Health care in Canada: Incrementalism under fiscal duress

Driven by fiscal pressures in the 1990s, Canada's provincial Medicare syste ms cut inpatient care, expanded community services, and consolidated hospit als under regional authorities in nine often provinces. Public confidence h as been badly shaken by the transition. No province has successfully integr ated services across the continuum of care. Home care and prescription drug coverage vary from province to province. Efforts to reform physician payme nt have stalled, and capacity to measure and manage the quality of care is generally underdeveloped. Thus, for the next few years, policymakers must s tabilize the acute care sector, while cautiously pursuing an agenda of piec e-meal reforms.