Public Spending on Health Services and Policy Research in Canada: A Reflection on Thakkar and Sullivan; Comment on “Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal”

Document Type : Commentary


Canadian Medical Association, Ottawa, ON, Canada


Vidhi Thakkar and Terrence Sullivan have done a careful and thought-provoking job in trying to establish comparable estimates of public spending on health services and policy research (HSPR) in Canada, the United Kingdom and the United States. Their main recommendation is a call for an international collaboration to develop common terms and categories of HSPR. This paper raises two additional questions that have an international comparative dimension: There is little doubt that public spending on HSPR represents more than the “tip of the iceberg,” but how much more? And how do the countries fare on the uptake of HSPR by decision-makers? I have long speculated that probably as much or more is spent by provincial/territorial governments, regional health authorities, hospitals and other agencies on HSPR activities carried out by consultants in Canada than by the federal, provincial/territorial granting agencies. Support for this contention is provided in a paper by Penno and Gauld on spending on external consultancies by New Zealand’s District Health Boards (DHBs). Their estimate of the amount spent on consultancies in 2014/15 represents 80% of the amount spent on research by the Health Research Council of New Zealand in 2015. In terms of the uptake of research Jonathan Lomas pioneered the concept of linking researchers with decisionmakers when he became the founding Chief Executive Officer (CEO) of the Canadian Health Services Research Foundation (CHSRF) in 1997. An early assessment was promising, and it would be interesting to know if other countries have tried this. Most assessments of research uptake and impact are short-term in nature. It might be insightful to assess HSPR developments over the long term, such as prospective reimbursement through diagnosis related groups (DRGs) that has been evolving internationally for more 40+ years. In the short term the prospects for a major infusion of funding in HSPR in Canada are not promising, although there have been welcome investments in the Canadian Foundation for Healthcare Improvement (formerly CHSRF).


Main Subjects

  1. Thakkar V, Sullivan T. Public spending on health service and policy research in Canada, the United Kingdon, and the United States: a modest proposal. Int J Health Policy Manag. 2017; forthcoming. doi:10.15171/ijhpm.2017.45
  2. Health services research. Canadian Institutes of Health Research website.   
  3. Penno E, Gauld R. The role, costs and value for money of external consultancies in the health sector: a study of New Zealand’s District Health Boards. Health Policy. 2017;121(4):458-467. doi:10.1016/j.healthpol.2017.02.005
  4. Health Research Council of New Zealand. Annual report 2016.  Accessed July 21, 2017.
  5. Hunter DJ, Frank J. Making research matter: Comment on “public spending on health service and policy research in Canada, The United Kingdom and the United States: a modest proposal.” Int J Health Policy Manag. 2017; forthcoming. doi:10.15171/ijhpm.2017.97
  6. Millar K. Canadian Institute for Health Information. Accessed August 1, 2017.
  7. Office of the Auditor General of Ontario. Consultant use in selected health organizations.  Accessed August 1, 2017.
  8. Romanow R. Building on Values: the future of health care in Canada.  Accessed August 1, 2017.
  9. Lomas J. Improving research dissemination and uptake in the health sector: beyond the sound of one hand clapping. McMaster University Centre for Health Economics and Policy Analysis Policy Commentary C97-1. Published November, 1997.
  10. Department of Finance Canada. Budget 1996. Budget plan.  Accessed August 1, 2017.
  11. Ross S, Lavis J, Rodriguez C, Woodside J, Denis JL. Partnership experiences: involving decision-makers in the research process. J Health Serv Res Policy. 2003;8 Suppl 2:26-34. doi:10.1258/135581903322405144
  12. About Academy Health. Academy Health website.  Accessed September 11, 2017.
  13. Health System Impact Fellowhips – host employer partner organizations. Canadian Institutes of Health Research website.  Accessed September 11, 2017.
  14. Lewis S, Naylor CD, Battista R, et al. Canada needs an evidence-based decision-making trade show. Cmaj. 1998;158(2):210-212.
  15. Britnell M. In Search of the Perfect Health System. New York NY: Palgrave Macmillan. 2015.
  16. Tamblyn R, McMahon M, Girard N, Drake E, Nadigel J, Gaudreau K. Health services and policy research in the first decade at the Canadian Institutes of Health Research. CMAJ Open. 2016;4(2):E213-221. doi:10.9778/cmajo.20150045
  17. Canadian Institutes of Health Research. Funding overview.  Accessed August 3, 2017.
  18. Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD. Case mix definition by diagnosis-related groups. Med Care. 1980;18(2 Suppl):iii, 1-53.
  19. Congress of the U.S. Office of Technology Assessment. Diagnosis Related Groups (DRGs) and the Medicare Program: implications for medical technology. Washington, DC; 1983.
  20. Busse R, Geissler A, Quentin W, Wiley M. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Berkshire, England: Open University Press; 2011.
  21. American Hospital Association. Medicare’s bundled payment initiatives: considerations for providers.  Accessed August 3, 2017.
  22. Sutherland J, Crump RT, Repin N, Hellsten E. Paying for hospital services: a hard look at the options. Accessed August 3, 2017.
  23. Advisory Panel on Healthcare Innovation. Unleashing innovation: excellent healthcare for Canada.  Accessed August 3, 2017.
  24. Department of Finance Canada. Building a strong middle class #Budget2017.  Accessed August 3, 2017.
  25. Canadian Foundation for Healthcare Improvement. Home is where the health is: scaling up INSPIRED approaches to COPD care. Prospectus.  Accessed Septemebr 11, 2017.
  26. Canada’s Fundamental Science Review. Investing in Canada’s future: strengthening the foundations of Canadian research.$file/ScienceReview_April2017-rv.pdf.  Accessed August 3, 2017.
  27. Innovation, Science and Economic Development Canada. Statement from the Government of Canada on receiving the expert panel’s report on Canada’s Fundamental Science Review. ofcanadaonreceivingtheexpertpanelsre.html. Accessed August 3, 2017.
  28. Schneider E, Sarnak D, Squires D, Shah A, Doty M. Mirror, mirror 2017: international comparison reflects flaws and opportunities for better U.S. health care.  Accessed August 3, 2017.
  • Receive Date: 03 August 2017
  • Revise Date: 16 September 2017
  • Accept Date: 12 September 2017
  • First Publish Date: 01 May 2018