The health care philosophy that nearly destroyed Medicare in Canada in a single decade.
Bibliographic record
Abstract
BACKGROUND: In 1989, governments in Canada perceived an economic crisis in health care funding and commissioned two economists, Drs. Barer and Stoddart, to review policies. They indicated that major costs were caused by physicians and recommended cutting physician training and hospital facilities. In 1991 governments selectively implemented their recommendations. The Federally established Romanow Commission 're-reviewed' the problem and reported in 2002. OBJECTIVES: To examine whether there was an economic crisis and to assess the effects of reductions in funding on the provision of health care in Canada. METHOD: We analyzed data from Statistics Canada, the Association of Canadian Medical Colleges, and the Canadian Institute of Health Information, the Canadian Nurses Association, and Health Canada. We focus exclusively on public health care spending. RESULTS: Publicly financed health care spending remained stable as percentage of Gross Domestic Product in the five years leading up to the commissioning of the Barer-Stoddart report (1986-1990). An increase in the elderly population partly explained rising costs. By 2000, people over 65 accounted for 48% of overall health costs. Emerging from the report's recommendations, between 1990 and 2000 medical students and residents as a proportion of the population were cut by 17% and 12% respectively and hospital beds by a third. Nurses per 100,000 fell 12%. Home care remained under-funded, less than 4% of the total health budget. CONCLUSION: There was no economic health care crisis in the early 1990s. Growing costs were principally due to increased patient need. Funding reductions resulted in inadequate care, including the creation of prolonged wait lists that have resulted in legalizing private care, thereby threatening the universal equal care principle.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.009 | 0.006 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".