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The article discusses the reaction to the planned health care reform in Canada. It claims that there is some room for improvement in the country's health care. It speculates that proposals for reform might focus on improving the efficiency of the care provided, or the timeliness or responsiveness of provision. Related issues are further discussed including the financial architecture of health care systems, the axes of conflicting interests and cost shifting which is implemented in British Columbia's pharmacare program.

The utility of using fish held in cages for investigating the potential effects of industrial and municipal effluents has been demonstrated. These types of exposures are able to control the influence of some confounding factors and also provide a measure of certainty with regard to exposure. However, Canada's current Environmental Effects Monitoring (EEM) Program for metal mines does not accept caged fish as a viable alternative for use in place of wild fish surveys. Concerns appear to be focused on the confounding influences of confinement stress op typical EEM endpoints. Confinement stress may be reduced in smaller-bodied fish relative to larger fish, increasing the relevance of their use for EEM. A standardized technique for deploying small-bodied fish in cages that may be useful for EEM programs is described. [ABSTRACT FROM AUTHOR]

Background: Although expenditures on health care are continually increasing and often said to be unsustainable, few studies have examined these trends at the level of services delivered to individual patients. We analyzed trends in the various components that contributed to changes in overall expenditures for physician services in British Columbia from 1985/86 to 1996/97. Methods: We obtained data on all fee-for-service payments to physicians in each study year using the British Columbia Linked Health Data set and analyzed these at the level of individual patients. We disaggregated overall billing levels by year into the following components: number of physicians seen by each patient, number of visits per physician, number of services rendered on each visit and average price of those services. We removed the effect of inflation on fees by adjusting to those in 1988. We used direct age-standardization to isolate and measure the effect of demographic changes. We used the Consumer Price Index to determine the effects of inflation. Results: Total payments to fee-for-service physicians in British Columbia rose 86.3% over the study period. The increase was entirely accounted for by the combined effects of population growth (28.9%), aging (2.1%) and general inflation (41.4%). Service use per capita rose 10.5%; this increase was offset by a... [ABSTRACT FROM AUTHOR]

Objectives: To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia. Methods: This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97. High users were defined as the most costly 5% of users of fee-reimbursed services. Key variables included age, sex, an ecological socio-economic status indicator and a comprehensive set of morbidity indicators, derived from the diagnoses recorded on the utilization records. Results: The top 5% of users consumed a disproportionate 30% of spending on physician services. High users were overwhelmingly characterized by a significant burden of morbidity. Over 80% had at least six different types of morbidity during the study year compared with fewer than 20% of other users. High users were also much more likely to have major diagnoses that were both acute and chronic in nature. Co-morbidity involving psychosocial and chronic medical conditions was also very common. Conclusions: High users of physician services are overwhelmingly characterized by multiple and complex health problems. Policy tools based on a philosophy of deterrence such as cost-sharing are unlikely to have much impact on their costs and will likely do considerable harm. [ABSTRACT FROM AUTHOR]

Objectives. This article describes Canadian civil servants' awareness of, attitudes toward, and self-reported use of ideas about the determinants of health. Methods. Federal and provincial civil servants in departments of finance, labor, social services, and health were surveyed. Results. With civil servants in finance departments a notable exception, most Canadian civil servants see the health of populations as a relevant outcome for their sectors. Many (65%) report that ideas about the determinants of health have already influenced policymaking in their sector, but most (83%) say they need more information about the health consequences of the policy alternatives their departments face. Conclusions. Civil servants should consider developing accountability structures for health and researchers should consider producing and transferring more policy-relevant research. (Am J Public Health. 2003;93:658-663) [ABSTRACT FROM AUTHOR]

Studies the potential effects of exposure to contaminants with estrogenic activity on wild fathead minnows from a lake experimentally treated with the synthetic estrogen ethynylestradiol (EE2). Addition of EE2 to Lake 260 in the Experimental Lakes Area, Ontario from May to October 2001; Range of EE2 concentrations in epilimnetic waters; Presence of widespread fibrosis and inhibition of testicular development in winnows.

Reports on the modernization of health care system in Canada. Principles and basic structural features of health care organizations; Details of the health care finance system; Changes in the relationship between the federal and provincial governments.

