Bulletin Index/

Health Care Reform

1. What do Women Want?

2. Privatization and Women’s Health in Canada: Tracking the Effects of Health Care Reform

Serving Diversity

3. Marginalized Voices from Vancouver’s Downtown Eastside: Aboriginal Women Speak About Their Health Care Experiences

4. An Exploration of Women-Centred Care in the Context of Cervical Cancer Screening in Ethnocultural Groups

Unpaid Caregiving

5. Caregivers’ Support Needs: Insights from the Experiences of Women Providing Care in Rural Nova Scotia

6. Caregivers and Support Services: Becoming Empowered

Midwifery

7. Challenges of Integration: Perspectives on the Regulation of Midwifery in British Columbia

8. Midwifery Care: Women’s Experiences, Hopes and Reflections

Privatization and Women’s Health in Canada: Tracking the Effects of Health Care Reform

In the last decade, the Canadian health care system has undergone significant restructuring. The system has been evolving ever since its inception in the late 1950s, but the extent and intensity of the "reforms" has been greatest in the 1990s when most provincial governments launched health care reform measures. In each and every jurisdiction where health care reform has been initiated, it has been couched in terms of a crisis of rising costs. Northcott (1993:362) maintains that "The crisis rhetoric appeals to the emotions and calls for exceptional sacrifice—sacrifices that the ageing population, the health care system, and the taxpayer are being called upon to make."

When we look at the various strategies implemented by governments to reform health, it is clear that they are mainly intended to reduce how often individuals use the system, or reduce the length of time they spend in the system, to reduce the cost per unit of care, and/or to reduce the overall costs of health care. These aims are achieved using measures such as: day surgery, delayed admission, and early release; de-listing of services and restrictions on entitlement to insured services; the imposition of ceilings on the number of physician services that will be reimbursed (through restricted billing practices); bed closures; reductions in health care personnel (notably nurses and other allied workers); adoption of labour-replacing and productivity-enhancing technologies; and various managerial/organizational reforms (e.g., Total Quality Management and Continuous Quality Improvement). Even while these types of changes are being implemented, governments still strive to maintain high quality health care and to achieve efficiencies in terms of costs.

Much has been written about health care reforms, yet research assessing the effects of these reforms on the health of Canadians and on their access to services has been remarkably limited in scope. To date the work of the National Coordinating Group on Health Care Reform and Women has focussed on examining the impacts of health care reform on women as patients, providers, and decisionmakers, and on coordinating research on health care reform and gender between the five Centres of Excellence.

The Coordinating Group began its work by using privatization as the thematic lens through which to capture the range of initiatives occurring in both reform strategies and research on women. For our purposes, we defined privatization in broad social and cultural, and not merely economic, terms. That is, privatization includes the transfer and relocation of service delivery, care work and costs, as well as the adoption of forprofit methods for care delivery and management.

We commissioned nine papers on privatization. One paper focuses on the context of health care reform and sets out the global and local pressures influencing change (Armstrong, 1999). Seven papers prepared regional scans on privatization in order to capture the range of initiatives in reform strategies, as well as in research on women’s health. Based on these papers, and in light of the many research gaps identified in the scans, a paper on methodology and research was commissioned (Grant, 2000). An analytic glossary that examines the language and discourses related to health care system restructuring and reform is in progress. A plain language document (in English and French) that raises awareness of the impact of health care privatization on women in Canada was published (Wilson et al., 2000) and has been widely distributed to the women’s health community across Canada (an online version is at www.cwhn.ca). The Coordinating Group organized a dialogue with key health care researchers and policy makers in Ottawa in February, 2000, and has subsequently been invited by Senator Michael Kirby to provide expert testimony at the Senate hearings on the health care system.

This sizeable body of work, to be published as a book later this year by Garamond, reveals much about the state of Canadian research on health care reform, including the following points:

1. There are significant gaps in the research on health care reform.
   
   
2. The extant research tends to privilege quantitative data, even when the measures used are inappropriate or incomplete (e.g., traditional biomedically-oriented indicators such as mortality, morbidity, and health care utilization are commonly used, but do not tap into the full range of experiences and effects of health care reform).
   
   
3. Relatively little of the research is gender-sensitive. In general, gender is ignored altogether, and the experiences of women and men are treated as if they are similar even in the absence of evidence to support such a claim.
   
   
4. Where researchers focus on the privatization of care, they treat it primarily as an economic concept, thereby ignoring the potentially significant social impacts and consequences of privatization on those receiving care, and also on those providing care, many of whom are women.
   
   
5. While our focus was on privatization, inevitably our investigations revealed that "quality of care" was a central, albeit poorly understood, concern that merits more detailed scrutiny.

Our work is now extending into an examination of the definition and measurement of quality of care, synthesizing the Centres’ research on home care, and investigating models of primary care for women across the country.

One of the most exciting features of this research is that it involves collaboration between individuals in the academic, community and policy sectors. It represents an opportunity for university-community alliances in research, along with direct access to knowledge transfer and uptake processes between researchers and those in government.

Copies of the individual scans are available from the Centres of Excellence. The report on Alberta is available through the Prairie Women’s Health Centre of Excellence and a report on privatization in Newfoundland is available from NNEWH. The other documents are available as noted below. Most documents are available in either official language.

Commissioned Papers

Armstrong, P. (1999). The Context of Health Reform. Workshop on Health Reform, Montebello, Quebec.

Armstrong, P. and H. Armstrong. (1999). Women, Privatization and Health Reform: The Ontario Case. Toronto: NNEWH.

Bernier, J. and M. Dallaire. (1999). Public-private Relations in Health and Social Services Reform: What are the Consequences for Women? Overview of Research, Policy and Response in Quebec. Montreal: CESAF.

Botting, I., Neis, B., Kealey, L. and S. Solberg. (2000). Health Care Restructuring and Privatization From Women’s Perspective in Newfoundland and Labrador. Toronto: NNEWH.

Fuller, C. (1999). Reformed or Rerouted? Women and Change in the Health Care System. Vancouver: BCCEWH.

Gurevick, M. (1999). Privatization in Health Reform from Women’s Perspectives: Research, Policy and Responses. Halifax: MCEWH.

Grant, K. R. (2000). Is There a Method to this Madness? Studying Health Care Reform as if Women Mattered. Ottawa: National Coordinating Group on Women and Health Care Reform.

Howard, J. and K. Willson. (1999). Missing Links: The Effects of Health Care Privatization on Women in Manitoba and Saskatchewan. Winnipeg: PWHCE.

Keddy, B. (2000). Health Care ‘Reform’ and its Impact on Nurses in Nova Scotia and British Columbia: Market-dependence and the Exploitation of Nurses’ Work. Halifax: MCEWH.

Scott, C. M., T. Horne and W. E. Thurston. (2000). The Differential Impact of Health Care Privatization on Women in Alberta. Winnipeg: PWHCE.

References

Northcott, H. C. (1993). The Politics of Fiscal Austerity and Threats to Medicare. Health and Canadian Society, 1: 347-366. And Women’s Health

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