Trends Canadians Confront Health Care Reform A 2002 survey shows that Canadians’ attitudes toward health system changes are in a state of flux. by Julia Abelson, Matthew Mendelsohn, John N. Lavis, Steven G. Morgan, Pierre-Gerlier Forest, and Marilyn Swinton ABSTRACT: In 2002 Canadians were less anxious about the state of their health care sys- tem than they were a few years earlier, when perceptions peaked that the system needed major reform. They expressed strong support in 2002 for maintaining the status quo on health care financing (that is, no user fees and no two-tier care) within the traditional do- mains of physician and hospital care. But they appeared more receptive to two-tier care and for-profit delivery for the newer and rapidly expanding domains of home care and high-tech care. C anadians have recently been through a series of soul-searching ex- ercises to consider the problems fac- ing their health care system and options for its reform. The provincial and national com- missions that have led these exercises have re- acted to growing perceptions that the system needs major reform. 1 The most recent national inquiry, the Commission on the Future of Health Care in Canada (also known as the Romanow Commission), provided advice about the sustainability of the health care sys- tem and about how best to bring about change. 2 The results of our survey of public opinion, which was conducted at the time of the commission’s final report, may be particu- larly instructive for the United States, given that both Americans and Canadians are grap- pling with what should constitute “core” ser- vices within their respective Medicare pro- grams and the role for the for-profit sector in delivering these services. 3 Beginning in the 1990s Canadians ex- pressed growing concern that their health care system was failing to deliver timely access to high-quality care when needed; that Canadian Medicare—built around universal public in- surance for hospitals and doctors—inade- quately addresses increasing expenditures on prescription drugs and home care; and that an Health Tracking 186 May/June 2004 DOI 10.1377/hlthaff.23.3.186 ©2004 Project HOPE–The People-to-People Health Foundation, Inc. Julia Abelson (abelsonj@mcmaster.ca) is an assistant professor in the Department of Clinical Epidemiology and Biostatistics, a member of the Centre for Health Economics and Policy Analysis, and an associate member of the Department of Political Science, McMaster University, in Hamilton, Ontario. Matthew Mendelsohn is an associ- ate professor in the Department of Political Studies, Queen’s University, in Kingston, Ontario. John Lavis is an as- sociate professor in the Department of Clinical Epidemiology and Biostatistics, a member of the Centre for Health Economics and Policy Analysis, and an associate member of the Department of Political Science, McMaster Uni- versity. Steven Morgan is a member of the Centre for Health Services and Policy Research and an assistant profes- sor in the Department of Health Care and Epidemiology, University of British Columbia, in Vancouver. Pierre- Gerlier Forest is the G.D.W. Cameron Chair, Health Canada, and a professor in the Department of Political Sci- ence, Université Laval, Québec. Marilyn Swinton is research coordinator in the Centre for Health Economics and Policy Analysis, McMaster University.