I. Essay: A New Financial Framework: Lessons From Canada

Prologue: In April 2989, the board of The Commonwealth Fund authorized $1 million for the development and funding of a program to examine lessons from Canada for a revised financial framework for American health care. This research program will be developed by staff and consultants and announced this fall This GrantWatch essay, drawn from a report to the directors of The Commonwealth Fund, represents an opportunity to show an example of the actual content of the case for such a step as presented to a foundation s board of directors. It illustrates how issues are framed and the depth and sophistication with which they are presented and discussed. More particularly, it illustrates how health services research features in and is credited for ideas presented in such discussions and, conversely, what kinds of policy questions such discussions offer for health services research. This report also deals with a timely subject. In the past year, a growing number of legislators, policy analysts, and organizations have advanced proposals that, if implemented, would dramatically restructure America's health care enterprise. The concept of universal health insurance is back in our midst because of a view among some policymakers that nothing less encompassing will lead to the kind of change needed to address our current health care financing and delivery problems. In the course of this work and the ongoing discussion of the health policy community, one approach that has drawn attention is Canada's provincially administered network of health insurance plans. The authors, Thomas Moloney and Barbara Paul (senior vice-president and program officer, respectively, of The Commonwealth Fund), have used recent health services research findings to develop their own view of an emerging consensus about the directions for a revised American health system. We hope that publishing this report will encourage other private foundations to articulate their views on how the United States should reform health care delivery and finance to address the problems of soaring costs, less than universal access, and questions about the quality of some delivered care.