Health department administration of the Canadian Health Care Program.

Public administration of the Canadian health care program has been very successful in preserving a single-tiered system, ensuring accessibility and accountability, reducing administrative costs and the need for regulation, and fairly successful in achieving orderly planning and cost control. Although the provincial programs are administered by health departments, failure to link personal to public health services has robbed them of a population perspective, resulting in insufficient emphasis on prevention and on the effectiveness of interventions, and has hampered the development of comprehensive primary care. The program supports insufficient research and innovation, and has failed to link payments to performance. Four lessons for a national health care program are drawn from the Canadian experience: (1) keep it public; (2) use a single payer; (3) link personal health services to public health; and (4) provide health departments with policy expertise. Despite its overall success, the Canadian program can no longer be afforded. Many of the proposals for its reform challenge the values upon which the program is built.