IHEA pre-conference symposium

Policy options for the financial sustainability of healthcare systems in Canada and abroad

Type of event: CHSRF hosted

Fees: $50 (for Congress Attendees), $200 (Everyone else)

CHSRF is hosting this pre-conference symposium at the 8th World Congress, which takes place July 10–13, 2011, in Toronto.

Register through the Congress website.


Healthcare costs are rising at a rate faster than revenue growth in most jurisdictions across Canada and around the world. Healthcare ranks among the top public concerns in most countries. In Canada, the approaching expiry of A 10-Year Plan to Strengthen Health Care (established in 2004) is expected to generate widespread discussion of how best to ensure accessible, high-quality and sustainable healthcare for Canadians.

Governments can respond to the pressure to provide more healthcare services while managing healthcare costs by attempting to contain spending and improve efficiency in the system or by adopting new approaches to financing to expand the resources devoted to healthcare—or a combination of both.

At this symposium, experts commissioned by the Canadian Health Services Research Foundation (CHSRF) will examine eight approaches to healthcare spending and financing. Symposium participants will have an opportunity to participate in an active discussion on these issues with the international panellists.


Diagnosing the fiscal viability of the healthcare system in Canada
Livio Di Matteo, Department of Economics, Lakehead University

Livio Di Matteo will present the fiscal context of the Canadian publicly funded healthcare systems. This introduction will provide the backdrop for subsequent presentations.

Part one—Pharmaceutical pricing options

1. What if: A health impact fund rewarded innovation and managed spending on new drugs?
Aidan Hollis, Department of Economics, University of Calgary

This presentation will explore the option of a health impact fund that rewards drugs to the extent they improve health globally. The mechanism creates significant advantages as a supplement to the patent system and further stimulates research and development.

2. What if: A sliding scale were used to reimburse generic drugs to effectively drive down prices?
Aidan Hollis, Department of Economics, University of Calgary

The reimbursement of generic drugs using a sliding scale and granting a royalty to the first generic firm would allow market forces to set the price of generic drugs and promote timely generic competition.

3. What if: The entry of new pharmaceuticals was managed and their prices were negotiated based on value for the country as a whole, by using existing Health Technology Assessment capacity?

Chris G. Cameron, Canadian Agency for Drugs and Technologies in Health (CADTH)

An illustrative example of the development of a price menu and strategy of ex-post assessment will be provided.

Part two—Physician payment options

4. What if: The price of new provider fees were coordinated across Canada, supported by existing HTA capacity and networks?
Don Husereau, University of Ottawa

This presentation provides an illustration of a national suggested fee, based on national relative-value modifiers that include the value of the new service.

5. What if: Group-based profit-sharing strategies aligned physician incentives with the priorities of hospitals and policy-makers?
Pierre-Thomas Léger, HEC Montréal

Group-based profit sharing creates cost savings from quantity and market share discounts. Profit-sharing programs could allow hospitals to provide bonuses to physicians based on savings created by their coordinated use of drugs and devices.

6. What if: Financial incentives were better aligned across hospital and community settings by combining activity-based funding and global budgets?
Trafford Crump, University of British Columbia

Activity-based funding provides financial incentives to stimulate productivity and efficiency and is associated with higher volumes of hospital care and shorter lengths of stay. However, it is linked to higher overall spending. This presentation explores an approach that aligns funding mechanisms with policy objectives across the continuum.

7. What if: Medical saving accounts were established?
Raisa B. Deber, University of Toronto

Medical savings accounts derive from the theory that people will be more efficient purchasers if they must pay from their own resources. The conditions under which medical saving accounts could play a role are examined.

8. What if: Social insurance could pay for prescription drugs and long-term care?
Sara Allin, University of Toronto

An examination of the use of a social insurance model to achieve universal coverage of non-Canada Health Act services is explored as an alternate means of supplementing healthcare revenue and current national health insurance.

Who should attend?

This session is for health system decision-makers and researchers in Canada and abroad. To enrich the discussion, a package will be sent to participants before the Symposium with summaries of the policy options to be presented as well as questions on the issues to be explored.


The objectives of the Symposium are to:

  1. Explore recent healthcare financing and payment policy research commissioned by the Canadian Health Services Research Foundation
  2. Consider the strengths and weaknesses of proposed policy options and their implementation in various jurisdictions