The Health System Sustainability Initiative

Background

About the Initiative...

Government spending on health care has been growing more rapidly than inflation for years and is at risk of crowding out spending on other publicly funded services. This challenge has been exacerbated by a range of factors, including inaccessibility to primary care, an aging population, increasing rates of chronic disease, rising costs of medical technologies, and persistent health inequities. Additionally, delays in accessing care and workforce shortages have further strained the system, highlighting the urgent need for change. We require urgent action to ensure the long-term sustainability of  Canada’s health care system and other publicly funded programs. 

 In an effort to build a more sustainable future for Canada’s healthcare system, The Centre for Health Policy is leading the Health System Sustainability Initiative (HSSI). The goal of this initiative is to develop evidence-informed health policy options that identify key priorities, address barriers to reform, and support sustainable improvements in the health care system.  

Our Approach... 

The initiative is structured around four key areas of research and action: 

1. Define a Vision for Health System Reform 

A guiding vision—or “North Star”—is crucial for successful reform. The Health Policy Forum 2022 brought together citizens, policy researchers, government decision-makers, and health system leaders in a deliberative dialogue to identify reform priorities. 

2. Identify Priorities for Reform 

Successful reform requires collaboration between the public, policymakers, healthcare leaders, and academics. The HSSI conducted extensive community engagement through qualitative interviews to identify key structural and process challenges in the healthcare system. This included interviews with public citizens, healthcare leaders, academics, and political decision-makers from across Canada 

3. Identify Barriers and Facilitators to Policy Implementation 

One  barrier to healthcare reform in Canada has been the historical failure to implement advisory body recommendations. HSSI conducted interviews with 12 key informants, including advisory board members and implementers of five major federal advisory bodies (e.g., the Romanow Commission, the Advisory Council on Pharmacare), to understand barriers and facilitators to policy implementation and strategies to facilitate implementation.  

4. Learn from International Health System Reforms 

The HSSI conducted a comprehensive literature review and concept analysis to examine patterns of health system reform across OECD countries. The initiative systematically reviewed historical policy changes to identify the types of reforms implemented, the key drivers of reform, and the factors that contribute to successful implementation. To further refine insights, the HSSI conducted a concept analysis of 25 studies on healthcare transformations, focusing on four key dimensions: planning, context, stakeholder interests, and evaluation mechanisms. 

Moving Forward... 

The HSSI is committed to driving evidence-informed, actionable reform that improves health care value, strengthens public and system outcomes, and ensures the long-term sustainability of the Canadian health care system. By engaging with community members, system administrators, healthcare providers, academics, policy experts, and learning from international best practices, our initiative aims to create a healthcare system that is efficient, equitable, and resilient for future generations. 

Learn more about our research and recommendations here.