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.     

Reforming rural Ontario

Abstract: This paper turns the scholarly spotlight onto an overlooked aspect of the Ontario municipal system by exploring the issue of county government reform in four selected communities in southern Ontario. Various proposals for county government reform have been advanced by the provincial government during the last quarter-century; here we consider the “common sense” approach to municipal government reform adopted by the Harris government after its election in 1995. We analyse how four counties have responded to this concerted and forceful attempt to bring about major county restructuring. The study has two major objectives. First, it illustrates the forces that have at once advanced and constrained county government reform in recent years; second, it attempts to explain major differences in the manner in which individual counties have responded to the Harris government's drive for reform. Finally, the paper concludes with some reflections on the viability of rural government in Ontario in the light of the substance and process of county government reform. Sommaire: Cet article examine un aspect négligé du système municipal ontarien en explorant la question de la réforme des gouvernements de comté dans quatre communautés choisies du sud de l'Ontario. Le gouvernement provincial a fait diverses propositions de réforme du gouvemement de comté au cours du demier quart de siècle; ici, nous examinons l'approche basée sur le « ban sens » adoptée par le gouvernement Harris en ce qui concerne les gouvernements municipaux, après son élection en 1995, et nous analysons la manière dont quatre comtés ont réagi à cette tentative concertée et vigoureuse de déclencher une forte restructuration au niveau du comté. Cette étude a deux grands objectifs. Premièrement, elle illustre les forces qui ont à la fois promu et retenu la réforme des gouvernements de comté au cours de ces dernières annèes; deuxièmement, elle essaie d'expliquer les principaux écarts dans la façon dont chaque comté a réagi aux efforts de réforme du gouvemement Harris. Enfin, I'article offer quelques réflexions sur la viabilité du gouvernement rural en Ontario à la lumière du fond et du processus de réforme des gouvernements de comté.     

Industry, occupation, and disability insurance beneficiary work return.

This article uses the New Beneficiary Data System to describe the first job held after award of Disability Insurance benefits, in terms of occupation and industry. It examines work activity within sectors of employment, and looks at the issues of whether work return in certain industries and occupations varies according to the demographic characteristics of the beneficiaries. The article also presents data on sector-specific employer accommodations that can aid in sustained work return. Postentitlement work was fairly evenly distributed across occupational and industrial sectors. Persons with higher levels of educational attainment were found to be in white-collar employment sectors. There were noticeable differences in the availability of employer accommodations across postentitlement occupations and industries.     

Specificity versus representativeness: methodological approaches to the study of Mexico-U.S. migration

"This article compares two sources of data on Mexico-U.S. migration, based on radically different methodologies: the Mexican Migration Project (Promig) and the National Survey of Population Dynamics (Enadid).... This comparative study shows that a micro-social design drawing on multiple community samples, such as Promig, can solve the methodological conflict between specificity and representativeness.... The authors' research also highlights the problem of selectivity and specificity entailed by traditional surveys such as Enadid as a result of restricting their samples to international residents in Mexico and attempting to explain such a complex, socioeconomic process using a limited number of variables." (EXCERPT)     

TexPool's Experiences in the 1990s: Policy Implications for Other State Investment Pools

The State of Texas's local government investment pool, TexPool, has faced major challenges in the 1990s. This article provides an overview of two major events involving TexPool: (1) a $2.2 billion "run" on the pool in 1994 and (2) the out-sourcing of TexPool's functions in 1997. The article describes these events and analyzes potential implications for other state-administered investment pools. The article addresses issues such as: (1) the need to develop investment policies and practices that are suitable for a particular pool's objectives and purpose, (2) whether a state government has a responsibility to ensure that participants in a state investment pool do not incur losses, (3) the possible implications of having an elected official as the person with primary responsibility for overseeing the pool, and (4) concerns related to the outsourcing of state investment pools. This article is intended to encourage debate on the policies and practices of state investment pools, which currently are serving more than 15,000 local governments in the United States.