Background: There has been considerable downsizing of acute care services in British Columbia over the past 2 decades. In this population-based study we examined changes in the proportion of elderly people who used acute care, long-term care and home care services between 1986-1988 and 1993-1995 to explore whether the downsizing has influenced use. Changes in death rates were also examined.Methods: The British Columbia Linked Health Database was used to select all British Columbia residents aged 65 years, 75-76 years, 85-87 years or 90-93 years as of Jan.1, 1986 (cohort 1), and Jan.1, 1993 (cohort 2). Each person was assigned to 1 of 6 mutually exclusive categories of health care use reflecting different intensities of use (i.e., hospital, long-term or home care). The proportions of people within each category were compared between the 2 periods, as were the age-standardized death rates.Results: There were 79175 people in cohort 1 and 92 320 in cohort 2. Overall, the relative proportion of people in each use category was similar between the 2 study periods. The most substantial changes were an increase of 2 percentage points in the proportion of people who received no facility or home care services and a decrease of 2 to 3 percentage points in the proportion who received some acute care but no facility-based continuing care. The age-adjusted all-cause death rates for the earlier and later cohorts were virtually identical (15.7% and 15.8% respectively), although the rate increased from 63.6% to 70.1% among those in the "full-time facility with acute care" group.Interpretation: Overall changes in health care use were small, which suggests that the repercussions of the decline in acute care services for elderly people have been minimal. The higher age-adjusted death rates in the later cohort in full-time care suggests that long-term stays are becoming reserved for a sicker group of elderly people than in the past. [ABSTRACT FROM AUTHOR]

Assesses public health services in Canada. Features of the country's health care system; Comparison between the health care financing policies of Canada and the United States; Ways by which the financing system in the country has influenced system behavior and organization; Sources of funds for financing the nation's health care system; Role of the provincial government in making decisions related to health care; Rules governing patients' private payment for medical or hospital care; Historical origins of the Canadian health care funding system; Laws governing public health insurance in the country.

Discusses the rapid growth in expenditures on prescription drugs in Canada. Factors contributing to shifts from old to new products; Criteria for "breakthrough," "me-too," and "vintage generic" drugs; Methods used in the study which took data from the annual reports by the Canadian Patented Medicine Prices Review Board to explain the 80% increase in drug expenditure in British Columbia between 1996 and 2003; Finding that increased spending is on new drugs introduced in established chemical subclasses.

The article discusses the challenges facing Canadians who study medicine abroad. Topics discussed include majority of Canadians who study medicine abroad were unsuccessful applicants to medical schools in Canada, the requirement for those with a foreign medical degree to complete the Medical Council of Canada Evaluating and Qualifying Examinations (MCCQE), a two-year Canadian residency training and policies limiting the number of postgraduate training opportunities for Canadians.

Elevated concentrations of Se have been detected in cold, flowing water habitats near uranium and coal mines in Canada. Fish from these systems have concentrations of Se in their tissues that exceed toxic effect thresholds that have been established for warm-water fishes. However, the applicability of toxic effect thresholds and guidelines to cold water, lotic habitats is a matter of contention in the literature since most cases of Se toxicosis have been documented in standing, warm-water systems. To examine the possibility of impaired reproduction in wild rainbow trout (Oncorhynchus mykiss) and brook trout (Salvelinus fontinalis) near coal mining activity in the northeastern slopes region of Alberta, Canada, spawn from both species were collected from exposure and reference sites. Gametes were fertilized in the laboratory, reared to the swim-up stage, and examined for deformities. A significant relationship was observed for rainbow trout between the amount of Se in eggs and the incidence of developmental abnormalities, specifically craniofacial defects, skeletal deformities, and edema. These associations approximate exponential functions with probabilities that 15% of the population would be affected occurring between 8.8 and 10.5 µg Se per gram of wet egg weight, based on probit analysis. These relationships are similar to those described for centrarchids inhabiting a seleniferous warm-water lake. No such relationships were established for brook trout. [ABSTRACT FROM AUTHOR]

To examine the extent to which Canadian residents seek medical care across the border, we collected data about Canadians' use of services from ambulatory care facilities and hospitals located in Michigan, New York State, and Washington State during 1994-1998. We also collected information from several Canadian sources, including the 1996 National Population Health Survey, the provincial Ministries of Health, and the Canadian Life and Health Insurance Association. Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home. [ABSTRACT FROM AUTHOR]

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of "physician shortages," that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again., (Copyright © 2014 Longwoods Publishing.)

Clyde Hertzman's sudden and untimely death was a terrible blow to those who knew him. It was also a major loss to health research and policy in canada and well beyond. He was an outstanding public academic, at the top of his intellectual game. here i attempt a highly selective and personal account of how he developed the conceptual framework that he called "the whole enchilada," of the social context influencing both biological and behavioural development from earliest infancy. From these roots spring our life trajectories, evolving social gradients of more--or less--successful experience at each life stage. the international performance of a society reflects the sum of these trajectories. Canada could do much better, but not in Harperland., (Copyright © 2013 Longwoods Publishing.)

