First Do No Harm: Making Sense of Canadian Health Reform

Marilyn Mardiros is an associate professor of health sciences at the
University of Ottawa.

Although there has been a decline of public confidence in Canada’s
health-care system, the authors of this book are not afraid to
acknowledge the system’s three main virtues. First, it is a subsidy
and transfer program that operates on the basis of need, not ability to
pay. Second, it is simple, keeping administrative and transaction costs
to a minimum through a single public-payment mechanism. Third, costs are
controlled due to the bargaining power of a single payer. Sullivan and
Baranek regard the involvement of the federal government in health care
as both a strength (ensuring standards across the nation) and a weakness
(resulting in slow change and rigidity in the development and provision
of services).

The impact of international trade agreements, free market practice, the
notions of public and private, the basis of perceptions of lengthy wait
lists, abuse of the system, and skyrocketing costs are discussed. The
authors identify as key challenges the allocation or purchasing
mechanism, the delivery and management of services, and expanding the
range of services publicly covered (specifically, home care and
pharmaceuticals).

First Do No Harm makes a significant contribution to the ongoing debate
over the efficacy of our health-care system. Sullivan and Baranek do not
offer a comprehensive approach to reform; instead, they wisely caution
against simplistic approaches based on ideology and assumption.