Spasoff R A
J Public Health Policy. 1995;16(2):141-51.
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.
加拿大医疗保健计划的公共管理在维护单一层次体系、确保可及性和问责制、降低行政成本及监管需求方面非常成功，并且在实现有序规划和成本控制方面也颇为成功。尽管省级计划由卫生部门管理，但未能将个人医疗服务与公共卫生服务相联系，使其缺乏人口视角，导致对预防和干预效果的重视不足，阻碍了全面初级保健的发展。该计划对研究和创新的支持不足，且未能将支付与绩效挂钩。从加拿大的经验中得出了国家医疗保健计划的四点经验教训：（1）保持公共性质；（2）采用单一支付方；（3）将个人医疗服务与公共卫生相联系；（4）为卫生部门提供政策专业知识。尽管加拿大的计划总体上取得了成功，但现在已难以维持。其许多改革提议对该计划所基于的价值观构成了挑战。
