SPPH 304 Final Exam Short Answer Practice Questions PDF

Group Discussion Short Answers 1. Although sold as a means of fostering “tailored solutions” and “regional innovation” in health care, bilateral agreements necessarily exacerbate differences in health care access and quality across Canada. That is because they fund whichever programs ar...

Group Discussion Short Answers 1. Although sold as a means of fostering “tailored solutions” and “regional innovation” in health care, bilateral agreements necessarily exacerbate differences in health care access and quality across Canada. That is because they fund whichever programs are a priority of each province or territory, without clear national standards and mechanisms of accountability. Describe two reasons why a federal government might wish to embrace bilateralism even if it has these kinds of drawbacks. Tie each reason back to lessons from this course. Two sentences per reason should suffice. Reason 1: would be because it is politically easier. There are many governments, federal or provincial, which are quite constitutionalist in their ideals and therefore think that healthcare is a provincial jurisdiction so other than providing funding, provincial governments should have full scope over what to do. There are already province-federal tensions over jurisdictions power, so giving into bilateralism is less politically costly. Provokes less provincial opposition regarding federal interference. Reason 2 is that bilateralism is quicker. Trying to achieve agreements federally is very time costly, and this way even if there are issues, some influential change is able to be implemented fairly quickly, if it is in the hands of each province individually. Reason 3 would be that the federal government is favoured in public opinion as it is able to take credit and looks like it is taking lead. It seems like the federal government is still attaching some strings to the money allocated and therefore still playing some sort of federal role in healthcare, which is often what many governments promise to do when trying to get elected. 2. Think about what primary health care in BC really and truly should (and could) look like in 10 years. Be visionary but pragmatic. What is the big difference between your vision and PHC today? Describe that difference in no more than three sentences. Perhaps one sentence describing your chosen characteristic of PHC as it is today, one sentence describing what that characteristic of PHC could look like in 10 years, and one sentence describing why that change is important. What is the most important institution (formal or informal) that must be dismantled or restructured to achieve your vision? Do this part in one or two sentences. ○ Primary healthcare in ten years should be a model full shifted to interdisciplinary, community care centers with a large focus on preventative health, perhaps even more so than treating diseases ie primary care. Though such centers exist in Canada, they do so in very little capacity with the majority of care clinics and overall care provided still entirely physician centric. This vision is instead a radical change approach, as slow changes that we have relied upon are clearly not effective in the Canadian healthcare system as outlined by Aggarwal et al. ○ As Hutchinson outlines, formal institutions are teh key barrier and the most significant barrier to outcome would be the reliance of physician-primary centric care models which exist. Although these are encased in great formal institutions  it is equally encased in informal institutions imposed by the ideas of what canadians are used to when they seek primary healthcare. Such radical changes must confront the institution of independent, private practice at once and not in incremental steps. There is great corporatization of primary care through commercial ownership and clinics, virtual care platforms and even artificial intelligence. To implement such a change we would require a radical reform in ownership and governance which is often only brought upon by a special kind of political leadership. 1. Levels, Trends, and Determinants of Health Care Spending 1. What is the total amount spent on health care in Canada, and what is the largest component of this spending? The total amount of health care spending in Canada is 343 billion a year. This is composed of various sectors, the largest components of which are hospital care, long term care, pharmaceutical spending and physician services. The largest component of this is spending on hospital care. However, it should be noticed that recent spending in pharmaceutical care has been rising faster than any other sector. Furthermore, spending on long term care is also rising by a noticeable but small account. Hospital costs covers inpatient and outpatient care, emergency services, and specialized treatments Drug costs includes the cost of prescription medications, vaccines and other medical supplies Long term care spending includes services provided in nursing homes and other residential care facilities. Physician payment services for care include consultations, surgeries and specialized treatments 2. Explain the difference between trends in health expenditures adjusted for population growth and general inflation and trends in health expenditures as a percentage of GDP. In terms of overall growth, total health care spending has steadily increased in Canada in the post-war era. Adjusting for population growth and general inflation, the increase has been particularly noticeable after the mid 1990s, with rapid growth from the 1997 to 2010. Inflation-adjusted per capita health care spending declined during the 1990s before assuming an upward trajectory. Spending as a percentage of GDP has risen significantly, from 2% por war to 12% in 2023. This reflects an increase in healthcare expenditures and a slower growth of GDP. Hospitals: A contraction in 1990s, increased rapidly in the 2000s but remained flat post 2010. Pharmaceutical: Grew faster than any othe rcomponent from mid 1990s to 2010s but remained flat since.  