Provinces, territories and U.S. state governments face many common challenges in delivering health care, but for the most part, they’ve had only their own experience to guide decisions. There’s been no academically rigorous way of comparing performance with other systems across the continent, or understanding how they can learn from experimentation in other places. That’s about to change with the creation of the North American Observatory on Health Systems and Policies (NAO), to be housed at IHPME. It will generate “policy learning” by responding to requests from health system decision makers, as well as pursuing grants for conducting curiosity-based comparative research.
Gregory (Greg) Marchildon, Professor and Ontario Research Chair in Health Policy and System Design at IHPME, will be answering the call when ministries and state departments of health need quick, accessible comparative research and analysis. It’s a role he’s familiar with. In addition to a background in academia, he’s also served as a deputy minister and cabinet secretary in the government of Saskatchewan, and as Executive Director of a federal Royal Commission on the Future of Health Care in Canada (the Romanow Commission).
As founding director of the NAO, he will tap into a network of other scholar practitioners in the U.S and Canada. When a request is received, a rapid response will be delivered within one to two weeks, consisting of an environmental scan, literature review and policy briefs. IHPME faculty member Jay Shaw will serve as head of research and Alexandru Titeu is NAO’s research officer.
Research findings to be widely shared
The rapid response team will eventually include between 30 and 40 researchers in the U.S and Canada, covering a range of expertise. Those selected for a particular query would deliver a rapid response, and then later publish more extensive findings after further research into the topic. “This will produce relevant policy analysis that is accessible to a non-academic audience. Rather than beginning with a research question, it is more focused on solving a problem,” says Greg.
Hundreds of other researchers will engage with the NAO through grant applications that will bring academic rigour and methodology to comparing outcomes among various jurisdictions. These findings will be made widely available through a website. Already, this process has resulted in one major research initiative — a comparative policy analysis of programs supporting people with dementia and their unpaid caregivers in three provinces and two U.S. states.
The North American trend towards decentralization
The NAO’s goal of comparing health system performance in Canada, the U.S., and eventually, Mexico is based on successful models of health observatories in Europe and Asia, with some key differences. “In North America, the most useful comparisons are at the sub-national level. In other parts of the world, comparisons between countries are more common,” says Greg.
For various reasons, the time is right for increased comparison and collaboration in North America. In the United States, the Affordable Care Act has been a force for decentralization and greater local decision making. Even if the future of the legislation is uncertain, Greg points out that state governments increasingly see themselves as stewards of health systems, a trend that is unlikely to be reversed. While Canadians may see stark differences in U.S. political rhetoric on health care, the reality on the ground is that differences are not so pronounced. “In some states, with recent expansions in Medicaid, there is a higher proportion of public spending on health care than in Canadian provinces. There are also policy experiments happening in the U.S. that could be of great benefit to Canada.” Mexico is also moving towards decentralization, though they are moving from a place of highly centralized decision making to begin with, when compared to the U.S. and Canada.
International partnerships and a world of ideas
The NAO will create partnerships with its observatory counterparts in Europe and Asia to provide North American provinces, states and territories with exposure to ideas from abroad. “If they want comparisons with individual countries, or insights on an overseas initiative, we’ll be able to help with those questions,” says Greg. European initiatives which are already catching the interest of some provincial governments include the setting of health system performance and outcome targets as well as activity-based funding for hospitals.
Broad, diversified and self-sustaining
The NAO is already making plans for an annual Canadian health summit, to be held at the University of Toronto, which will report on the health system performance of provinces and territories. The goal is to someday also organize a North American summit. Greg points out that a major strength of the observatory approach is that the institution is self-reliant and does not depend on government funding. “The NAO will provide a systematic approach to disseminating immediately useful and relevant policy analysis in a way that is robust, diversified and self-sustaining,” he says. “This is policy learning — examining structures and policies that have proven to be effective and exploring how they might be adapted and refitted to work in environments which may have very different financing, administrative approaches and political cultures.”
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