Canadian Public Policy

While governments are responsible for monitoring and evaluating health reforms and overall performance, this chapter explains why some of this function has shifted in recent years to specialized intergovernmental bodies, and increasingly, to organizations and networks external to European countries and the federal and provincial governments in Canada. In particular, it examines academic networks that have emerged in response to the need for better comparative data analysis. Some attention is devoted to the potential impact of these academic networks.

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 and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality an  regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.

This book argues that the Canadian centre of government has evolved a great deal during the past 20 years. It presents a study of how the central agencies have changed between the 1970s and 2000. Donald Savoie adopts the position that prime ministerial power has been enhanced in recent years. However, a similar position was adopted by Thomas Hockin years ago. This suggests that issues in public sector management are also the subject of continuous debate. The case for the power of the prime minister is presented in Chapter 2, "The Centre Is Born" (pp. 20-45); Chapter 3, "Render Unto the Centre" (pp. 46-67); and in Chapter 4 (pp. 71-108). These chapters are further supported by a separate focus on the Privy Council Office (pp. 109-55); Finance (pp. 156-92); and the Treasury Board and the Public Service Commission (pp. 193-238). The background to the changes in the past 30 years can be related to the leadership of Pierre Elliott Trudeau in 1968-79 and later between 1979 and 1984. The study examines the roles of the core central agencies: the Prime Minister's Office, the Privy Council Office, the Treasury Board Secretariat, and the Department of Finance. The enhanced position of the Privy Council Office and the Department of Finance are significantly emphasized.

Analysis of amended data from a large-scale Canadian employment audit study (Oreopoulos 2011) shows substantial organization size differences in discrimination against skilled applicants with Asian (Chinese, Indian, or Pakistani) names in the decision to call for an interview. In organizations with more than 500 employees, Asian-named applicants are 20 percent less likely to receive a callback; in smaller organizations, the disadvantage is nearly 40 percent. Large organizations may discriminate less frequently because of more resources in recruitment and training, more human resources development, and greater experience with diversity. Anonymized résumé review may allow organizations to test hiring procedures for discrimination fairly inexpensively.

La loi C-32 "An Act to Amend the Copyright Act" a reçu l'aval royal le 25 avril 1997. Ceci était connu sous l'appellation "Phase II" de la réforme des droits d'auteur qui est entré en vigueur en 1988. En plus d'amendements techniques, elle apporte de profonds changements à la loi sur les droits d'auteur: une clarification des exemptions pour les institutions charitables tels que les universités et bibliothèques; des règles plus sévères contre l'importation parallele de livres; des droits sur les cassettes audio vierges dont les recettes iront aux collectivités des droits d'auteur; et des "droits de voisinage" pour les artistes du son ainsi que les producteurs. Il y a deux façons distinctes de penser à la loi sur les droits d'auteur. La première se concentre sur les droits naturel des créateurs au revenu généré par leurs travaux. L'autre se concentre sur le problème économique de conception d'un régime de droit d'auteur qui maximise le bien-être social. L'auteur suggère qu'alors même que les deux points de vue ont été mis de l'avant lors du débat sur la réforme, le point de vue sur les droits naturels a eu plus d'influence sur la conception de la loi C-32 que le point de vue économique.

Nested Federalism and Inuit Governance in the Canadian Arctic traces the political journey toward self-governance taken by three predominantly Inuit regions over the past forty years: Nunavik in northern Québec, the Inuvialuit Settlement Region in the western Northwest Territories, and Nunatsiavut in northern Labrador. The Canadian federal system was never designed to recognize Indigenous governance, and it has resisted formal institutional change. But change has come. Indigenous communities have successfully mobilized to negotiate the creation of self-governing regions. Policymakers and politicians have responded by situating almost all these regions politically and institutionally within existing constituent units of the Canadian federation. The varied governance arrangements emerging as a result are forms of nested federalism, a new and largely unexplored model of government that is transforming Canada as it reformulates the relationship between Indigenous peoples and the state. ...

