Canada\u27s Supreme Court and Its National Health Insurance Program: Evaluating the Landmark Chaoulli Decision from a Comparative Perspective

This article proceeds in three modes. The first briefly characterizes my reactions to the Chaoulli decision in June 2005 as a policy analyst and one of the experts in the Quebec trial testifying on behalf of Canada\u27s Attorney General. The second part discusses some of the commentaries of others in connection with this decision. The third-and the main section-deals with the Court majority\u27s use of international evidence in arriving at its decision and argues that the approach taken violated almost every scholarly standard for competent, cross-national policy analysis

Canada\u27s Supreme Court and Its National Health Insurance Program: Evaluating the Landmark Chaoulli Decision from a Comparative Perspective

This article proceeds in three modes. The first briefly characterizes my reactions to the Chaoulli decision in June 2005 as a policy analyst and one of the experts in the Quebec trial testifying on behalf of Canada\u27s Attorney General. The second part discusses some of the commentaries of others in connection with this decision. The third-and the main section-deals with the Court majority\u27s use of international evidence in arriving at its decision and argues that the approach taken violated almost every scholarly standard for competent, cross-national policy analysis

How Not to Think About Managed Care

The claim of this Article is that the concept of managed care, like many concepts now prominent in commentary about medical care finance and delivery in the United States, is incoherent and thus a barrier to useful analysis. To demonstrate this conclusion, we first discuss the managerial context in which managed care claims have arisen and outline the diverse trends to which the category is regularly and confusingly applied. We then suggest an alternative approach to characterizing recent changes in medical care and show how this approach alters and deepens our understanding of recent economic and political developments. We conclude by arguing for more neutral categories to make sense of past and projected developments in methods of reimbursement, techniques of management, and organizational structures

A New Look at Nonprofits: Health Care Policy in a Competitive Age

The importance of organizational form in American medicine has been the subject of much debate. But the character of the debate-the nonprofit form versus its competitors-has been sufficiently confused that much of the controversy should be reconsidered. That debate has been both ideological (commercialism and profit versus service and professionalism) and practical (which form is more efficient)? The challenge of public policy is to adapt public rules to the central realities of American medicine, not the shibboleths of shrill discourse. In the case of medicine, factors other than the form of legal ownership-among them, the nature of the service provided, the developmental stage of the service, the role of physicians in providing the service, and the nature of government regulation-are more important in fashioning those appropriate responses

Politics ahead of patients: The battle between medical and chiropractic professional associations over the inclusion of chiropractic in the American Medicare System

Health care professions struggling for legitimacy, recognition, and market share can become disoriented to their priorities. Health care practitioners are expected to put the interests of patients first. Professional associations represent the interests of their members. So when a professional association is composed of health care practitioners, its interests may differ from those of patients, creating a conflict for members. In addition, sometimes practitioners’ perspectives may be altered by indoctrination in a belief system, or misinformation, so that a practitioner could be confused about the reality of patient needs. Politicians, in attempting to find an expedient compromise, can value a “win” in the legislative arena over the effects of that legislation. These forces all figure into the events that led to the acceptance of chiropractic into the American Medicare system. Two health care systems in a political fight lost sight of their main purpose: to provide care to patients without doing harm. Dans leur recherche de légitimité, de reconnaissance et d’une juste part sur le marché de la santé, les professionnels de la santé peuvent perdre de vue leurs priorités. Ces praticiens doivent donner préséance aux intérêts des patients tandis que les associations professionnelles représentent ceux de leurs membres. Lorsqu’une association professionnelle regroupe des praticiens de la santé cependant, ses intérêts s’opposent parfois à ceux des patients, créant ainsi un conflit pour les membres. De plus, les praticiens peuvent être endoctrinés par un système de valeurs ou mal informés, au point de se tromper dans l’évaluation des besoins réels des patients. De leur côté, les politiciens peuvent préférer une « victoire » dans l’arène législative à une juste appréciation des impacts d’une loi. Ces forces ont toutes participé aux évènements qui ont mené à l’acceptation de la chiropraxie par le système américain Medicare. Dans cette bataille politique, deux systèmes de santé ont négligé leur principal objectif : soigner des patients sans leur nuire

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article