Wasting Away: The Undermining of Canadian Health Care. 2nd ed.

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

The authors of this well-researched book argue that the Canadian
health-care system should abandon the “medical model” approach,
which focuses on treatment, in favour of the “determinants of
health” approach, which emphasizes prevention through consideration of
socioeconomic factors and the like. (In their colorful phrase, the
medical model relies on “cuts and chemicals,” whereas the
determinants of health approach would focus on “carrots and
condoms.”) They do an especially good job of analyzing the
consequences of the drastic budget cuts that began in 1995. Management
techniques (including total quality management and continuous quality
improvement) that were introduced in an effort to maintain quality with
a reduced workforce did not prevent the inevitable outcome: stressed-out
staff and uncared-for patients.

The Armstrongs argue persuasively that health-care costs are not
escalating in Canada’s publicly managed system. Rather, it is in the
private sector where costs are out of control, pharmaceuticals being a
prime example. One can only hope that the message of this timely book is
heeded.