Long Term Care: Growing gradually since 1970s Physicians: Flat during early 1990s, grew significantly till 2015, flat since. 3. Describe how aging affects health care spending in Canada, including a significant factor that contributes to this trend. Aging has a small but noticeable impact on healthcare spending in canada. Since the 1980s, this cost has been increasing but only by 1% which is quite small. Spending per individual increases from ages 60-80 due to increased need as they approach end of life stages. Population as a whole is aging more slowly. More than age, we should care about cost of dying. As people are living longer, the cost of dying is decreasing which is the compression of morbidity. We should instead me looking at average utilization of services and technologies and the average cost of those services. 4. What does the concentration of health care costs mean in terms of the distribution of health care spending in Canada? Concentration of costs refers to the phenomena that a small part of the population 20%, account for 80% of the costs. It also says that there is a high likelihood that those who remain in the top 20% of healthcare users in terms of cost have an 80% chance they will remain there for their entire life. 5% of the population with the highest healthcare spending need, account for 50% of the total spending. 5. How does the persistence of health care costs among the top 20% of health care users impact the overall health care system? This has implications for policy planning. It suggests that targeted interventions for high cost individuals could be better than broad based policies. 2. Efficiency and Wait Times 1. What is the key difference between the instrumental and comparative constructs of efficiency, as defined by Stone? Stone describes efficiency as a complex construct which is dependant on many measures. One such measure is instrumental construct of efficiency. This refers to the method of producing a specific output with the least amount of inputs. However, if the wrong output is achieved then true efficiency is not accomplished. Comparative constructs of efficiency outline that efficiency is not inherent rather defined by comparing different methods of producing the same output. She also says efficiency is contestable which means that the selection and valuation of certain outputs and inputs are contestable and open to debate 2. What are the challenges in health care markets that violate the assumption of voluntary exchange, particularly in relation to patients’ ability to decline necessary care? For healthcare markets to be free the following assumptions must be true; ○ Voluntary exchange - this is however not true as many times patients do not have the choice or ability to decline or defer use of necessary healthcare  ○ Rational, well-informed consumers - this is also not true as medical professionals are often the gatekeepers of medical information which is complex, incomplete and asymmetrically held and consumers or patients do not understand what they might need ○ Externalities and altruism - this is also not true as it assumes others healthcare choices have no impact on your health and indirect impacts on wellbeing which is simply not true. ○ Budget constraints - this is also not true as neither patient nor provider are responsible for the full cost of treatment decisions 3. How does the "urgency" of a condition differ from "severity" in the context of wait times, and why is this distinction important? Severity is the extent, degree or intensity of suffering to which the illness causes threat to life or limits activities Urgency is severity plus the added benefit of treatment given the natural progression or history of condition Need is closely related to urgency not severity as a patient does not need a treatment that will not help them Priority is a combination of urgency and social factors which can influence prioritization of treatment 4. What is the difference between a "benchmark" and a "target" in the context of health care wait times, and why are both important? Benchmark is all the recommended maximum wait time for specific condition and level of urgency Target is a percentage of patients aims to be treated within the benchmark time Guarantee is a commitment that all cases will revive care within a specified time frame, regardless of circumstances - can be worrisome in health care 5. How does the decentralization of wait time management in Canada affect its ability to address wait times for elective procedures? Wait times are managed in various different ways. While Canada does relatively well in wait times for urgent procedures, the wait times for elective procedures and not as great. The decentralization of wait time management in Canada leads to inconsistent performance across provinces. This results in an uneven approach to addressing wait times, with some provinces struggling more than others to meet wait time targets for non-urgent procedures. 