Efficiency Versus Equality: Health Reform in Canada

K.V. Nagarajan is an associate professor in the School of Commerce and
Administration, Northern Health Human Resources Research Unit,
Laurentian University.

This wide-ranging, interdisciplinary collection of essays examines the
goals, assumptions, and implications of health-care reform.

As Stingl notes in Chapter 1, the “communitar-ian” vision enshrined
in the Canada Health Act is being challenged by those who advocate an
individualist, market-oriented vision. Brown in Chapter 11 and Wilson in
Chapter 13 cut through the rhetoric and lay bare the design flaws,
inequities, and elitism of Alberta’s restructuring. The painful
downsizing, they conclude, has reaped few benefits. If Alberta sets a
poor example for the rest of Canada, health-care reform in Germany
(Chapter 10) and Oregon (Chapter 3) offers little that can be applied to
this country.

Although no specific model for health-care reform is advocated in this
book, the authors appear to be endorsing a decentralized participatory
system that includes frontline workers and the public in the
decision-making process. Without rejecting efficiency-enhancing
measures, they argue that the founding principles of the Canadian system
(universality, comprehensiveness, accessibility, public administration,
and portability) ensure an egalitarian health-care system. This book
warns about the serious consequences of straying too far from those
principles in our quest for efficiency.