Healthcare Policy最新文献

{"title":"Commentary: Gender Equity Is Essential for Optimal Surgical Prioritization: A Response to Quinn and Brennand.","authors":"Alana M Flexman, Gianni R Lorello","doi":"10.12927/hcpol.2026.27833","DOIUrl":"10.12927/hcpol.2026.27833","url":null,"abstract":"<p><p>Gender equity in surgical care remains an outstanding issue requiring coordinated, system-wide solutions. Persistent inequities are amplified by embedded systemic and structural biases, including full recognition of gynecology as equal surgical service, lower renumeration for gynecological procedures compared with equivalent urological procedures, the gender pay gap and the chronic deprioritization of gynecological conditions. The legacy of these historic inequities urgently needs to be addressed in contemporary practice, with enhanced accountability and transparency on surgical wait times, scheduling priorities and remuneration. Only with such reforms can we move toward full equity for patients and providers of gynecological care.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"70-73"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Improving Access to Surgical Care in Canadian Health Systems: Technology or Culture?","authors":"David R Urbach","doi":"10.12927/hcpol.2026.27837","DOIUrl":"10.12927/hcpol.2026.27837","url":null,"abstract":"<p><p>The most serious threats to Canadian medicare have arisen because of public concern over wait times for elective orthopaedic surgery. Various system factors result in long surgical wait times, but a fundamental cause is the lack of coordination of surgeons' independent practices. While most efforts to address wait times to date have focused on technological solutions, cultural changes in the model of surgical practice have the potential to enhance access to surgery and improve the professional work environment of Canadian surgeons.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"43-46"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking Surgical Capacity Through Collectable Time: A Multi-Level Policy Framework for Canadian Health Systems.","authors":"Jean-Pierre Eskander, Trevor Bardell","doi":"10.12927/hcpol.2026.27772","DOIUrl":"https://doi.org/10.12927/hcpol.2026.27772","url":null,"abstract":"<p><p>Canadian healthcare confronts persistent surgical capacity constraints driven by demographic pressures, economic limitations and inefficient resource utilization. Despite substantial resource requirements, operating rooms frequently remain underutilized due to misaligned policies and incentives. Introducing \"collectable time\" provides a foundation for comprehensive policy reform to resolve these inefficiencies. Addressing these inefficiencies through detailed, multi-level policy changes is critical to sustainably improving healthcare system productivity. Embedding collectable time metrics within institutional, provincial, federal and regulatory frameworks could increase surgical capacity without requiring additional staff or infrastructure.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Cost Savings Are Possible, But Success Is Not Guaranteed: Challenges of Bundled Payment in Canada.","authors":"Tim Zhang, Amity E Quinn","doi":"10.12927/hcpol.2026.27838","DOIUrl":"10.12927/hcpol.2026.27838","url":null,"abstract":"<p><p>Bundled payments are often proposed to improve surgical care value by shifting financial risk from payers to providers. While they may generate savings, evidence from international programs and Ontario shows mixed cost effects and modest utilization changes. They are also not a substitute for the capacity reforms needed to address Canada's surgical backlogs. Key implementation challenges - including selecting participating teams, building analytic and data infrastructure to evaluate proposals and set prices, designing shared-savings arrangements and aligning incentives within multidisciplinary teams - cannot be overlooked. Without careful design and piloting, bundled payments risk limited savings and unintended consequences.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"30-35"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Urgent Call for Reform in Surgical Policy Making in Canada.","authors":"Jason M Sutherland","doi":"10.12927/hcpol.2026.27840","DOIUrl":"10.12927/hcpol.2026.27840","url":null,"abstract":"<p><p>This issue of healthcare policy is focused on surgery policy in canada. Surgery policy is significantly undervalued from a health systems perspective as it affects millions of Canadians. A focused issue on surgery policy is one effort to draw policy makers and researchers to advances in this important area and identify additional topics where policy attention and additional research are needed to improve health and well-being.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"6-18"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency Through Equity: Prioritizing Gynecologic Surgery to Improve Health System Performance.","authors":"Amity E Quinn, Erin A Brennand","doi":"10.12927/hcpol.2026.27834","DOIUrl":"10.12927/hcpol.2026.27834","url":null,"abstract":"<p><p>Gynecologic surgery is underserved in Canada, despite its volume and impact on health system performance, including the experiences of women surgeons and patients. Structural gender biases in reimbursement, scheduling and innovation contribute to long wait times, reduced surgical throughput and diminished quality of care. This editorial outlines five strategies to improve system efficiency: formal recognition of gynecologic surgery, compensation and scheduling reform, investment in inclusive surgical tools and infrastructure, primary care integration and public advocacy. Prioritizing gynecologic surgery is essential to achieving a high-performing, equitable Canadian health system.