3. Interests and Pharmacare 1. What role do beliefs play in shaping policy interests, and how do they influence mobilization around policy issues? Beliefs play a role in the subjective and objective understanding of needs and interests. Beliefs matter just as much as reality - people can be conscious or unconscious about their beliefs  People's beliefs can shape how they view problems and solutions, affecting their priorities and policy goals. Beliefs also influence mobilization around policy issues. Mobilization is dependent upon needs. People are loss aversive and are more likely to mobilize if they are reducing loss than gaining benefits. Mobilization is also more likely when there are concentrated interests, small group - largely shared idea, vs with diffused interests, big group - less strongly shared idea. Winners of policies are often less likely to mobilize. Issue framing also matters - actors frame issues to leverage good vs bad narratives 2. How does the concept of "intersectionality" affect the way individuals perceive their policy interests? People often have group based interests - group identities - things that would benefit their group. However intersectionality occurs when a member is in multiple groups and if the interests of those groups are not aligned and clash, there can be complications in understanding interest regarding policies. 3. Describe the difference between self-interest issues and general-interest issues in the context of policy mobilization. Self interest issues are raised bottom-up by affected actors usually about things that concern the individual Often related to business or profit General-interest issues are raised top down usually by political entrepreneurs who advocate for policy changes about interests that concern society as a whole Vulnerable interest issues such as healthcare or social welfare are usually raised by champions 4. What is the "free rider problem" in relation to public policy, and how does it impact the mobilization of support for public goods like pharmacare? The free rider problem concerns the concept that those individuals who do not contribute anything to the society can still benefit from the contributions of others. This issue arises when people take advantage of public goods and for pharmacare this can hinder collective action and make it difficult to garner broad support, resulting in overall lower mobilization 5. What has been a major barrier to implementing universal pharmacare in Canada, according to the Morgan and Boothe paper? There are various barriers to the implementation of pharmacare. One reason is because the constraint of existing institutions, complex federation the constitutionalist nature of healthcare, the disagreement with provinces - Quebec’s move in 1997 Another reason is because of pharmaceutical and insurance company lobbying both industries that stand to lose money in national pharmacare Another reason is because of the 1% who have politicised tax and are themselves concerned about raising taxes and government spending  Lastly, a patchwork of provincial initiatives already cover various marginalized populations which makes mobilization difficult. 4. Primary Care and Primary Health Care 1. How does "primary care" differ from "primary health care," and why is this distinction important? Primary care is the provision of first contact services for the treatment of disease and providing basic health services, primary health care is a far broader idea that encompasses the entire health system of services designed which includes prevention of diseases, promote health and treat disease with an emphasis on community based care that addresses social determinants of health This distinction is important as we should be discussing and striving towards good primary healthcare a practice beyond simplify treating patients as they come in. It even includes education and health promotion. 2. What are the key features of the WHO’s Alma-Ata Declaration concerning primary health care systems? Important for achieving health for all - recognizing right to health as fundamental right Promotes physical, mental and social well being Care that is universal and affordable, available, accessible and appropriate Care that focuses on treating illnesses and preventing of diseases Care that is specific to the needs of communities and underserved populations Should provide continuity and coordination of care with interdisciplinary teams addressing full spectrum of health determinants Equitable comprehensive and community cenetred care 3. Why did many of Canada’s primary care reforms in the late 20th century fail to result in system-wide transformation? In the 1970s, new delivery models such as CLSCs and CHCs were introduced. In the 1980s, non-physician providers integrated into certain settings, regionalization of governance began, but funding for providers was not restructured In the 1990s, there were many pilot projects, but few reforms led to lasting transformation By 2000s and 2010s, there was significant finding to incentivize team-based care models, access, patient attachment but structural changes rexamined incremental and fragmented and focused on primary care rather than primary health care 4. What are the major barriers to implementing comprehensive primary health care reform in Canada, according to Hutchison's thesis? Aggarwal and Williams say system integration and accountable governance were overlooked  Institutional barriers in the form of over reliance on physicians as per the Canada Health Acts focus on physician provided care, canada's complex federation as per the constitution