Título en español: El paradigma emergente en las políticas de cuidados a la salud: el caso de Canadá.

Bibliografía p. 46-47.

The model of health care financing and delivery for which Canada is best known internationally is its universal, single-payer, first-dollar system of coverage for physician and hospital services. For several decades following its establishment in the late 1950's and 1960's, this model provided public finance from the general tax base (like the UK), at levels of generosity, relative to GDP, like those of continental Europe, all the while maintaining a system of delivery based on private fee-for-service medical practice and independent not-for-profit hospitals (like, historically, the US). This is a remarkable combination of qualities; and for a time, Canada appeared to have found a model that was extraordinarily popular with the public, and supported by providers as well. In fact, the total health care system is much broader and more complex than this sketch would imply; and in the past 15 years the system has been under great fiscal and political pressure. Much experimentation is underway. While the single-payer model for physician and hospital services is still essentially intact, it represents a diminishing share of the system and is being challenged at the margins by private alternatives. Meanwhile, non physician and nonhospital services, especially out-of-hospital pharmaceuticals, are growing in clinical importance and financial share, and exhibit a miscellany of organizational and financial arrangements. In this context, questions of the "organization and management of care consumption" (albeit not under that rubric) are squarely on the policy agenda.

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