tCanada is the only Universal Health Insurance country in the OECD without universal insurance for outpa-tient prescription drugs, a situation generally perceived as unfair and inefficient. In June 2018, the federalgovernment launched an Advisory Council on the Implementation of National Pharmacare, to report in2019 on the best strategy to implement a national Pharmacare program that would provide all Canadiansaccess to affordable outpatient prescription drugs. The Council was asked to consider three options: auniversal public plan for all Canadians; a public catastrophic insurance plan that would kick off oncespending on prescription drugs reaches a given threshold; and a more modest patching of existing gaps,providing coverage to those who are not eligible to any form of insurance. Beyond the relative consensusaround the ideas that gaps in coverage should be filled to make drugs affordable to all, and that the costsof drugs are too high in Canada, the Council faces the challenge of addressing three underlying issues:1) what amount of income redistribution will result from each of the three options; 2) how much sav-ings would the implementation of a single payer generate? 3) what role restricting a national formularywould play in achieving those savings, and what would be the political consequences of narrowing theformulary?

Dans le domaine de la santé, l'approche traditionnelle en planification des ressources humaines accorde une très grande importance aux effets des changements démographiques sur les besoins en ressources humaines. La planification est largement basée sur la taille et la composition démographique de la population, appliquées à de simples ratios population/fournisseur de soins ou population/utilisation des soins. Dans cette étude, nous proposons un cadre d'analyse plus large basé sur la production de services de soins de santé et sur les multiples facteurs qui déterminent les besoins en ressources humaines. Nous posons comme hypothèse que les besoins dépendent de quatre facteurs distincts : la démographie, l'épidémiologie, les standards de soins S2 S. Birch, G. Kephart, G. Tomblin-Murphy, L. O'Brien-Pallas, R. Alder and A. MacKenzie CANADIAN PUBLIC POLICY -ANALYSE DE POLITIQUES, VOL. XXXIII, SUPPLEMENT/NUMÉRO SPÉCIAL 2007 et le niveau de productivité des fournisseurs de soins. Pour illustrer notre propos, nous appliquons le cadre théorique à des scénarios hypothétiques concernant l'ensemble de la population des provinces atlantiques canadiennes.

La fermeture, à Hamilton, en 2002, d'une agence d'aide aux familles, à domicile, syndiquée et sans but lucratif, fournit un cas d'étude qui est révélateur des impacts locaux de la politique contractuelle de l'Ontario en matière de soins à domicile. Une enquête portant sur les 317 employés qui ont été licenciés révèle que seulement 38 pour cent d'entre eux sont restés dans le secteur de soins à domicile; la plupart ont été absorbés par des agences à but lucratif, non syndiquées, où leurs conditions d'emploi se sont détériorées. Nos conclusions vont à l'encontre du lien traditionnellement établi entre la qualité de l'emploi et la qualité du service de soins à domicile. Elles ont des répercussions sur le développement de critères pour la dispersion des fonds publics dans des économies mixtes de soins de proximité, et sur la conceptualisation de la responsabilité des gouvernements dans la coordination de la création de services de soins à domicile.

Addresses in some provincial health care registries are not systematically updated. If individuals are attributed to the wrong location, this can lead to errors in health care planning and research. Our purpose was to investigate the accuracy of socioeconomic classification based on addresses in Ontario's provincial health care registry. The study setting was Toronto's inner city, an area with a population of 799,595 in 1996. We ordered enumeration areas by 1996 mean household income and divided them into five roughly equal income groups by population. We then assigned an income quintile to each individual using both the address from Ontario's provincial heath care registry and that from hospital discharge abstracts. We compared these two sets of income quintiles and also used them to generate quintile-specific rates of medical hospital admissions in the year 2000. Provincial registry and hospital-based addresses agreed on the exact enumeration area for 78.1% of individu...

While there is widespread support for a national single payer plan, there has been little consensus about a specific detailed policy architecture and role for the federal government. There are two possible ways to achieve single payer Pharmacare in Canada. One is through 13 provincialterritorial program in which the federal government provides funding to the provinces and sets national standards, perhaps through the Canada Health Act, or through separate legislation. In return for the cash transfer, which would likely only cover incremental costs, PT governments would agree to provide universal coverage to their residents for an agreed upon schedule of medically necessary pharmaceuticals. The second major option is a federally financed, regulated and administered Pharmacare program. This is constitutionally feasible because of the federal government’s current jurisdiction over drug safety, price regulation and patent protection. While it is generally assumed that federalism and provincial jurisdiction over health stand in the way of a federal government public single payer program, the provinces have supported this option in the past, with the caveat that special arrangements may have to be made for Quebec. On balance, we see considerable advantages for the second option. Strong federal leadership is needed to make Pharmacare a reality, because it is far from clear that expanding public health insurance is a current priority for all provinces. Fiscal capacity varies a great deal between the provinces but the federal government has the fiscal means to act if it finds the political will to do so. The federal tax system could be used to recoup some of the cost savings of employers, workers and individuals which would result from a more cost efficient single-payer plan. A federal program would make it easier to establish a national drug formulary and to achieve the savings of co-ordinated drug purchasing. Finally, a federal Pharmacare plan could be implemented more quickly.