which requires the lacking FPT agreement Favouring of small incremental changes rather than radical systematic change Ideas matter - professional and political ideologies of stakeholders such as physicians maintain a status quo 5. How has the COVID-19 pandemic influenced primary health care delivery in Canada? Introduced a rapid expansion of virtual visits which come with their own issues that complicate primary health care as they challenge traditional in person interactions Accelerated adoption of EHRs and digital health information systems Increased investment in team-based care models and health networks Gradual shift in ideation in health professionals and health leadership towards integrated and digital approaches to care Highlights challenging of integrating these changes into current PHC system 1. How does the concept of "path dependency" explain the incremental nature of healthcare reforms in Canada? In what ways does path dependency affect the structure and delivery of primary care in Canada? Path dependency refers to the concept that past policy decision influence likelihood of present and future policy decisions. Shape and constrain future policy choices making major policy shifts difficult This means that due to previous institutions future policy decisions are constrained which explains why PHC reforms never put forth radical change but instead are incremental and small in nature Radical changes under path dependency are both politically and financially costly Medicares foundation was physician provided and hospital provided caere and sue to that it has been difficult for the PHC system to move beyond it in Canada and only use incremental changes like promoting team bas ed care in small moves 5. Dimensions of Health Systems 1. Explain the role of financing in health systems and how it affects equity, efficiency, and quality. Concerns how healthcare funding is collected, pooled and allocated Healthcare financing is concerned with the pooling of money to fund healthcare. They concern who pays for healthcare, how much and to who. This determines who pays for healthcare, how the financial burden is distributed and how resources are managed within the system It is an important dimension of healthcare and in turn impacts the equity, efficiency and quality of the system as well as implications for healthcare delivery. Financing mechanism also impact health system equity and efficiency: ○ Progressive financing, regressive financing or neutral financing. ○ Also centralized financing vs fragmented financing  2. What is the difference between "public" and "private" delivery in health systems, and how does this impact system outcomes? This has to do with whether healthcare is publicly administered or whether physicians and healthcare providers practice privately, acting as business owners. Public delivery is state owned hospitals or government funded institutions where accountability is directed towards the public or elected officials Private delivery is care provided by privately owned businesses or organizations including for profit entities where providers are accountable to their owners, shareholder, focusing on profitability and organizational goals Whether delivery is public or private has implications for the equity, efficiency, quality and accountability of care provided. 3. How does the governance dimension of health systems influence decision-making in health care delivery? Governance is often the ultimate determinant of health is the decision-making process and institutional structure that regulated healthcare activities. It also includes the management of relationships between financing agencies, beneficiaries and service providers. It makes decisions about coverage, payments and care delivery, who they are accountable to and shapes overall performance. 4. What is the significance of the TAPIC model in health system governance, and how does it relate to universal, equitable access to quality health care? TAPIC is a standard set forth by the UN’s Right to Health Framework and it concerns good governance that promoted the right to health and promotes affordable, appropriate and accountable healthcare based on the five characteristics: Transparency, Accountability, Participation, Integrity and Capacity Transparency - open about processes and share information in timely manner Accountability - held responsible with mechanisms to monitor performance Participation - meaningfully engage stakeholders Integrity - operate with honesty and fairness Capacity - have necessary resources 5. Describe the Bismarck Model and its key characteristics in terms of governance, financing, and delivery. The Bismarck model is the Social Health Insurance Model which is characterized by predominantly societal governance where corporatist structures where insurers and professional associations play significant roles, societal funding paid through premiums paid by employees and employers and private delivery 6. Equity in Health Care Financing 1. What is the difference between vertical and horizontal equity in health care financing, and how do they influence system fairness? Horizontal equity is the principle that people who are the same should be treated the same  ○ Treating people the same when they have the same needs Vertical equity is the principle that people who are different should be treated differently. ○ Treating people differently when they different needs, often prioritizing people with greater needs This is exemplified in financing as people who have the same incomes should all be paying the same and people with different incomes pay differently. This is usually how people with higher incomes are expected to pay more and people receiving the same treatment should pay the same. Healthcare financing has great implications for equity as it has the responsibility to not make financial burdens worse. 