What's in, what's out Stakeholders': views on the boundaries of Medicare
Bibliographic record
Abstract
Although there was consensus that the system should continue to be needs based but needed reform, the concept of path dependency explains why reform remains stalled. It was found that the ideas of the policy elites are "stuck" in what has been created. The ideas and interests supported the existing institutional framework that privileges the public funding of medically necessary hospital services and physician services. Policy decisions that have been made at an earlier time have limited the choices and influenced the ideas of the policy elites on what should be funded under Medicare. The sustainability of the Canadian model of health care known as Medicare is the subject of intense public debate and has focused on updating the determination of what services should be publicly funded. Provincial/territorial health insurance plans must fully cover all medically necessary hospital and/or physician services. Even though there have been numerous reports over the last few decades identifying similar themes, reform has been stalled. The objective of this thesis was to assist in the policy process by ascertaining the views of policy elites from key stakeholder groups across Canada on what should be "in" and "out" of the publicly funded system. Using a non-experimental, cross-sectional design, a self-administered questionnaire (available in both French and English) was distributed between January and April, 2002, to policy elites involved in health policy discussions, either as health providers (doctors, nurses, pharmacists, home care providers, hospital/health authorities) or as business. The results are based on 2,523 responses. The ability of government to "buy real change" will largely depend upon its ability to mediate the scope of conflict within the existing institutional framework. Even incremental changes could prove contentious, as evidenced by the views on funding insured hospital services regardless of the site of delivery. A shift to a more holistic approach that would include an expanded funding role for government could be even more contentious, as the path of the medical model is so solidly established in governmental regulations and funding frameworks. Successful reform will need to address, rather than assume, a broader view of health.
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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 | 0.016 | 0.027 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.026 | 0.023 |
| Scholarly communication | 0.012 | 0.005 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 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".