Governance and Public Policy in Canada lays the foundation for a systematic analysis of policy developments, shaped as they are by multiple players, institutional tensions and governance legacies. Arguing that provinces are not the most central site of governance and policy innovation, the book assesses the role of the provinces and places the provincial state in its broader economic, institutional, social, and territorial context. The aim throughout is to highlight the crucial role of provinces in policy changes that directly affect the lives of citizens.
Three key themes unify this book. First, it addresses the role of policy convergence and divergence among the provinces. Although the analysis acknowledges the enduring differences in political culture and institutions, it also points to patterns of policy convergence in specific areas. Second the book explores the push and pull between centralization and decentralization in Canada as it affects intergovernmental relations. Third, it underscores that although the provinces play a greater role in policy development than ever before, they now face a growing tension between their expanding policy ambitions and their capacity to develop, fund, implement, manage, and evaluate policy programs.

This is the revised addition of a history of the community clinics in Saskatchewan written by Stan Rands, a noted social activist, public servant and community clinic administrator who died in 1985. This edition includes a new introductory chapter by Gregory P. Marchildon on primary health community clinics and Stan Rands' struggle for the transformation of health care in Saskatchewan and in Canada. This books also includes an examination of co-operatives and consumer control of health care services 50 years after the tumultuous doctors' strike of 1962 in Saskatchewan that marked the birth of universal medical care insurance in Canada.

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 and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.

Regionalization is arguably the most significant health reform in Canada since medicare. Although a majority of provinces continue to have regionalized systems in Canada, the policy is more contested today than it was a decade ago. Since Ontario's implementation of local health integration networks (LHINs) in 2006 and Alberta's elimination of regional health authorities (RHAs) in favour of Alberta Health Services in 2008, Canada has had differing approaches to regionalization. However, due to the centralization of physician budgets in provincial health ministries, primary care has not been integrated into any regionalization model in Canada. This factor has severely constrained the performance of RHAs and their ability to meet their respective legislative mandates. Moreover, the lack of research on regionalization has meant that provincial governments are working from an extremely limited evidence base on which to make critical decisions on the structuring of health systems in Canada.

his 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 and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.

This is a special guest issue of Canadian Public Administration devoted to the rise and presumed decline of universality in social policy with special emphasis on the Canadian experience. Considerable attention is paid to the conceptualization and definition of universality as well as the historical trajectory of universality and the use of history in explaining such trends in public policy.

With a population of 35 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 although the Government of Canada has an important role in maintaining high level standards for universal health coverage through the Canada Health Act as well as pharmaceutical regulation, health research and data collection. With 70% of total health spending financed by federal, provincial and territorial governments, most are used to provide universal access to hospital and physicians services as well as more targeted coverage for prescription drugs and long-term care. In the last decade, provincial and territorial governments have focused on reorganizing their regional delivery systems and improving the quality, timeliness and patient experience with acute, chronic care and primary care medical services. While Canada's system of universal coverage for Medicare has been effective in providing deep financial protection, the narrow scope of coverage has resulted in gaps in coverage and equitable access.

Feasance is a developing area of the law of torts. Torts is an area of law that deals with private wrongs. In essence, breaches of duties or obligations by a person or legal party that causes injury to another. It also has the distinction as being the only element of tort law applicable to the actions of public officials versus all other torts which are private
wrongs causing injury. In Civil law systems such as Quebec along with much of Europe and South America this area or tortious wrongs is covered in an area of law known as delict, which similarly focuses on the obligations of people (or legal entities) to others and the possible remedy when obligations are breached, and significant damages result.
In this study I will explore the origins and early development of feasance in both civil law and common law and will also examine how the law distinguishes between the three types of tortious feasance: malfeasance, mis-feasance and nonfeasance. Finally, using the claims
of the Nova Scotians for Equalization Fairness (NSEF) that Halifax has been unduly hording constitutionally directed federal equalization transfers to the Province of Nova Scotia from the outer laying regions of the province, a spotlight will be shown on Cape Breton Island’s (CBI) demise and fiscal neglect to gauge whether NSEF might potentially
have a substantiated claim of tortious action via litigation for damages incurred due to one or more of the feasance heads.