2. How does progressive financing impact economic inequality in health care systems? Progressive financing is the idea that individuals with higher income should pay a larger percentage of their income towards financing healthcare thereby lessening financial equities. 3. What role does equity in financing play in ensuring that health care is accessible to all citizens, regardless of income? It should not further any financial inequities and ensure that care is appropriate and affordable for all It involves considering vertical and horizontal equity as well as different forms of financing models 4. How does the current Canadian pharmacare system contribute to inequities in access to medications? Current lack universal drug coverage 1 in 10 Canadians don't have access to medication insurance 1 in 10 do not have full access People repeatedly report skipping medication due to affordability issues ○ Due to out of pocket costs Pharmacare has been promised since 1990s and repeatedly been in Throne speeches but never delivered Canada is the only high income country with a universal medical system to not offer universal pharmacare Currently there are 100+ provincial pharmacare programs which target specific demographics in need and thousands of private plans usually offered to full time unionized employees through their employer. ○ Patchwork coverage with employer linked benefits that also contribute to provincial dispairities 5. What are the key features of a universal pharmacare system, as seen in countries like the UK and Sweden, and why are they considered more equitable? Offer universal access to necessary medications ○ Comprehensive public coverage that is integrated into the health care system ○ Limited to no out of pocket cost  They have proven that it is possible and not just affordable but actually cost effective as it saves money. ○ Centralized purchasing allows for price negotiation National drug formulary - list of approved medication based on evidence of safety, efficacy and cost effectiveness of essential medicines 7. Liberty and Medicare in the Courts 1. How does John Stuart Mill’s harm principle influence debates about liberty and government intervention in health care? He says that governments should not intervene with any freedoms of people and only do so in the case of preventing harm to others. This is not a great principle as it often falla s apart in complex systems with many things at play (such as many people and many actions). An opposing view is that governments should intervene with some negatively defined liberties to ensure the safety and wellbeing of society, even actions that may cause potential harm. 2. What role does private financing play in public health care systems, and how does it challenge equity in care? Private financing often results in out of pocket costs which can exacerbate already present financial equities and ,make it difficult to seek essential medical and health care - unequal access, provider incentives, increased costs through profit driven models and erosion of universal coverage Roles of private financing: ○ Complementary: covers gap like co-payments without directly increasing provider fees ○ Substitutive: Replaces public coverage for specific patients who are ineligible or opt out of pubic insurance ○ Supplementary: Provides faster or enhanced services, giving paying individuals priority access 3. What was the central issue addressed in the 1995 Chaoulli decision regarding private insurance in Quebec, and what was the Supreme Court's ruling? This case concerned a patients right to purchase private insurance for services already covered under the Canada health Act The decision was ruled as violating the Quebec charter but was silent on the Canadian charter 4. What was the primary focus of the 2021 Cambie decision, and how did it impact wait times and private insurance in Canada? The Cambie decision concerned a providers right to bill both the government and patients. The decision ruled against this and claimed that while unreasonable wait times beyond medically acceptable benchmarks constitute harm but no system  achieves 100% because many factors can influence wait times and a solution that only solves a problem for a few, such as purchasing private insurance to seek priority treatment, would only benefit a few and is not allowed as it should be a solution that solves the problem for everyone. 5. What is the significance of the "pressing social purpose" as stated by the BC Supreme Court in the Cambie decision, particularly regarding universal access based on need? I assume this is concerned with unreasonable wait times in terms of elective procedures and how they impeded upon a patients right to health however they make the case for access on the basis of need, sicker patients will get care first. 7. History of Medicare Part 1, Part 2, and Part 3 1. Describe the Rowell-Sirois Commision. Revaluated the institutions of Canada, to see what could be done within the constitution and proposed that Canadians should have equal access to social services at comparable rates of taxations. Highlighted growing responsibility of provinces and recommended a stronger federal role in revenue, income, security and national standards for social insurance including healthcare. This was a royal commision that was set up to evaluate whether some kind of medical public insurance could be set up. This was in the post war era and healthcare in canada was mostly provided through a non profit basis through religious organizations. 