Health care is the most hotly debated public policy issue in Canada. There is no question that, whatever results, the current debate will have a significant impact on the Atlantic region.

In an effort to allow people to explore this issue for themselves AIMS has constructed this resource page on health care. Here you will find a direct link to AIMS major project called Health Care’s Hidden Face: The Private Sector and its Relationship with Medicare. By following that link you can take a direct part in our ongoing research by reading and commenting on a series of working papers related to health care.

In addition to this innovative step, AIMS has also made available here a wide range of material, including our Sir Antony Fisher Award winning piece Operating in the Dark, media reports, commentaries, public presentations, and links to other sources of information and analysis.

Books and Major Research

Public Health, State Secret
This is AIMS’ most recent report on the state of Canada’s health care system. The study demonstrates that politicians and senior health officials simply don’t know where or why medicare is failing because they still lack the proper tools to evaluate the quality or timeliness of the care Canadians receive. More to the point, the authors demonstrate why, under the current system, it is not in the government’s interests to know what is really happening in health care.
Swedish Health Care in Transition
How to improve health care delivery and manage health care costs are central themes in public policy debate in Canada today. It is not only Canada that faces these challenges, however, and we need not only look to ourselves for solutions. In AIMS’ latest commentary series we look at Swedish Health Care in Transition. The author, Johan Hjertqvist, is a senior advisor to the Greater Stockholm Council on health care reform. Mr. Hjertqvist is also director of “Health in transition”, a four-year pilot project whose objective is to describe and analyse the operation of a competitive market within the public system. Click this link to see the entire series, which is a collaboration between AIMS and the Frontier Centre for Public Policy.
Health Care’s Hidden Face
This is an interactive research project of AIMS’ meant to examine how and why the frontier between public and private medicine has shifted over time within Canada and elsewhere, including when and under what circumstances such shifts have been beneficial in terms of access and quality of care. Click this link to explore the research underway.
Operating in the Dark: The Gathering Crisis in Canada’s Public Health Care System (requires Adobe Acrobat Reader)
This study garnered considerable attention when it was published in November 1999 for its argument that the health care system could not be properly managed because managers and policymakers did not have access to vital information about the system’s performance. The paper also argued that if Canadians wanted to preserve the key elements of the system, and particularly a tax-financed approach that did not distribute medical care on the ability to pay, then greater private sector participation in health care provision was virtually unavoidable. Follow this link to consider the implications of this study more fully.

 AIMS Commentary

The Mazankowski health care report: a personal view. AIMS President Brian Lee Crowley is a member of the Alberta Premier’s Advisory Council on Health, chaired by former Deputy Prime Minister, Don Mazankowski. The Council’s recent report (the “Mazankowski Report”) on the future of health care in Alberta, released in January, has garnered national attention and is deeply influencing the debate about future directions for medicare in every province. At the request of the Conference Board of Canada, Crowley recently attended their Leaders’ Roundtable on Health, Health Care and Wellness in Toronto, where he recounted his experience on the Advisory Council, and sketched out his views on where health care reform is headed. To read “The Mazankowski Committee Report and the Future of Health Care in Canada: A Personal View”, click here.

The Mazankowski Report on Alberta health care: the AIMS connection. On 8 January 2002 the report of the Alberta Premier’s Advisory Council on Health was released. Chaired by former Deputy Prime Minister Don Mazankowski, the Council’s groundbreaking report has generated a tremendous amount of discussion across the country and the political spectrum. Within 24 hours of the release of the report, there were 16,000 hits on the website to download the report, and 4,700 to download the appendices. Within days of its release, the government of Alberta had to print a second run of the report as they were running out of hard copies.

AIMS President Brian Lee Crowley was a member of the Council, in recognition of the innovative public policy work done by AIMS in the health care policy field. Two AIMS projects proved to be particularly helpful to the Advisory Council in its deliberations. The new AIMS research report, Public Health, State Secret, more fully explores many of the themes and arguments that are presented in the Alberta report. Health Care’s Hidden Face, an ongoing interactive research initiative of AIMS, supplied valuable background and comparative information that was fed into the Alberta process.

The report is available at

Two Keys to Excellent Health Care for Canadians – Dr. David Zitner, AIMS Fellow in Health Care Policy, and Brian Lee Crowley, AIMS President, have made a submission to the Commission on the Future of Health Care chaired by the Honourable Roy Romanow.

The submission outlines the conflict of interest arising from government acting as health services insurer, as health care provider and as evaluator of health care delivery and suggests that these functions need to be separated. The authors also recommend that regulators require health organisations to collect and publicise valid and reliable information linking health outcomes to their activities, and also provide reliable information about access to care. They close with a discussion of the need to assess proposals to change health care by tying them to a testable estimate of how the new structures and processes will influence access to care or patient and/or population health.

Don’t Close the Shutters
David Zitner and Brian Lee Crowley analyse some recent proposals to protect the privacy of individual medical records, and find that they would greatly increase the cost and reduce the efficacy of medical research while conferring little benefit in terms of additional privacy. They recommend a less draconian solution, one consistent with the community’s need to maximise its knowledge about its own health and the effectiveness of various medical procedures. Originally published in The Medical Post on 11 January 2000.

How Politics and the Economy Affect Risk Management and Ethics in Health Care. On 24 November, 2000, AIMS President Brian Lee Crowley addressed the Nova Scotia Association for Quality in Health Care. Crowley addressed an order of medical ethics beyond that normally covered in such talks. He described the significant impact political and economic considerations have on the central decisions about the design and delivery of health care in Canada. Decisions that we as a society make about how to administer the health care system, who shall have access to the system and under what conditions, what share of the national wealth should be devoted to health care, and who should be entitled to establish policies about access to care.