Chappell and Hollander "offer an evidence-based policy prescription to meet the challenges …[of] an aging society." The fallacies of apocalyptic demography are briskly dismissed; their message is that decades of solid evidence support the critical importance of an integrated system of continuing care for the chronically ill elderly, both health services and home support. But the paper loses focus with discussions of "ageism", the compression of morbidity, and healthy communities. The authors might have explored why (as they argue) public policy has retreated from their prescription in recent decades. That prescription would require either a re-allocation of resources (incomes) away from politically well-entrenched interests, or simply more money. Neither appears currently promising.

The book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations represented a milestone in our evolving understanding of the determinants of population health. Building on Marc Lalonde's earlier A New Perspective on the Health of Canadians, it created a theoretical framework that could incorporate emerging evidence from a wide range of disciplines. Central to its authors' approach was the observation of heterogeneity, of the systematic differences in health observed when populations are partitioned on characteristics such as income, education, geographic region, etc. The universal observation of a social gradient, of a strong correlation between socio-economic class and health, led to a focus on how the social environment might influence health. Social position strongly influences both the stresses to which individuals are subject, and the resources available to cope with them. Furthermore, healthy and unhealthy responses to stress become "embedded", learned or conditioned both behaviourally and biologically, thus influencing health over the whole life course. The book's impact has been remarkable, not merely in academic citations but through its authors' subsequent work and strategic positions in Canadian health research organizations. The concept of "Population Health" has become part of our shared intellectual heritage.

Background: Previous studies of infliximab in psoriasis have demonstrated rapid improvement with induction therapy and sustained response with regularly administered maintenance therapy., Objective: The efficacy and safety of continuous (every-8-week) and intermittent (as-needed) maintenance regimens were compared., Methods: Patients with moderate-to-severe psoriasis (n = 835) were randomized to induction therapy (weeks 0, 2, and 6) with infliximab 3 mg/kg or 5 mg/kg or placebo. Infliximab-treated patients were randomized again at week 14 to continuous or intermittent maintenance regimens at their induction dose., Results: At week 10, 75.5% and 70.3% of patients in the infliximab 5 mg/kg and 3 mg/kg groups, respectively, achieved PASI 75; 45.2% and 37.1% achieved PASI 90 (vs 1.9% [PASI 75] and 0.5% [PASI 90] for placebo; P < .001). Through week 50, PASI responses were better maintained with continuous compared with intermittent therapy within each dose, and with 5 mg/kg compared with 3 mg/kg continuous therapy., Limitations: Longer term (>1 year) maintenance therapy and further study of infliximab serum concentrations over this period, in both PASI 75 responders and non-responders, would be preferable., Conclusions: Through week 50, response was best maintained with continuous infliximab therapy. Infliximab was generally well-tolerated in most patients.

Introduction: Beginning in 1992, governments throughout Canada began reducing expenditures in an effort to eliminate fiscal deficits and reduce their alarmingly high debt burden. As part of this deficit-fighting era, governments reduced hospital expenditure levels quite dramatically. Some of the current problems in the Canadian healthcare system - the recent unrest in the nursing labour market in particular - are often attributed to this hospital downsizing era., Methods: This article examines trends in the labour market for registered nurses in Canada during the hospital downsizing period. Of particular interest is the effect of hospital spending reforms on nurse employment levels in hospitals and on the age structure of the nursing workforce. After identifying the trends, the main factors driving the trends are discussed., Results: Results indicate that a decrease in the demand for nursing labour resulted in large staff layoffs during the restructuring period, particularly among the youngest age groups., Discussion/conclusion: The evidence does not support the claim that deteriorating wages and working conditions in hospitals led nurses to quit their jobs during the hospital downsizing period.

The authors' 1990 article "Producing Health, Consuming Health Care" presented a conceptual framework for synthesizing a rapidly growing body of findings on the nonmedical determinants of health. The article received a very positive response, and here the authors reflect on what lessons might be learned from that response about the style or content of effective interdisciplinary communication. Much substantive knowledge has been accumulated since 1990, and a number of different frameworks have been developed before and since. The authors situate theirs within this literature and consider how they might have modified it if they "knew then what they know now." They ask what impact this article, and the much broader stream of research on the determinants of health, has had on public policy?