This chapter examines the history of the regulation of private finance in Canada, in particular the key decision points that would establish medicare's regulatory regime in two key areas. The first was the active contestation among provincial governments over a single-payer design versus a multi-payer design, and the ultimate selection of the latter as the dominant design. The second key area concerns hospital user charges and physician extra-billing as part of the medicare policies of selected provincial governments and their eventual elimination.

Since its enactment in 1984, the iconic Canada Health Act (CHA) has been at the centre of a polarized de- bate on whether universal coverage should be expanded or restricted in Canada. This discussion on the future direction of Canadian medicare has been vexed by prevailing myths about the CHA. These myths are un- helpful in that they
perpetuate misleading notions about the ambit and impact of the CHA. This article decon- structs 10 of the more common myths to get at the realities of the CHA and the extent to which it sets national standards and constrains — or does not constrain — provincial health reform and innovation. Understanding the realities of the CHA is becoming a critical litmus test for the courts as they interpret the CHA and the pro- vincial laws and regulations, which were established in conformity with five criteria — public administration, comprehensiveness, universality, portability, and accessibility). Separating myths from realities also allows practitioners and scholars to better understand the limits of the CHA.

This chapter reviews the history of drought in a region of Western Canada knowns as the Palliser Triangle From the time that agriculture was introduced in the last decades of the 19th century, drought has been a recurring feature. Focusing on the Dust Bowl of the 1930s, this chapter reviews the policy interventions of the day to extract some lesson for the future of the region in preparing for prolonged droughts that may be exacerbated by climate change.

The purpose of this dissertation was to identify and review the health barriers to settlement for refugees in Canada. In 2012 the Conservative Federal Government made changes to the Interim Federal Health Program, claiming to save Canadian taxpayers money, which resulted in the loss of certain health coverage for refugees and refugee claimants in Canada. After widespread protest to the changes to the program from the Canadian public and stakeholders, a major evidence base was created detailing the adverse affects of the change in policy, including an overall increase in cost.

Interestingly, the change in policy was undertaken with neither a stakeholder analysis nor health impact assessment for the end users, the refugee patients. Therefore, the main recommendations for improving the program were consistent throughout the various groups interviewed and researched, including an adequately detailed consultation with key stakeholders, and an evidence-based health impact assessment of any further change in policy.

Investigating the earnings and income disparity faced by Aboriginal people in Canada from 1995 to 2005, we find that Aboriginal people face substantial income and earnings gaps in comparison with Canadian-born majority-group workers with similar characteristics (such as age and education). The estimated gaps are large: about 10 to 20 percent for women and 20 to 50 percent for men. However, these gaps eroded somewhat over 1995 to 2005. Among Aboriginals, registered Indians fare worst, persons with self-reported Aboriginal identity fare somewhat better, and persons with Aboriginal ancestry (but not identity or registry) fare better still.

Although Canada is known as a liberal welfare regime, universality is a key issue in that country, as several major social programs are universal in both their core principles and coverage rules. The objective of this article is to discuss the meaning of universality and related concepts before exploring the development of individual universal social programs in Canada, with a particular focus on health care and old-age pensions. More generally, the article shows how universality can exist and become resilient within a predominantly liberal welfare regime due to the complex and fragmented nature of modern social policy systems, in which policy types vary from policy area to policy area, and even from program to program within the same policy area. The broader analysis of health care and old-age pensions as policy areas illustrates this general claim. This analysis looks at the historical development and the politics of provincial universal health coverage since the late 1950s and at the evolution of the federal Old Age Security program since its creation in the early 1950s. The main argument of this article is that universality as a set of principles remains stronger in health care than in pensions yet key challenges remain in each of these policy areas. Another contention is that there are multiple and contested universalisms in social policy.

A review of COVID-19 case and contact management strategies in Canada that examines: workforce capacity; skills and training; case identification and management; contact identification and management; and various technologies for case and contact management.