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"60-69"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Surgical Outcomes While Lowering Costs: The Case for a Bundled Payment Model for Surgical Episodes of Care.","authors":"Stephen Pinney, Glen Sumner","doi":"10.12927/hcpol.2026.27839","DOIUrl":"10.12927/hcpol.2026.27839","url":null,"abstract":"<p><p>This paper argues that improving surgical outcomes while controlling costs requires viewing surgery as one step within a full <i>episode of care</i>, from pre-operative optimization through post-operative recovery. We contend that Canada's current fee-for-service and block-funding models fragment this continuum, reward volume over value and misalign incentives between ministries, hospitals and surgeons. Drawing on agency theory and international bundled-payment experience, we propose an episode-of-care bundled payment made to integrated surgical programs that assume both clinical and financial accountability. We outline design options, success factors and governance requirements, and identify key policy, regulatory and cultural barriers that must be addressed to implement this model in Canada.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"19-29"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Surgical Access in Canada Through Self-Governing First Nations.","authors":"Trafford Crump, Mariam Hegazy","doi":"10.12927/hcpol.2026.27832","DOIUrl":"10.12927/hcpol.2026.27832","url":null,"abstract":"<p><p>Prolonged surgical wait times in Canada have prompted models exploiting <i>Canada Health Act</i> (1985) loopholes, often compromising care continuity. This review assesses the feasibility of private surgical facilities on First Nations lands. We reviewed modern treaties and self-government agreements of First Nations within 200 km of urban centres, analyzing provisions on legal status and health jurisdiction. Five First Nations met the inclusion criteria. Their agreements confer self-governing status with varying authority over health services, though federal or provincial paramountcy may apply. First Nations under modern treaties may have legal basis to establish private surgical facilities, addressing wait times. Legal ambiguities require further study.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"74-85"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Publicly Reported Surgical Wait Time Information by Community Family Physicians in Toronto, Canada.","authors":"Olivia J S Varkul, Noah Ivers, Julie L Takata, Vasily Giannakeas, David R Urbach","doi":"10.12927/hcpol.2026.27801","DOIUrl":"10.12927/hcpol.2026.27801","url":null,"abstract":"<p><p>The Ontario Wait Time Information System (WTIS) provides publicly accessible surgical wait time data. This study evaluated WTIS use among Ontario primary care physicians to understand how wait time information is interpreted and applied. We invited 1,306 physicians to complete an online survey. Of 151 respondents, 90.9% were unaware of the WTIS. However, 87.5% said hospital wait time data would influence referrals, and 95.1% preferred surgeon-specific wait times. In addition, 97.2% were willing to use a single-entry referral system. Increasing WTIS awareness and adding surgeon-level data may enhance referral practices.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"100-108"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Population-Based Comparison of Wait Times for Common Elective General Surgery Procedures Between Immigrants and Non-Immigrants in British Columbia.","authors":"Michael Y Guo, Christine Li, Ahmer A Karimuddin, Jason M Sutherland","doi":"10.12927/hcpol.2026.27800","DOIUrl":"10.12927/hcpol.2026.27800","url":null,"abstract":"<p><strong>Background: </strong>Long wait times for elective surgery represent a persistent challenge in healthcare systems and for waiting patients, particularly in Canada. Delays to elective surgery impact patient well-being but may also disproportionately affect vulnerable populations. Despite high levels of immigration to Canada, research regarding immigrants' access to elective surgical care remains scarce. This population-based study measures and compares wait times for common elective general surgeries for immigrants with non-immigrants in British Columbia (BC), Canada.</p><p><strong>Methods: </strong>All elective general surgery procedures performed in BC, Canada, between 2013 and 2021, were identified using hospital discharge summaries' procedure codes. A longitudinal cohort was created by linking cohort members with immigration and physician billing data. Patients' wait time was defined as the duration between the last general surgery visit and the surgery date. Wait times were compared between immigrants and non-immigrants, adjusting for patient- and system-level factors using multivariable regression.</p><p><strong>Results: </strong>Among 159,151 elective general surgeries, 14.3% were performed on immigrants. Immigrants experienced longer wait times on average compared with non-immigrants (83.7 vs 76.3 days), a difference that remained significant after adjustment (rate ratio [RR]: 1.03, 95% confidence interval [CI]: 1.01, 1.05). Differences were most pronounced for cholecystectomies; immigrants waited 15.4 days longer on average (unadjusted) than non-immigrants. Among immigrants, \"visible minorities\" waited longer compared with immigrants from European/English-speaking countries (RR: 1.06, 95% CI: 1.03, 1.10).</p><p><strong>Conclusion: </strong>This study highlighted that immigrants tended to wait longer for elective surgery in this study's setting. Visible minorities experienced the longest waits. Despite sharing the same structures and processes of care in the setting's publicly funded health system, barriers in healthcare delivery delayed access to elective surgical care for immigrants.</p>","PeriodicalId":39389,"journal":{"name":"Healthcare Policy","volume":"21 3","pages":"86-99"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}