| Chapter 1: | Examining Provincial Variability |
increasing for federal dollars allotted to public security, roadways, public transit (Choudry 2006), and job-creation initiatives. Furthermore, in a country where first-generation immigrants constitute about 20 percent of the population, the priority of educational quality and availability may possibly trump the historical Canadian emphasis on the health care system as a public good (Forest 2010).
Aging is a particularly difficult question. There are claims that aging is not a major factor in the increase in health care costs (Lee 2006; Reinhardt 2003); however, this is controversial (see Payne et al., 2007; Tuohy 2009), and we believe that these optimistic estimates do not examine sufficiently the overlap in the costs surrounding dying (for which the aged are at greater risk), the costs involving increased reliance on pharmaceuticals, and the long-term care costs associated particularly with those aged seventy-five and older, who are more likely to suffer from multiple disabling chronic conditions. In a very prudent 2010 report, the Parliamentary Budget Officer of Canada concluded that “in general, the demand for and total costs associated with providing health care services will tend to rise as the population gets older” (PBO 2010, 16).
Arguments focusing on political and economic sustainability have contributed to significant convergence regarding publicly regulated private, for-profit health-service providers both within the publicly financed system and outside that system in the three provinces that we examine in this study: Ontario, Quebec, and Alberta. Moreover, the politics of commercial private health insurance corporations in the delivery of health services has differed in these three provinces, as the case studies indicate.
Privatization and Commercialization within Canadian Health Systems
Privatizing a health care delivery system may involve changes in financing, such as shifts in user fees and public budget reductions.