The accepted narrative of the history of medicare in Canada does not do justice to the struggle between premiers Tommy Douglas of Saskatchewan and Ernest Manning of Alberta over two very different models of universal health coverage. Douglas and Manning were committed advocates of their respective models for ideological reasons, but these political differences had their origins in their conflicting interpretations of Christian teachings and biblical interpretation. These differences are examined in detail in order to arrive at a richer understanding of the values and the key policy design features of their respective models of medicare. Ultimately, Douglas’s model of medicare would be adopted in the rest of Canada even though Manningcare was the preferred choice of doctors, insurance companies, the business establishment, the majority of provincial governments, and fundamentalist Christians such as Manning who believed that Douglas’s model resulted in an abdication of individual responsibility and moral choice.

Dans cet article, je présente les résultats du MC 3 Project (Meeting the Climate Change Challenge). Ce projet, qui a rassemblé plus de 100 chercheurs, praticiens, leaders de la société civile et décideurs politiques, a été mené par des chercheurs de la Royal Roads University, de la Simon Fraser University et de la University of British Columbia ainsi que par 12 partenaires de recherche importants des secteurs public et privé, dont la Union of British Columbia municipalities. Les chercheurs ont réalisé une évaluation détaillée de 11 municipalités de la Colombie-Britannique, différentes mais toutes chefs de file en matière de changements climatiques, pour déterminer les innovateurs et les innovations les plus importants en cette matière. Les études de cas ont montré que les moteurs essentiels de l'innovation sont, en ordre d'importance : les cadres législatif et politique, soutenus par des outils et des mesures incitatives du gouvernement provincial ; l'accès à du financement de partenariat et au soutien d'intermédiaires ; et le fait de considérer l'enjeu comme essentiel.

Les auteures conçoivent pour les Canadiens en âge de travailler un programme hybride de revenu de base garanti et de subvention salariale qui résout les préoccupations relatives au fédéralisme et aux facteurs de désincitation au travail associés au revenu de base traditionnel grâce à l'extension de l'allocation canadienne pour les travailleurs. Établissant le coût de leur programme, elles proposent un modèle de fi nancement sans incidence sur les recettes, faisant appel à la consolidation des programmes d'aide sociale et à la suppression de plusieurs crédits d'impôt. Elles simulent les effets de redistribution de leur programme et de leur modèle de fi nancement sur le revenu disponible des ménages, selon les déciles et les types de famille, et en analysent l'incidence sur les taux effectifs marginaux d'imposition et les interactions avec les programmes pour personnes handicapées. Le programme des auteures réduit sensiblement les taux de pauvreté chez les familles biparentales et chez les célibataires ou les couples sans enfants, en âge de travailler.

Cet article examine les politiques européennes concernant la ségrégation professionnelle et l'écart entre les salaires selon le sexe, à la lumière de quelques faits de base, stylisés. En utilisant trois sources de données comparables pour les pays d'Europe, nous montrons que: (i) la ségrégation est liée de manière positive à l'emploi des femmes; (ii) la redistribution des emplois féminins entre des occupations diverses, suivant le schéma des emplois masculins, a un effet minime et contradictoire sur l'écart entre les salaires selon le sexe, tandis qu'une redistribution interne des emplois suivant l'échelle hiérarchique a un effet plus important; (iii) la dispersion des salaires est liée de manière négative à l'écart entre les salaires selon le sexe. Il est démontré que ces faits peuvent impliquer des compromis lorsqu'on poursuit simultanément la déségrégation, l'élimination de l'écart entre les salaires et l'accroissement des emplois féminins. This paper reviews European policy toward occupational segregation and the gender earnings gap in the light of some basic stylized facts. Using three sources of comparable data for European countries it shows that (i) segregation associates positively with female employment; (ii) redistribution of female employment between occupations toward the male pattern has low and contradictory effect on the gender gap whereas within-occupation redistribution up the hierarchical ladder has some significant impact; and (iii) dispersion of earnings associates negatively with the gender gap. It is argued that these facts may imply trade-offs when desegregation, closing of the gender gap and higher female employment are simultaneously pursued.

