Healthc Pap
· 2025 Aug · PMID 41125559
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This commentary builds on Jean-Louis Denis' comprehensive review of the Canadian health governance literature to explore three interpretations of its function: as an analytical tool, a guide for structural reform and a s...This commentary builds on Jean-Louis Denis' comprehensive review of the Canadian health governance literature to explore three interpretations of its function: as an analytical tool, a guide for structural reform and a symbolic or divinatory discourse. While the built-in flexibility of the concept of governance enables cross-provincial comparisons in structurally diverse systems, its high level of abstraction risks diluting its practical value. As a guide for reform, the literature struggles to offer cumulative, actionable knowledge. The commentary then examines the possibility that governance discourses serve more to legitimize political decisions than to inform them, functioning rhetorically rather than empirically.
Healthc Pap
· 2025 Aug · PMID 41125558
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Health governance is political as it is tied to goals specific to individual health systems. The best health governance is context-specific. Health governance is a collective practice that involves stakeholders across le...Health governance is political as it is tied to goals specific to individual health systems. The best health governance is context-specific. Health governance is a collective practice that involves stakeholders across levels and sectors. The universality of health governance offers great opportunities for learning across jurisdictions. The view across borders is best at inspiring self-reflection about what is good enough health governance in one's health system. Health governance affords political and administrative crafts(wo)manship, drawing on in-depth knowledge of one's health system, excelling at collaboration and being open to experiences from other jurisdictions as a tool of self-reflection.
Healthc Pap
· 2025 Aug · PMID 41125557
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The governance of publicly funded health systems in Canada has attracted attention for decades. Governance refers to the steering of the whole health system and goes beyond the role of healthcare boards for hospitals or...The governance of publicly funded health systems in Canada has attracted attention for decades. Governance refers to the steering of the whole health system and goes beyond the role of healthcare boards for hospitals or regions. In this article, we analyze the potential of system-level reforms of governance that have been implemented in seven Canadian provinces since 2008. These reforms involve a movement toward greater centralization of the governance of health systems with the creation of province-wide governing agencies. These reforms of governance are not, by design, a panacea nor an absolute policy mistake. The potential of these governance reforms, as with any structural changes, will largely depend on how actors in power inhabit these new agencies and how patients, citizens, non-governmental organizations and communities relate to them. To assess the potential of these reforms, we first review works on challenges faced by these new health authorities. We then explore the literature on high-performing health systems and on contemporary approaches to governance, offering guidance for leaders of these organizations.
Healthc Pap
· 2025 Aug · PMID 41125556
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This issue of HealthcarePapers tackles the challenging question about how to strengthen health system governance in Canada and helps to make sense of the wave of structural reforms underway across the country. The lead e...This issue of HealthcarePapers tackles the challenging question about how to strengthen health system governance in Canada and helps to make sense of the wave of structural reforms underway across the country. The lead essay and commentaries in this issue provide the much-needed empirical and experiential evidence on the intended and unintended effects of reforms to governance, with a focus on the recent wave of centralization of regional authorities across provinces. This issue provides the necessary tools for health system leaders to maximize the potential of these new governing agencies.
Healthc Pap
· 2025 Jun · PMID 40741666
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In reviewing feedback on our article, we are reassured by the unanimity of concern about the current situation. However, there remains much oversimplification about what is meant by "public" and "private," which undermin...In reviewing feedback on our article, we are reassured by the unanimity of concern about the current situation. However, there remains much oversimplification about what is meant by "public" and "private," which undermines clearer thinking and innovation in practice. The confusion that results needs all our efforts to be removed. Canada's health system today holds much-deserved pride and praise. However, preserving and sustaining those accomplishments is in doubt, due in part to drivers of population need and change, which cannot be avoided, and in part to, in our view, somewhat misplaced rigidity and misunderstanding about the current situation and options going forward. We observe greater flexibility and innovation in other high-income countries. We urge learning from those innovations with a more open mind. May these exchanges move us a bit further along that path.
Healthc Pap
· 2025 Jun · PMID 40741665
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Canadian healthcare consistently underperforms. The (1985) is far from ideal, but it has never been the main impediment to system improvement, and updating or replacing it has limited potential to effect transformationa...Canadian healthcare consistently underperforms. The (1985) is far from ideal, but it has never been the main impediment to system improvement, and updating or replacing it has limited potential to effect transformational change. It is impractical to shift from a Beveridge-style tax-funded system to a Bismarckian social insurance approach. Improvement requires better policy, incentives aligned with goals and accountability for performance. The key ingredients are wisdom and courage.
Healthc Pap
· 2025 Jun · PMID 40741664
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Canadian healthcare faces a myriad of challenges. Debates focused on reform often occur within the "public vs. private" paradigm, despite a body of evidence that has largely resolved the issue. Thus, the debate is not on...Canadian healthcare faces a myriad of challenges. Debates focused on reform often occur within the "public vs. private" paradigm, despite a body of evidence that has largely resolved the issue. Thus, the debate is not one of evidence; it is political. Piercing this debate can occur through a return to values, operationalizing them via design and adopting an assets-based approach. Challenges to reform cannot be ignored, including recognizing material realities. No matter what form changes to the healthcare system take, considerable social and political capital will be required for reform.
