Healthcare Challenges In An Era Of Fiscal Restraint

Lessons learned and enduring legacies

Those who cannot remember the past are condemned to repeat it.”
- George Santayana

In the early- to mid-1990s, provincial governments in Canada made deep cuts to health budgets following an economic recession. These cuts began amid a secular trend toward health system reform, but spurred governments to accelerate their efforts to get health spending under control and to balance their budgets. Recounting the reform experience and some of its enduring legacies can inform today’s health system managers. The videos, presentations and written materials below give a rich description of the experience in the 1990s, as told by senior health leaders involved in provincial decision-making at the time.

Originally produced as part of a one-day master class (a partnership between CHSRF and the Nuffield Trust), speakers shared their knowledge and experience with senior policy- and decision-makers in the English National Health Service as they continue to manage current fiscal challenges. History, as they say, is the best teacher.

Canadian healthcare reform during an economic downturn

Maureen O’Neil
President, Canadian Health Services Research Foundation
Ms. O’Neil comments on Canada’s experience managing its healthcare systems through the economic downturn in the 1990s and the future challenges to improving healthcare services.

Ms. O’Neil co-chaired the event, alongside Nuffield Trust Director, Dr. Jennifer Dixon.  

Between a rock and a hard place: Canada’s healthcare challenges in the 1990s

TSullivan Nuffield Terrence Sullivan
Professor, University of Toronto

Professor Sullivan explains how, in the face of a deep recession, the federal government took steps to address the deficit and manage healthcare costs. While hospital productivity increased, access to healthcare emerged as a serious concern.

Video | slides | more information

Setting priorities in Saskatchewan: Tackling deficits while revamping healthcare

LSimard Nuffield Louise Simard
Former Minister of Health, Saskatchewan

Ms. Simard explains how Saskatchewan took on the immediate challenge of confronting its annual deficit head-on, while maintaining a long-term vision for revamping its healthcare system. Key to the government’s plan was keeping stakeholders and community leaders apprised of how their plans were unfolding and justifying their chosen course of action.

Video | slides | more information 

Healthcare reform in Ontario in the 1990s: The role of the Health Services Restructuring Commission

MRochon Nuffield Mark Rochon
CEO, Toronto Rehabilitation Institute

Spending 22% more than it was taking in, government officials in Ontario in the mid-1990s had no choice but to make cuts. Mr. Rochon explains how under mounting pressure, the newly elected government introduced an arms-length restructuring commission with authority to make tough, but necessary decisions about the hospital sector. While the government remained accountable, the Commission sought to address community concerns and explain to the public the financial and health system changes taking place.

Video | slides | more information

Canada’s past, U.K.’s future: Healthcare lessons during an economic downturn

JSmith Nuffield

Judith Smith
The Nuffield Trust, Head of Policy

Making changes to a healthcare system requires challenging the status quo. Dr. Smith reflects on the Canadian experience and the importance of honesty, hope and clarity. She highlights some of the key steps the federal and provincial governments took in Canada to tackle the healthcare challenges of the early- to mid-1990s.

Video | slides | more information

Research summary: Managing health reform through an economic downturn

The research synthesis Managing health reform through an economic downturn: Canada's experience with deficit reduction, told through case studies of two provinces, is based on the presentations and discussions held at the joint Nuffield Trust-CHSRF master class.

Visit the Nuffield Trust website for related materials.