Starting in January 2019, the Canadian federal government will require all provinces and territories to have a carbon pricing policy in place. Due to the inevitable increase in costs to industry, carbon pricing reduces the international competitiveness of Canadian industries that are emissions-intensive and trade-exposed (EITE). As a result, most provincial carbon pricing policies, as well as the federal government's carbon pricing backstop, contain complementary supports for EITE industries. The goal of these supports is to help Canadian EITE firms maintain their competitiveness compared to industries from international jurisdictions that do not have carbon pricing. When governments price emissions, costs increase for firms and consumers. The challenge that EITE industries face, however, is that the prices for their goods are set in international markets. Without the ability to pass at least of portion of the increased costs on to consumers, EITE industries must absorb them against their bottom line. This in turn can result in carbon leakage, where the affected industries move elsewhere to avoid the emissions price, or their domestic activity declines in response to the higher costs. Carbon leakage leads to a drop in the area's economic activity while the effect of industries moving away results in an increase in emissions internationally. In short, carbon leakage is a " lose-lose " outcome — it reduces the effectiveness of the carbon pricing policy at the expense of local industry. Through well-designed EITE support policies, governments can mitigate carbon leakage. Specifically, EITE support policies should lower the cost of the carbon pricing policy while maintaining the incentive for EITE industries to invest in emissions reductions. This paper examines the EITE support policies of the Canadian federal government, the provinces of British Columbia, Alberta, Ontario, and Quebec, and the international jurisdictions of Australia, California, and the European Union. It additionally identifies the best practices that have evolved in jurisdictions that have implemented EITE support policies alongside carbon pricing.

... Page 8. S8 Susan McDaniel and Paul Bernard ... Social policy is largely about making more options available to more people over their lives. It is about building and enhancing capabilities, and about providing help when chal-lenges occur (Hall and Lamont 2009). ...

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 are lacking. In this comparative study, we performed a narrative literature review to examine how Canadian health systems could support ACO models. Methods: We reviewed empirical studies (published 2011-2020) that evaluated ACO impacts in the US. Thematic analysis and critical appraisal were performed to identify factors associated with positive ACO impacts. These factors were compared with the Canadian context to assess the applicability and transferability of ACO models within Canada. Findings: Physician-led models, global budgets and financial incentives, and focus on collaborative care may optimize ACO impacts. While reforms towards alternative payments and team-based care are not unprecedented in Canada, significant further reforms to physician remuneration, intersectoral collaboration, and accountability for performance are required to support ACO-like models. Conclusion: This comparative study uncovered several insights on the applicability and transferability of ACOs to the Canadian context. Further comparative research outside the US is needed to infer the essential components of successful ACO models.

The Government of Canada first announced its intention to implement a
nation-wide carbon price in October 2016. After two years of announcements, retractions, discussions and debate, the rollout of carbon pricing in each province was finalized in October 2018: the federal government announced its assessment of proposed and implemented provincial carbon pricing plans. We now can compare the coverage, stringency and efficacy of provincial climate policies, and to consider how they measure up with each other and with the federal government’s standards.
This paper focuses primarily on provincial systems’ emissions coverage: the share of emissions subject to a carbon price. The federal government has set a pricing benchmark, the minimum level of emissions coverage that provincial pricing policies are required to meet. The federal backstop — consisting of a carbon tax and output-based pricing system (OBPS) for large emitters — is imposed on provinces whose policies don’t measure up to the federal benchmark. We
examine how the coverage of implemented, announced and former provincial pricing policies measure up to the benchmark and backstop. Using reported emissions data for each province from 2015, we provide an estimate of emissions coverage in each province from the policies in effect in 2019.

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 practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government’s large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province’s finances have led to major conflict with organized medicine over physician budgets and the government’s consideration of an even more radical restructuring of the system of primary care in the province.

This review explores the state of primary care reform across Canada. For this review we define primary care as being the day-to-day care that is provided by a physician or other qualified health care provider. Primary care providers are expected to be a patient’s first point of contact with the health system and should provide on-going, continuous care including referrals to other, more specialized providers, diagnostic testing and access to prescription drug therapies. We aim to elicit which jurisdictions have progressed primary care most innovatively through the last decade. To evaluate the degree of progress achieved in each jurisdiction, we have used six evidence-based criteria derived from the international scholarly literature and the institutional environment in Canada. These criteria are identified as necessary components for more effective and efficient primary care and its contribution to higher performing health systems.