Healthc Pap
· 2025 Jun · PMID 40741663
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Canada's healthcare system is at a crossroads. After years of declining performance, there is growing pressure to consider more radical changes in the way it is funded and delivered, including increasing the scope of pri...Canada's healthcare system is at a crossroads. After years of declining performance, there is growing pressure to consider more radical changes in the way it is funded and delivered, including increasing the scope of private options. But the Canadian Medical Association's engagement with more than 10,000 physicians, patients and members of the public - through surveys, town halls and focused dialogues - revealed that accessible healthcare, regardless of the ability to pay, remains a bedrock value. We need to continue the hard work of strengthening the public health system to ensure that it meets Canadians' evolving health needs.
Healthc Pap
· 2025 Jun · PMID 40741662
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Canada's public healthcare system grapples with persistent challenges, including long waiting times and limited coverage for essential services. Fierlbeck and Berman propose a "third way" for Canadian healthcare, which i...Canada's public healthcare system grapples with persistent challenges, including long waiting times and limited coverage for essential services. Fierlbeck and Berman propose a "third way" for Canadian healthcare, which involves a greater role for private service provision and private insurance, alongside improved price controls and efficiency measures. While they provide many sensible policy ideas, several critical issues require clarification, particularly the definition of private insurance, the scope of services it would cover and the potential financial impact on low-income populations. Rather than leaning heavily on private insurance and market-based solutions, expanding the public benefits package and reinforcing regulatory frameworks for integrating private capacity would be more equitable and sustainable paths forward.
Healthc Pap
· 2025 Jun · PMID 40741661
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The lead article interestingly suggests that there might be a third way between publicly funded health systems and profit-driven private offerings. Securing the principles of universality and equity underpinning the (19...The lead article interestingly suggests that there might be a third way between publicly funded health systems and profit-driven private offerings. Securing the principles of universality and equity underpinning the (1985) is at stake. However, healthcare cost is growing at a pace that is not sustainable; all the while, our health systems fail to keep up with demand. No matter how useful a third way system may prove to be, can it be a complete and sustainable solution? Deeper societal questions such as universality's affordability may also need to be answered. Built-in forces driving healthcare costs up, such as profit-driven research and development of all kinds, medical science advancement and population needs keep increasing costs unsustainably higher. What should we do? This commentary builds on the lead article to help reflect on the matter. Protecting universality and equity may mean redefining them in order to tame powerful hidden forces at play.
Healthc Pap
· 2025 Jun · PMID 40741660
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The framework for publicly insured healthcare in Canada was established in the middle of the twentieth century with the 1957 and the 1966 . These statutes were consolidated in 1984 as the (CHA) (1985). The key provisio...The framework for publicly insured healthcare in Canada was established in the middle of the twentieth century with the 1957 and the 1966 . These statutes were consolidated in 1984 as the (CHA) (1985). The key provision of this legislation was the stipulation that medically necessary healthcare provided in hospitals, or by physicians, was to be publicly insured. The point was to provide access to medically necessary healthcare independent of the ability to pay. This commentary suggests that the contours of healthcare in Canada have shifted substantially since the development of medicare and that, because of these changes, the CHA (1985) no longer facilitates either accessibility or equity. Owing to the "deep but narrow" provision of healthcare services, key aspects of contemporary healthcare (including pharmaceuticals and mental healthcare) are often not publicly insured. At the same time, because of changes in who provides medically necessary care, and where and how it is provided, many Canadians are increasingly able to access these services independently of public insurance. Somewhat paradoxically, the rigid structure of the CHA (1985) has both diminished access to publicly insured healthcare, on the one hand, and has permitted the emergence of two-tier healthcare, on the other. Achieving better access to, and equity in, healthcare provision will require a fundamental rethinking of the nexus between federal funding mechanisms and the regulatory landscape in the provincial/territorial [ PT] domain.
Healthc Pap
· 2025 Jun · PMID 40741659
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Publisher ↗
There is an overwhelming body of evidence documenting the failure of our health systems in Canada. Also, there are compelling comparative data showing that, despite similar challenges faced by health systems around the g...There is an overwhelming body of evidence documenting the failure of our health systems in Canada. Also, there are compelling comparative data showing that, despite similar challenges faced by health systems around the globe, Canada consistently underperforms relative to its peers on both healthcare quality and health outcomes.
The series of papers in this issue discusses artificial intelligence (AI) for healthcare in Canada, including key milestones and efforts, current trends and future needs for Canada to progress from being a leader in AI d...The series of papers in this issue discusses artificial intelligence (AI) for healthcare in Canada, including key milestones and efforts, current trends and future needs for Canada to progress from being a leader in AI development to responsible and ethical AI adoption that advances the quintuple aim. Three key discussion themes to support this bridge include: datasets, generalizability and equity; efficiency and evaluation; and focusing on the system rather than the product. Partnerships and interdisciplinary teamwork are essential, and the commentaries highlight perspectives from patients, providers and educators. AI for healthcare poses immense potential for both benefit and harm, and Canada has the essential building blocks and shared values to start pushing the balance toward benefit and improve health and well-being across its diverse geography and populations.
