This book focuses on the health care system in Canada along two sight lines. The first is evidence from other countries about how their health care systems are functioning and what reforms they are pursuing. The second is the requirements for policy change in Canada, using the province of British Columbia to illustrate many specific policy details. The reform proposals that emerge are intended to provide a restructuring of incentives to ensure that the choices made by system participants are economic in the sense that they reflect the alternative uses to which resources might be put.

One outcome of this exercise might be to also reduce the total cost of the system. Cost containment is not our muse, however, and we are concerned that such an approach to health care might adversely affect the growth and future prospects of our economy, and is in fact already adversely affecting the quality and quantity of health care available to all Canadians. We believe that the proposals contained in this document address the economic, quality, and quantity issues related to health care in Canada.

It is divided into two parts. The first part presents a survey of the evidence about the functioning of health care systems in a European and Australasian context. The second contains a comprehensive review of the Canadian system and a work plan for renewing publicly funded health care with elements of privatization and a thoroughgoing overhaul of incentives for health care consumers and providers.