Centre for Sustainable Health Systems, Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, Ontario, Canada.
Healthc Manage Forum. 2021 Sep;34(5):260-265. doi: 10.1177/08404704211012725. Epub 2021 May 17.
The phrase, "the federal spending power," identifies the federal government's ability to spend in areas beyond its constitutional authority to legislate-a power that has supported the development of a national system of universal healthcare coverage in Canada. Even before the COVID-19 pandemic, this power was critical to the expansion of Canada's narrow but deep basket of universally covered services. The challenges exposed by the pandemic mean that still more federal investment will be required. Yet for traditionalists, the material basis of this power is now constrained: the federal government may possess the constitutional authority to invest, but it lacks the fiscal capacity; some form of belt tightening-even austerity-will be necessary. As debates over public spending intensify, health leaders will need to address these questions. Depending on how they do so, health leaders will either support or detract from a healthy recovery.
“联邦支出权力”一词指的是联邦政府在超越其立法权的领域进行支出的能力——这种权力支持了加拿大全民医保体系的发展。即使在 COVID-19 大流行之前，这种权力对于扩大加拿大狭窄但深入的全民服务篮子也至关重要。大流行暴露的挑战意味着仍需要更多的联邦投资。然而，对于传统主义者来说，这种权力的物质基础现在受到限制：联邦政府可能拥有投资的宪法权力，但缺乏财政能力；某种形式的紧缩开支——甚至是紧缩政策——将是必要的。随着对公共支出的争论加剧，卫生领导人将需要解决这些问题。根据他们的处理方式，卫生领导人要么支持，要么损害健康的复苏。