Artificial intelligence (AI) has the potential to improve the patient and provider experience, contribute to better health outcomes, and strengthen the productivity and sustainability of health systems and advance equity...Artificial intelligence (AI) has the potential to improve the patient and provider experience, contribute to better health outcomes, and strengthen the productivity and sustainability of health systems and advance equity. Or to do the opposite. A policy lab involving diverse interest holders identified four guiding principles to help tip the balance toward positive outcomes. Participants noted the importance of bearing in mind the unique characteristics of AI as a technology, right-sizing its use, co-designing solutions and ensuring a focus on equity. The paper also includes reflections from an experienced patient partner on how these core principles apply from her perspective.
Northern and rural health systems experience unique challenges and opportunities for adopting artificial intelligence (AI). An embedded AI researcher could help these systems capitalize on existing strengths to better co...Northern and rural health systems experience unique challenges and opportunities for adopting artificial intelligence (AI). An embedded AI researcher could help these systems capitalize on existing strengths to better consider AI use. This professional would collect and manage meaningful health data; bridge the gap between the health workforce and AI tools; and ensure that these tools are adapted to the specific social, economic and cultural needs in the region. Critical research and use of AI tools could advance northern and rural learning health systems to achieve better outcomes while contributing to the global AI agenda.
Artificial intelligence (AI) adoption has progressed unevenly across healthcare disciplines, even for low-risk applications aimed at easing administrative burdens. This commentary examines AI scribes as valuable tools to...Artificial intelligence (AI) adoption has progressed unevenly across healthcare disciplines, even for low-risk applications aimed at easing administrative burdens. This commentary examines AI scribes as valuable tools to reduce administrative workload and improve provider well-being. A two-phase evaluation demonstrated significant reductions in documentation time and positive provider feedback, prompting provincial procurement. Highlighting the need for tailored, inclusive evaluations, we propose a structured approach to support broader AI adoption in primary care, focusing on fit-for-purpose assessments, robust simulations and diverse partnerships. This approach aims to foster equitable AI deployment across primary care settings in Canada, improving access and quality of care.
Appropriate training data are a prerequisite for health AI tools. Policy makers, clinicians and patients can assess the datasets used to train AI models as a practical step in determining whom health AI tools are likely...Appropriate training data are a prerequisite for health AI tools. Policy makers, clinicians and patients can assess the datasets used to train AI models as a practical step in determining whom health AI tools are likely to benefit. Analyses of training datasets can help prioritize which health AI tools to validate and help identify where changes are needed to improve the equity of health AI.
Artificial intelligence (AI) deployed into healthcare settings is touted as an exciting approach for improving health equity. However, several issues need to be addressed before this could be achieved, including improvin...Artificial intelligence (AI) deployed into healthcare settings is touted as an exciting approach for improving health equity. However, several issues need to be addressed before this could be achieved, including improving the collection and use of the social determinants of health data, enhancing data interoperability, closing the digital divide and conducting rigorous assessment and evaluation of AI applications to ensure that they achieve fair and equitable outcomes in real-world settings. Importantly, we should not neglect evidence-based strategies that will truly advance health equity, such as adequate housing, poverty reduction, accessible mental healthcare, food security and many other structural and social determinants of health.
Effective regulations can ensure a minimum level of performance from artificial intelligence (AI) systems. Canadian regulators face two major categories of challenges. First, the AI-specific challenges stem from the unpr...Effective regulations can ensure a minimum level of performance from artificial intelligence (AI) systems. Canadian regulators face two major categories of challenges. First, the AI-specific challenges stem from the unpredictable developments, use, evidence, and acceptable ethical trade-offs around AI systems. These uncertainties can drive the need for flexible definitions of risk, evidentiary threshold, change plan, and post hoc determination of ethical trade-off. These regulatory flexibilities could neglect impactful AI systems, allow regulatory capture, and undermine public oversight. Second, the jurisdictional challenges obfuscate the scope of products, regulatory boundaries, and division of power across regulations. Clarifying regulatory definitions, the responsibilities of professional bodies, and the need for provincial and territorial legislations may help. However, the lack of reason to believe that regulators have clear motivation and capacity to meaningfully protect patient health is worrisome.
Kueper and Pandit (2025) describe potential benefits and harms of technologies that incorporate artificial intelligence (AI), including bias and equity issues, effects on end-users and downstream impacts on quality of ca...Kueper and Pandit (2025) describe potential benefits and harms of technologies that incorporate artificial intelligence (AI), including bias and equity issues, effects on end-users and downstream impacts on quality of care and cost. They advocate for an iterative, life cycle approach in developing and monitoring "trustworthy" AI. Their model suggests that safe and effective deployment of AI requires "training" for end-users but leave ill-defined what such training might entail. The design of learning programs to facilitate safe incorporation of AI into healthcare must be proactive and deliberate and not an afterthought.