2. What was the first stage of Medicare in Canada? The first stage was the Hospital and Diagnostic Services Act - this was the first federally national hospital insurance plan. It was the largest federal spending power in Canadian history and it covered necessary hospital services. It was based on the Saskatewan model by Tommy Douglas. It offered to pay 50% of the cost of provincial hospital insurance that met national standards. By 1961 all provinces were on board 3. What was the Hall commission? This was another commission which stated that hospital insurance was not enough and that Canada should cover more. It also reiterated focusing on social determinants of health and expanding public health initiatives. This delivered a comprehensive report on healthcare that recommended a universal, comprehensive public health insurance system. Called for introduction of medical insurance followed by pharmacare, denticare and homecare. 4. What was the second stage of Medicare in Canada? This was the Medical Care Act which covered essential hospital and medical care. It also said federal governments would share 50% of all the costs and 50% would be the responsibility of the provinces. All provinces on board by 1971 5. Why was 50/50 cost sharing not effective?  Inefficiency Incentives: It was not cost effective as the provinces did not necessarily feel the need to control the cost when someone else was paying 50%.There were no strings attached to the 50% which means there were no standards on the care being provided Budget uncertainty: covernments ar reluctant to commit to budget items controolwed by others Regional Inequalities: Poorer provinces struggled to pay 50% Administrative complexity: audit process to verify spending was complciates FPT Politics: Need for an audit created tensions - hierarchical relationship 6. Describe the EPFA. EPFA is the Established Program Funding Act which introduced the Canada Health Transfer (CHT). It bundled together transfers for health care and education and bundling simplified financing of both and most importantly replaced 50/50 cost sharing. It still did not impose any standards on care. It used a combination of cash and tax credits to ensure that there was equity among the provinces. It lowered the tax power of the federal government and gave more spending power to the provinces. This loss of spending power was a consequence for years. Increased provincial spending power was likely to appease Quebec separatists. Resulted in equalization across the provinces. Gave the federal government control - transfers design dto grow according to a formula 7. Describe the CHST. This is the Canada Health and Social Transfer. This bundled education, social services and health care money. It also decreased the overall money that the federal government would pay to the provincial government for these social services. This resulted in budget cuts (largest since post-war) which resulted in regional boards in provinces cutting down on several healthcare services, leaving a lasting impact especially on hospitals. 8. Describe the Health Council of Canada. Inspired by romanow, purpose was to foster true cooperation, innovation and accountabilitywith mechanisms for data sugaring auditing and enforcement This was meant to have some kind of overseeing power and provide accountability. However it has no real power and was seen as a think tank more than anything else. It was boycotted by Quebec and Alberta - ineffective Closed by Harper in 2013 9. Describe the Health Accord. This was introduced to tackle the wait times for specific procedures. New funding was provided to provincial governments so that wait times in six areas were brought down to national standards. These were in knee replacement, radiation therapy, hip fracture surgery, hip replacement surgery, diagnostic imaging and cataract.  Allocated 40 billion dollars over 10 years - no new strings attacked FPT agreed to set benchmarks and targets 10. Describe the Canada Health Act. List its principles. Public insurance plan for hospital and medical care - targets user fees and provider compensation. This was accomplished through new funding where the federal government would decrease $1 for ever $1 of extra billing or user fees Meant to unify medicare - consolidate previous acts and added accessibility as a criteria. Public administration: The insurance plan must be administered by a public authority on a non profit basis subject to public audit. Comprehensiveness: the insurance plan covers all medically urgent, non elective care in hospitals, physician practices, urgent surgical care and even urgent surgical dental care Universality: the insurance plan covers all residents of a province on uniform terms and conditions Portability: the insurance plan covers urgent non elective procedures out of province or country at the cost that that service would be in province Accessibility: the insurance plan does not restrict access to care through user fees and provides compensation to providers 11. Why was there policy inaction in the 1970s? Oil crisis - External shock - related economic pressures created political tensions Quebec crisis: Rise of Quebec nationalism Provinces oppose federal involvement : Focus on healthcare as a provincial jurisdiction