Policy trade-offs in “home care”: the Ontario example

Abstract: As Canada enters the twenty-first century, its highly prized program, medicare, is undergoing radical transformation. With technological change and the restructuring of health systems, the locus of care is shifting from institutions to the home. As a result, care that was formerly publicly financed under the Canada Health Act is technically becoming de-insured. This paper analyses the reform of community-based long-term care services in Ontario from 1985 to the present. During this period, three different parties, the Liberals, the ndp and the Progressive Conservatives, in turn, formed the government. Four different models were put forward before the current model was adopted by the current pc government. Each of these models is analysed with respect to design decisions that must be made in the policy dimensions of financing, delivery and allocation and evaluated in terms of equity, liberty, security and efficiency. Underlying the debate in Ontario was a fundamental disagreement about the role of government, reflected in views about the responsibilities of individuals and their families, and the appropriate place of for-profit organizations within a publicly funded system. The reform of this sector has significance that goes beyond its boundaries, with wider implications and warnings for health care in general. Sommaire: Au moment même où le Canada se trouve au seuil du vingtième siècle, son très populaire régime d'assurance-maladie subit une transformation radicale. À cause de l'évolution technologique et de la restructuration du systéme de soins de santé, le fardeau de ces soins se déplace des institutions vers les foyers. Par conséuent, des soins auparavant financés par les deniers public en vertu de la Loi cana-dienne sur la santé deviennent techniquement non-assurés. Dans cet article, on analyse la réforme des services ontariens de soins à long terme axés sur la communauté, de 1985 áG ce jour. Pendant cette période, trois partis differents, les Libéraux, les Né-démocrates et les Progressistes conservateurs ont formé le gouvernment à tour de rôle. Quatre modèles différents ont été préconisés avant l'adoption du modèle actuel par le gouvernement progressiste conservateur qui est aujourd'hui au pou-voir. On y analyse chacun de ces modèles quant aux décisions conceptuelles á faire pour les politiques de financement, de prestation et d'allocation, et chaque modèle doit être évalué en termes d'équité, de liberté, de sécurité et d'efficacité. À l'arrièreplan du débat, en Ontario, il y avait un désaccord fondamental sur le rôle du gouvemement, que reflétaient les opinions concemant la responsabilité des citoyens et de leurs familles ainsi que sur la place appropriée des organismes à but lucratif à au sein d'un système financéà même les derniers publics. La réforme de ce secteur a des répercussions non seulement sur le secteur hi-même mais aussi sur les soins de santé en général.     

Reversal of fortune: the politics and economics of the superconducting supercollider

Congress approved the superconducting supercollider (SSC), but later cut all funding after construction for the project had begun. We claim that this reversal was due, in part, to a problem of time inconsistency. Representatives from states in contention to receive the project had an incentive to support it early in the process. Once Texas was chosen as the SSC site, the other contender states had a greatly diminished incentive to continue to support it. Our empirical results show that the probability of switching from ‘for’ to ‘against’ the project is significantly higher for representatives from the former contender states.     

Politics and Culture: Toward an Arab Agenda for the 21st Century

The author o/Bitter Legacy: Ideology and Politics in the Arab World (Syracuse University Press, 1994), the editor of Conflict Resolution in the Arab World: Selected Essays (American University of Beirut 1997), and numerous articles on Lebanon and the Arab world.     

Competence to Stand Trial: A Neuropsychological Inquiry

Law and Human Behavior - How might the deconstruction of the legal theory of competence be related to modern neuropsychological models of cognition? To address this question, we examined...     

The relationship between psychosocial maturity and assertiveness in males and females

The relationship between psychosocial maturity (psychological health) and assertiveness was investigated in a sample of United States college males and females. Results revealed a moderately high positive relationship between psychosocial maturity (PSM) and self-reported assertiveness on the Rathus and Galassi scales for both sexes. This relationship was slightly stronger (in terms of variance accounted for) for males than females, significant differences being obtained for Intimacy on the Rathus scale and PSM and Intimacy on the Galassi scale. Multiple regression analyses revealed that the personality components most consistently accounting for major portions of the variance in predicting male assertiveness scores on both the Rathus Assertiveness Schedule and the College Self-Expression Scale were Intimacy and Initiative, while in predicting female assertiveness, only Initiative was involved. The findings were related to previous research, recent work on the androgyny construct (instrumental vs. expressive behaviors), and exhortations for increased cooperation between schools of psychotherapy to establish it as a more unified discipline.Received his Ph.D. from Syracuse University in 1971. He has also been a Post-Doctoral Fellow in Clinical-Community Psychology at the University of South Carolina and a Clinical Psychologist at the Behavioral Medicine Unit of St. Joseph's Hospital- McMaster University in Hamilton, Ontario, Canada. Current research interests include personality moderators of social cognition and self-concept theory.Received his Ph.D. in Psychology from Northern Illinois University in 1972. Current research interests include personality moderators of social cognition and behavior change, and psychological assessment.