Office of the Chair

Linking Health Services Research, Policy and Practice

As Canadian healthcare continues to top public opinion and policy debates federally and provincially, the need for close relationships between health researchers and health policymakers is paramount. Government officials need to make informed decisions about complex health issues, whether these relate to the allocation of resources, primary care reform, the approval and monitoring of drugs, patient safety or quality improvement.

As seen in this issue of NewsBytes, HPME faculty are at the fore in providing evidence and analysis to inform and transform health care debates. This past winter, Ross Baker with Peter Norton presented to the House of Commons on patient safety; Raisa Deber presented to Health Canada on the public/private healthcare funding; and Andreas Laupacis was appointed to the Health Canada Science Advisory Committee (below). Alumnus Marsha Barnes talks about her role in primary care reform as Director of the Primary Health Care Team, MOHLTC, and member of the CCAC/Family Health Teams work group (Alumni).

In our new "In the News" section, a number of faculty including Raisa Deber , Geoff Anderson, Muhammad Mamdani, Terry Sullivan and Mary Jo Haddad (adjunct) have received major media attention for their roles in improving Canadian healthcare (In the News). We would also like to draw your attention to new publications, in particular the findings from the Canadian Stroke Quality of Care Study published in CMAJ by Patrice Lindsay et al. (Research). Don't miss research and teaching profile of Dr. James Wright , orthopaedic surgeon and winner of the 2005 CIHR, Institute of Musculoskeletal Health and Arthritis (IMHA) Quality of Life Research Award (Research). And finally, don't forget this year's fast-approaching Research Day, the first ever to include a student-led morning conference (below).

• Baker and Norton Present to House of Commons
  Ross Baker (Professor in HPME) and Peter Norton (University of Calgary) were invited on February 9, 2005 to appear as witnesses before the House of Commons Standing Committee on Health. Baker and Norton were asked about their study and the current status of patient safety activities in Canada . MPs engaged them along with representatives from the Canadian Patient Safety Institute for 90 minutes and asked questions about strategies for safer care.
  
  
• Deber Presents to Canada Health Act Policy Forum
  Raisa Deber (Professor in HPME) presented a talk at the Health Canada, Canada Health Act Policy Forum on March 1, 2005, entitled, "Public and Private: Some (evidence-based) Thoughts". She defined public and private healthcare across the dimensions of delivery, financing and allocation, distinguishing between three types of private care: not-for-profit, for-profit small business, and for-profit investor-owned corporation. She noted that the ongoing debate about public and private roles often confuses financing and delivery, and even forgets that in Canada, about 70% of health expenditures come from public sources (lower than the OECD average), while almost all delivery is already private, albeit with a relatively small role for investor-owned corporations. Australia, in comparison, has both public and private delivery of care. In addition, regardless of ownership type, the method used to allocate resources creates incentive structures. For example, capped budgets give incentives to reduce the volume of service whereas service-based budgets give incentives to increase the volume of service. The literature reviewed suggests that under many circumstances, the incentive structures for corporate for-profit ownership may be incompatible with public goals. For example, for-profit firms are unlikely to wish to serve groups which do not generate sufficient profit. Unprofitable clients may be found in certain geographical regions, particular disease categories or in particular groups of people (e.g. the uninsured). Reimbursement models which do not take such heterogeneity into account may leave such clients unserved, or penalize those more altruistic providers willing to serve them. The appropriate place for for-profit corporate providers thus depends heavily upon the 'production characteristics' of the services being provided (particularly the ability to measure and monitor expected results and the extent to which care must be coordinated across providers). To the extent that such monitoring itself imposes high transaction costs, it is noteworthy that many countries have decided to opt for a 'high trust' stewardship model, which relies largely upon not-for-profit delivery.
  
  
• Laupacis Appointed to Health Canada's Science Advisory Board
  On March 30, 2005 , Federal Health Minister Ujjal Dosanjh announced the appointment of Dr. Andreas Laupacis, Professor in HPME and the Department of Medicine, to Health Canada 's Science Advisory Board. Dr. Laupacis is one of five new members who fill vacant seats on the Board, bringing his expertise in clinical trials, pharmacoeconomics, drug policy, and the use of diagnostic tests.
  
  "These scientists are the best in their fields," said Minister Dosanjh. "They represent a range of perspectives from across the country and they will bring added vigour to the Board. I rely on this Board's thoughtful and practical advice to help me address the broad and complex issues that arise within the health portfolio."
  
  The Science Advisory Board has operated at Health Canada since 1997. It provides independent advice to the Minister of Health on the future directions of Health Canada 's scientific programs and activities, on emerging health sciences and trends. It also makes recommendations on Health Canada 's priorities and advises on the relevance and effectiveness of its research.
  

Final Reminder About HPME 2005 Research Day

This year's research day will be held on May 4, 2005 . On the morning of May 4, HPME students are hosting an inaugural pre-Research Day student conference entitled, "From Silos to Integration: An HPME Student Research Conference". The student conference includes concurrent oral presentations, an expert panel on primary care and a complementary luncheon for students and invited guests. The expert panel will be facilitated by Dr. Louise Lemieux-Charles and includes Dr. Ruth Wilson, Action Group on Family Health Teams, Dr. Ted Broadway, Ontario Medical Association, Doris Grinspun, Executive Director of the Registered Nurses Association of Ontario, and Dr. James R. MacLean, Markham-Stouffville Hospital . See the HPME GSU website for more details.

In the afternoon, HPME will hold its poster session from 2 pm to 4 pm in the MSB Alumni Lounge, followed by keynote speaker Dr. John Birkmeyer M.D., the George D. Zuidema Professor of Surgery, University of Michigan. He will present his talk, "Measuring the Quality of Hospitals and Physicians", at 4 pm in MSB Room 3154 . See Dr. Birkmeyer's biography and the full agenda on the HPME website. After the awards are presented, Research Day will wrap up with a wine and cheese reception from 5 pm to 7 pm in the MSB Alumni Lounge. See you there!

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