New focus on determinants of health 12. Why was there policy inaction in the 1980s? Continuing impacts from oil crisis and major recession. Neoliberalism gained traction - empasizing free market and reducing government involvement in social programs Political Tension: Quebec lost referendum, energy policy issues alienated the west Hall Commison - focused the discussion user charges and provider compensation and thus away from medicare coverage 13. Why was there policy inaction in the 1990s? Focus on cuts on federal spending. Debt reduction focus through CHST Alberta wanted to exit CHA due to EPFA Provider pushback - providers lobbied for reinvestment in healthcare after cuts Quebec separatism high - almost won census 14. Why was there policy inaction in the 2000s? First half: Liberal party instability - sponsorship scandal. Focused on reinvestment without significant reform Second half: Harper - strict constitutionalist thought that healthcare was not federal jurisdiction.  Chaouilli case - highlighted concerns about stability of core of medicare focusing on the legality of wait times and private insurance 15. Why was there policy inaction in the 2010s? First half: Harper amended CHA, cut federal programs, closed health council, very federal hands off policy , focused on changing CHT Second half: liberal government promised federal leadership faced resistance from provinces which demanded funding without reform Rising inequality - growing income inequality and rise of for profit health insurers shifting focus away from public insurance 16. Describe policy in 2020. System at brink for change New pharmacare bill proposed liberal-NDP bilateralism Pandemic changes everything. Strains in every component. Misinformation and mistrust everywhere Provinces want cash with no strings 8. Welfare and Human Rights and Institutions 1. Define Stone’s dimensions of welfare. Symbolism - people don't just have need, people have ideas about their needs Instrumental Value - Some things have limited intrinsic value but enable goals Quality - some needs are difficult to quantify in measurement Volatility - security against uncertainty Relational Needs - some needs about community and connection Relative Needs - needs defined by context and comparison 2. What is the "right to health" as defined by the UN, and how does it differ from Canada’s health care system approach? The right to health is the highest attainable standard of health and wellness that is physical, mental and social wellbeing. Healthcare should be available, acceptable, appropriate (scientifically and medically correct) and accessible (physically and financially) Countries must respect the right to health (not cause harm), protect the right to health (prevent harm) and promote the right to health 10. Public Policy Analysis 1. Define public policy and explain how inaction can be considered a form of policy. Is a course of deliberated action, or inaction chosen to address a specific public problem as put forth public officials Inaction can be a policy if policy makers think the problem isn't a problem or solving this problem will make a need to solve other problems 2. List and briefly describe the three elements of a policy. Problem, goals and instruments  Problem - something needs to be sufficiently wrong to justify public policy intervention Goals - tangible measurable objectives that if achieved could address the problem Instruments - type of tool ised to meet goals and address the problem 3. Explain what the “spectrum of coercion” means in policy instruments and provide one example from each level of coercion. Spectrum of coercion refers to the extent to which policies and in extension the government infringe on your personal choices Inaction - when the government consciously decides to do nothing Information based policies - aim to shape your ideas indirectly through education and messaging (changing information or changing beliefs) Expenditure based policies - aim to shape outcomes indireclty by changing teh price of choices Regulation based policies - aim to shape your actions indirectly through some limits on choices Direct instruments - the most coercive - make decisions for people directly 4. What is the 3-i framework in public policy analysis? Describe each component briefly. Ideas - the beliefs people, organizations and governments hold towards a specific problem. Even the ideas they may have about a specific solution ○ What is known or believed about a certain policy (problem, goals, instruments) Institutions - formal or informal laws or practices (or norms) that regulate behaviours of actors in a system Interests - all the possible actors involved in the policy - perceive they have a stake in the policy problem or both The 3-i framework uses these three characteristic to judge the policy 5. What are the three streams in the Multiple Streams Framework, and how do they influence policy-making? Problem Stream - this defines the problem or need - about agenda setting - whether an issue or condition is defined as a problem that government should do something about Policy Steam - about the solutions - choosing a policy response (instrument) Politics Stream - linked to electoral incentives whether political leaders can turn the implementation of a policy into a political win 6. Describe the concept of a "policy window" in the Multiple Streams Framework and explain what conditions must align for a policy window to open. This framework says that all three streams must align in a brief policy window in order to policies to be passed