The role of medical doctors in healthcare reforms in two Canadian provinces
Bibliographic record
Abstract
The federal context in Canada warrants attention as it influences the negotiating space for provincial governments and medical doctors. While healthcare services are mostly under provincial jurisdiction (Section 92, Constitution Act 1867), the federal government plays an important role, particularly by using its spending power to uphold national standards (for example, with respect to insurance coverage for services provided in hospital or by medical doctors via the Canada Health Act, 1985). 1 To various degrees and at different times in the history of Medicare in Canada, provincial governments have seen federal spending intervention as an attempt to exert control in a provincial domain (see Commission d’enquête sur la santé et le bien-être social, 1967–1972, for example). Frustrations were especially high when the federal government significantly reduced its financial contribution to provincial health systems during the recession of the 1990s (CPHA, 1995; Snoddon, 1998; BCMA, 2000: 14) while still requiring that provinces meet the same national standards. Spending power is the federal government’s main means of influencing provincial or territorial health insurance plans. As part of the reformative social policy agenda that emerged after the Second World War, the federal government adopted the Hospital Insurance and Diagnostic Services Act in 1957. Under the Act, the federal government would cover approximately 50 per cent of provincial and territorial expenses for hospital and diagnostic services, conditional on provinces or territories respecting criteria such as universality (such criteria would later be integrated into the Canada Health Act).
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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 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.027 | 0.008 |
| Scholarly communication | 0.011 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.008 | 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".