Talks and Presentations

David Zitner on CBC Radio
AIMS in the Media

Health care: competition and the single payer
Provinces now pay over 85 per cent of the cost of increasingly costly public health care. This burden is inevitably driving governments to adopt an attitude of ever-greater neutrality between public and private suppliers of health care within our single-payer system. In this column, AIMS President, Brian Lee Crowley, explains the benefits to be gained when provincial governments act as purchasers of health care services on behalf of their citizens. Governments will soon buy health services wherever they can get the best quality and best access at the lowest price. Neither public nor private providers will get preferential treatment, and the general public will get better quality, more accessible health care because of it.
Publication: CHH & MTT & VS & CH & OC, January 30, 2002
Debate on health care reform: no end in sight
In his regular Chronicle Herald column AIMS President Brian Lee Crowley explores the reasons why the debate on health care will take on greater and greater importance in the coming years. Most people are aware that health costs are going up, but few realize that the rate of growth is about to accelerate massively. New technologies, the increased incidence of chronic and new illnesses, and the significant cost of system renewal will force giant leaps in health costs in coming years. While starving funding for education and roads can provide some measure of short-term relief, the pressure is building. The tax system alone will not be able to handle these costs and a new balance of public and private expenditures will have to be found and the debate has barely even begun.
Publication: CHH, September 12, 2001

Health care system needs Swedish massage
Indifferent service, long waiting lists, poor management, low employee motivation, low pay and widespread recruitment difficulties – a description of the situation in Canada’s health care system? No, this is what the Swedish health care system used to look like. With the break-up of the public monopoly and an increase in the number of both public and private suppliers of health services the Swedish system now offers better health care with the same or lower costs. Swedish nurses, doctors, unions and industry all agree that the increase in independent health care organizations offers Sweden very large gains over the public monopoly model. According to AIMS President Brian Lee Crowley, this Swedish massage is just what the doctor ordered for Canada’s ailing health care system.
Publication: CHH, June 20, 2001

Health care debate, heal thyself
AIMS President Brian Lee Crowley questions the quality of the health care debate during the federal election campaign. At a time when all the indicators show us a medicare system with unsustainable patterns of spending growth, and new trends are about to hit that will force up spending again, the federal party leaders are still insisting on focussing the debate on side issues like whether people are queue jumping or where party leaders have got their health care.
Publication: CHH, November 22, 2000

Solving Nova Scotia’s health care problems with Newfoundland’s money
Nova Scotia Premier John Hamm has a solution to his health-care crisis — take tens of millions of dollars from Newfoundland’s transfer payments and give it to Nova Scotia. A fine strategy for Nova Scotia, but something that Newfoundland Health Minister Roger Grimes might find a tad unacceptable, says Peter Fenwick in his new Telegram column.
Publication: ETSJ, October 16, 2000

Dr. Hamm misdiagnoses our health-care ailment
According to a recently released Dalhousie study Nova Scotia’s health indicators are worse than those of many other provinces. That, says Dr. Hamm, means Nova Scotia should get more – up to 15 per cent more – in health-care funding from Ottawa to close the “health gap” with the rest of the country. Yet the real disease is poor management of the health-care dollars we’re already spending, a fact that comes through clearly when you compare the provinces’ health-care performance more carefully than the premier has done.
Publication: CHH, October 11, 2000

What we don’t know about health care
In an op-ed piece that originally appeared in the National Post, Dr. David Zitner of Dalhousie University and AIMS President Brian Lee Crowley argue that our health care problems stem chiefly from lack of information, not money.
Publication: NP, April 3, 2000.

Alberta’s health experiment could provide valuable answers
Is it right to say that Premier Ralph Klein’s proposals to allow overnight stays in private medical clinics in Alberta constitutes a fundamental challenge to medicare? AIMS President Brian Lee Crowley argues that, on the contrary, it is no more than a timid extension of some already widely-accepted principles of this country’s health care system.
Publication: CHH & TJSJ & SJT, March 15, 2000.

The best prescription for our ailing medicare is in Europe, not the U.S.
Our myopic fear of Americanizing our health care system blinds us to the many constructive reforms to publicly-financed health care that Europeans have introduced in recent years in response to the same sort of challenges our home grown medicare faces.
Publication: CHH December 26, 1999; SJT, January 9, 2000. By Nancy Faraday-Smith.

AIMS Events

Patient Power and Provider Competition: Is the Swedish Health Care Approach Right for Canada?

Center for Health Economics, University of York, UK
Swedish Institute for Health economics
York health Economics Consortium
David Gratzer on Health Policy Reform
University of Guelph
Alliance for Health Reform – US
Health Canada on-line
Capital District health Authority
Your World of Health Information – [email protected] Site
The Nova Scotia Hospital and Capital District Mental Health Program
Queen Elizabeth II Health Sciences Centre
IWK Health Centre
Dalhousie University School of Medicine
Nova Scotia Department of Health
Health Canada
Canadian Cancer Society
Canadian Mental Health Association
Heart & Stroke Foundation of Canada
Alzheimer’s Society of Canada
Canadian Blood Services
Canadian Red Cross
College of Physicians & Surgeons of Nova Scotia
Dalhousie University – Population Health Research Unit
Medical Informatics, Dalhousie Medical School
Computer Literacy and Electronic Medical Files
Communications Needs of the Physicians of Nova Scotia
Presentations on Medical Informatics