Int J Health Serv
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Review
Health as an irreversible part of the welfare state: Canadian government policy under the Tories.
This article provides an assessment of the health policy of the Canadian Conservative government under Brian Mulroney, 1984-1993. Underlying this assessment is the need to test the theory of the irreversibility of the welfare state in the light of its health component. The author argues that despite a political rhetoric that might have presaged a sharp rollback of Canada's Medicare, either through residualization or progressive commodification, Canada emerged from this period of New Right federal government with its state-funded health care system still in place. This argument is substantiated through a consideration of the social policy model inherited by the Mulroney government and how it was affected by the government's fiscal policies between 1984 and 1993.
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Considerations of equity in the context of health care systems are often related closely to the presence or level of prices incurred by users of health care services. Some politicians and commentators have suggested that the removal of user charges under the Canadian health care system has led to equal access to care. But it is not clear that the equity principle inferred from these claims corresponds to the equity goals of current Canadian health policy. ⋯ They then consider other approaches to equity in health care in the context of the stated objectives of Canadian health policy and identify the implications of pursuing reasonable access in future health policy. The authors suggest that the implications of the current equity goals have not been recognized by policy makers, and if they were to be recognized it is not clear that they would be acceptable to Canadian populations and/or policy makers. Moreover, some of the implications would appear to be incompatible with other stated objectives of public policy.
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Having achieved equality of access to health care, Canadian policymakers are setting new policy goals, within resource constraints, primarily to achieve equity of access to health. Across the country, provincial royal commissions have explored a number of policy options to achieve this goal. These options are reviewed and critically analyzed within the context of such challenges in health policy as insufficient access to high-technology care and the limits of medical care, and such external challenges as economic and demographic trends, federal-provincial disputes, and ideological beliefs. ⋯ Based on the provincial reviews, the authors conclude that Canada wants to achieve equitable access to health. With the shift of health policy away from the formerly protected arena of medical care, achieving equitable access to health will require both an alteration of priorities and values and considerable political will. Canada will be forced to meet these new challenges to maintain current achievements and to make its system even more successful.
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A corporate health ethic, forged in U. S. industry in the 20th century, clearly demarcated boundaries between private and workplace health concerns. This article advances evidence that the boundary is blurring, and argues that trends in workplace initiatives, including employee assistance, wellness programs, and drug screening, are giving shape to a new corporate health ethic. ⋯ Economic arguments such as "health care cost containment" are commonly offered as explanations for these new health initiatives. But the authors see the new ethic as a deeper response to a changing corporate environment and, more fundamentally, as emblematic of changes in the social control of work and productivity. They argue that the new health ethic may be a harbinger of new forms of social control in the workplace.
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In developing countries is medical technology transfer reaching women? Do women control new technologies or are they only passive recipients? What is the impact of these new technologies on women's health and welfare? To answer these questions this article explores concepts of health, technologies, and women, then gives findings from an extensive literature search on contraception, childbirth, immunization, essential drugs, oral rehydration therapy, water, sanitation, and breast-feeding. The article concludes with recommendations on pre-project planning studies, monitoring, and evaluation.