Working Papers

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https://unbscholar.lib.unb.ca/handle/1882/12775
Working or discussion papers circulated publicly or among a group of peers. Certain disciplines, for example, economics, issue working papers in series. (URI: http://purl.org/coar/resource_type/c_8042)

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Browsing Working Papers by Author "Brown, Malcolm, C."

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    Halfway Technologies, Quality of Life, and Affordable Public Health Policy: Biotechnology Drug Developments for Multiple Sclerosis
    Brown, Malcolm, C.; Jardine-Tweedie, Leanne
    The cost control problems associated with funding half-way medical technologies in national health insurance systems are considered, in the context of analyzing the effectiveness, efficiency and equity implications of publicly funding the new biotechnology drugs for treating multiple sclerosis. It is suggested that, while lip service is played to all three types of assessment for formulating public policy, in practice decision-making is based on the effectiveness and efficiency evidence only. The consequence is an inability to formulate resource allocation decisions where distributional health effects among patients are involved. The development of equity norms would not only generate more consistency and justification to distributional decisions, but also increase the ability of policy makers to make distributional choices explicitly in contexts where the implications of doing so implicitly are spiralling health care costs. For the purpose of increased cost control, almost any set of explicit equity norms would do, which does not mean to say that all equity norms are equally appealing, either philosophically or electorally. The development of explicit and socially acceptable equity norms is a high priority goal, even though their development requires more explicit judgements about what constitutes fair collective funding arrangements than either analysts or society have been want to make.
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    Where Has the Canadian Public Health Sector Gone?: The Optimal Mix of Patient and Community Oriented Health Programs and Policies
    Brown, Malcolm, C.
    In health terms, the post-war period in Canada has been noteworthy mainly for the introduction and maintenance of national health insurance (NHI); but the period has also been one of significant paradigm changes concerning public health. Before the introduction of NHI (roughly 1945-1970), public health was eclipsed by curative health objectives; with the objective of introducing medicare dominating all policy options designed to prevent diseases and injuries from occurring, or to promote healthy lifestyles and living environments. The decade following the introduction of medicare (the 1970s) was one of policy concern about health costs in the context of rapidly increasing prices. During this period, interest was rekindled in public health, not as a mechanism for promoting better health but as a mechanism for constraining curative health expenditures. By the beginning of the 1980s, this interest declined, and two new paradigms emerged. One was the paradigm of population health maximization via evidence based medicine - a paradigm in which containment of health sector expenditures remained the main objective of policy but reliance on public health ceased to be a primary cost containment tool. The other paradigm was health promotion, in which the idea of health policy was replaced by that of healthy public policy. Integral to both 1980s paradigms was recognition that public health was no longer appropriately defined as a sectoral concept, and no longer pertinent to health sector policies concerned mainly with the funding of curative services. Policy-makers and health analysts are currently struggling to find the best ways to define public health policy in a world where health and non-health goals are becoming increasingly comparable, and where non-health policies are as important as health ones in defining the standard of a health.