented, and as an external reviewer for over 20 journals, including stints on the editorial boards of the Canadian Medical Association Journal and Medical Decision Making, and work with various technology assessment organizations. I was also president of the Canadian Health Economics Research Association (CHERA), making Canada among the few countries where a political scientist would be allowed to assume such a position. I have served on grant review panels for NHRDP, SSHRC, and MRC, and am currently a member of SCOGAG, the research oversight committee for CIHR. I also field many calls from the media, assisting them in interpreting new developments, recommending others whom they might wish to speak with, and, on occasion, doing media appearances and interviews.

Research Activities

At the micro level, I was involved in several studies about decision making, beginning with providers (physicians and nurses), and then moving to examining the role that patients wish to play in treatment decision making (including involvement in developing and evaluating interactive videodiscs for shared decision making). Our work led to a new way to look at patient involvement in decision making, including development of the PSDM (Problem Solving Decision Making) scale which has subsequently been employed by other researchers (See Deber,Raisa B; Kraetschmer,Nancy; Irvine,Jane (1996): What role do patients wish to play in treatment decision making? Arch. Intern. Med. 156(13), 1414-1420.) We are currently applying it to understanding the preferred role for persons with HIV/AIDS, and the implications for the design of patient educational material.

At the macro level, my team produced a report on the Public-Private Mix in Health Care for the National Forum on Health. This report, which was said to have been useful to the commissioners in developing their recommendations, developed a conceptual approach for analyzing the public-private mix, included several case studies and suggested mechanisms for determining what should be paid for through the public plan.

Among the extensions of this work is an analysis of different ways of funding services completed for the Ontario Ministry of Health in 1998, studies for the Health Action Lobby (2000), the Canadian Nurses Association (2000) and the Dialogue on Health Reform (2000), and testimony to the Kirby Commission. More information about the Dialogue on Health Reform is available at http://www.utoronto.ca/hpme/dhr. I am currently writing a review for the Romanow Commission on the implications of different ways of delivering services, including the advantages/disadvantages of public, private not-for-profit, and private for-profit delivery. (Hard data, particularly Canadian data, is proving remarkably elusive - any contributions from readers of this newsletter would be extremely welcome.)

With Paul Williams, we are conducting several studies examining particular aspects of the shift from hospital to home and community, including the capacity of not-for-profit community-based agencies to respond to the growing numbers of Canadians with higher levels of health care needs now in home and community (funded by SSHRC), changes to rehabilitation services (funded by SSHRC), the implications of the Maritime provinces' natural experiment in designing regional health authorities on expenditures for such services as home care, public health, and mental health (funded by NHRDP/CIHR), variation in the funding and delivery of home care for children with complex care needs across Community Care Access Centres in different parts of Ontario (funded by Hospital for Sick Children Foundation). With M-THAC partners, we are also surveying the policy elites among hospitals/health authorities, physicians, nurses, pharmacists, home care, and business to ascertain their views about sustainability and what should be 'in' or 'out' of publicly financed Medicare.

Teaching and Supervisory Responsibilities

For many years, I taught the Health Administration graduate course in Canadian Politics and Health Policy. Last year, Paul Williams and I "blew up" that course and the former "Core 1" (Canada's Health System) to create a new, 2-term sequence merging an overview of Canada's health care system, and a 'policy toolkit.' The new HAD 5010 and HAD 5020 courses appear to be flourishing, and giving students a (sometimes painful) introduction to the writing of briefing notes. We are assisted by a superb complement of guest panelists and tutors (many of whom were graduates of the program). I also continue to teach my case studies course, and am developing the informal policy theory sessions for students preparing for comprehensives into a more formal course.

I also give guest lectures in other programs, including public health sciences, undergraduate medicine, physical therapy, occupational therapy, nursing, and industrial engineering, as well as participating in continuing education events and rounds.

Much of my research agenda is conducted with the assistance of graduate students. I am currently supervising 9 PhD students and 2 Masters students, and co-supervising another 3.

Future Research

Among the research questions I plan to address over the next few years are:

• The public-private mix. Our active program of research focuses heavily upon both the "Actual" trends in financing and delivering services at the boundary of our current system (e.g., home care, rehabilitation, and pharmaceuticals), and upon stakeholder views about an "ideal" system. Among our planned projects are: cost drivers for pharmaceuticals, and the implications of shifting employment patterns on healthcare workers (particularly nurses and rehabilitation).



• Revising healthcare delivery. What are the implications of moving from targeted programs toward integrated systems? Health services researchers are pushing for increased budgetary integration within geographically-based provider organizations, in part on the grounds that these likely to facilitate reallocation of resources to enhance the cost-effectiveness of service delivery. Political scientists would be less sanguine, and would wish to examine the relative power of various participants. We will also explore the tension between geographically-based models and communications technology, with particular attention to telehealth and options for financing and delivering specialized services.

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