Restructuring Canada's Health Services System: How Do We Get There from Here?

John H. Gryfe is an oral and maxillofacial surgeon practicing in
Toronto.

Assured universality in the delivery of health care has proven to be an
expensive and divisive commodity. There seems to be no country on either
side of the Iron Curtain that has failed to discover the impossibility
of continuing unrestrained public funding in an attempt to maintain a
superlative level of care. Research has shown, however, that there may
be too much sick care—i.e., doctors and hospitals—in the
health-care-delivery equation. While the public has tended to focus on
the issue of access, and politicians on that of cost effectiveness,
current rhetoric within the system itself identifies a more basic need
to restructure and reorient the thrust of health services.

In August 1990, the Fourth Canadian Conference in Health Economics
attempted to identify where the system wanted to go, and to anticipate
problems that could potentially accompany any change in direction. This
volume is an edited compilation of numerous papers delivered at the
conference. In many instances, the discussions that followed a paper’s
delivery have been included as well. All of the papers have been
subdivided into groups of common themes.

In her concluding remarks, Chairperson Raisa Deber pointed out that
decisions on future change should be based on “consensus, cooperation,
and planning,” but also that we should “just do it” without
bothering to consult anybody! Sound familiar?