2013 Tansley Lecture - Strategic Targets for Public Services: Lessons for Canada from the English Experience
Presented by Peter C. Smith, Professor of Health Policy, Imperial College London
April 18, 2013
When it came to power in 1997, Tony Blair’s government sought to revolutionize the way in which UK public services were planned and delivered. In particular, it sought to focus the actions of ministers on explicit objectives and targets, in the form of ‘Public Service Agreements’ (PSAs). The distinctive feature of this system was a range of high profi le mechanisms designed to ensure that PSAs led to measurable changes in public service performance. This presentation summarizes the history of the PSA regime, describes some of the major issues that arose in its implementation, and assesses its general relevance to the management of public services by governments in Canada contemplating, implementing or using performance management regimes.
Peter C. Smith is Professor of Health Policy at Imperial College London, where he co-directs the Centre for Health Policy. He is a mathematics graduate from the University of Oxford, and was formerly Director of the Centre for Health Economics at the University of York. He is author of many academic papers on the financing and efficiency of public services, and is with Sherry Glied joint editor of the Oxford Handbook of Health Economics. Particular research interests include health system performance assessment, value for money, and the equitable financing of public services. Smith has advised many government ministries and international agencies, including the World Health Organization, the International Monetary Fund, the World Bank, the European Commission and the Organization for Economic Cooperation and Development.
L-R:Richard Schlachter, Business Development Senior Manager, Deloitte; Colleen Quinlan, MPA student; Ryan Mang, MPA student; Kimberley Brown, Senior Policy Analyst, Western Economic Diversification Canada; Cam Swan, Chair, Public Service Commission, Saskatchewan Central Services (Photo credit: University of Regina Photography Department)
The Johnson-Shoyama Graduate School of Public Policy was also pleased to feature the third annual JSGS Policy Research Poster Presentation. During cocktail hour, students were asked to present posters summarizing their research activities, with opportunity for extended discussion and engagement with those attending the lecture. The poster presentations were evaluated by a panel of representatives including:
- Mr. Cam Swan, Chair, Public Service Commission, Saskatchewan Central Services
- Mr. Richard Schlachter, Business Development Senior Manager, Deloitte
- Ms. Kimberley Brown, Senior Policy Analyst, Western Economic Diversification Canada
We extend congratulations to the first-place winners of the 2013 IPAC Thought Leadership Award: Ryan Mang, Colleen Quinlan, Olga Gerry and Robyn Passmore, for their poster entitled, Improving Childhood Immunization Coverage Rates. In recognition of this achievement, one of the group members will travel to Montreal in August to present their poster and research at the Institute of Public Administration of Canada’s 65th annual conference. This same group was also the recipient of the Peer Choice Award.
Improving Immunization Coverage Rates, by Ryan Mang, Colleen Quinlan, Olga Gerry and Robyn Passmore (MPA students) - First Place Recipients
Abstract - Currently, Saskatchewan is not meeting the childhood immunization coverage rates needed to achieve herd immunity and in turn protect against preventable diseases in the general population. This poster outlines the current immunization coverage rates and provides recommendations to increase the immunization coverage rates through a number of policy instruments. Immunization has been hailed as a great public health achievement and the most effective way to prevent infectious disease. In the last century, diseases that can be prevented by vaccinations have been reduced by 98 -99%. Worldwide, childhood immunization rates are a recognized measure of the health of a population and the performance of the health care system. However, despite having universal publicly funded immunization coverage, the proportion of Saskatchewan children who are adequately immunized continues to be below recommended herd immunity targets. The policy options considered in this poster include increasing public education and awareness on the importance of childhood immunization, legislating and requiring childhood immunization prior to school entry and offering income-tested financial incentives to increase equity and effectiveness of childhood immunization programs. These options are assessed for their effectiveness in achieving increases to childhood immunization rates.
China in South America (SA): Development or Curse?....an Institutional Issue? by Giovanny Bastidas (PhD student)
Abstract - South America’s development has been always associated with the extraction of mining resources. In recent years, China has become the fastest growing investor in South America (SA) with 60% of its investments focus on mining resources. However, SA history reveals that most of the foreign natural resource investments have been synonymous with plunder. Taking into account these facts, the purpose of this study is to determine whether this new wave of Chinese investments will hinder or foster development, and what role institutions play in this process. Applying the decision chain framework* to South America mining countries, this research provides empirical evidence to show that success in the management of mining resources is linked to a country’s institutional capacity – i.e., the long-term sustainable development of mining resources depends on the ability of countries to address their institutional capacity. Thus, whether a country is able to benefit or not from China’s mining investments depends on a broad set of political institutions (e.g., rule of law, accountability) in that country.
Clubroot Control in Saskatchewan: Updating the Clubroot Management Plan, by Nancy Carlson (MPA student)
Abstract - AbraClubroot disease has been affecting canola crops in Alberta since 2003 and has caused significant yield loss. In September 2011, clubroot pathogens were identified in two canola crops in North Central Saskatchewan. The $5.4 billion canola industry in Saskatchewan faces the challenge of maintaining a high level of production while taking caution to prevent the further spread of this disease. The Government of Saskatchewan formed the Saskatchewan Clubroot Initiative, a network of stakeholders from government and industry, to develop a plan of action to be taken for clubroot control. The Clubroot Management Plan was completed in June 2011 and provided direction for stakeholders to spread awareness and encourage best practices that prevent the spread of clubroot. This plan has not been updated since clubroot was identified in the province and must be updated to respond to the heightened threat of an outbreak. Clubroot control is difficult because of the nature of the disease. The ease at which it is spread, the longevity of its life-cycle and the lack of practical or economical treatment options means that individual producers can not deal with this problem on their own. Collective efforts are required to keep clubroot from spreading further within the province. The most effective policy response at this time would be to target intensive testing and monitoring in the region where clubroot has been confirmed. This initiative can be funded by an increase in the canola levy from $0.75 per metric tonne to $1.00, matching the levies in both Alberta and Manitoba.
Consultation Under Duress: Reactions to the Saskatchewan Employment Act Consultation, by Kathy Johnson (MPA student)
Abstract - The Saskatchewan Government’s attempt to overhaul the province’s employment legislation has experienced backlash, mainly surrounding their consultation process. Though this study, I hoped to gain insight as to the cause of this reaction in hopes of assisting in similar future policy formation. Through assessing the responses from unions, businesses and other groups that had been posted on the Saskatchewan Government’s website, I found that the 90-day time period was the most commonly cited concern. This issue, however, was not discussed equally amongst all groups – union representatives’ submissions cited it at a much higher rate than the other groups. To understand this outcome, I considered the legitimacy of the consultation time period and analyzed the groups’ responses through the lens of prospect theory. Although I found that concerns about the consultation time period were likely justified, speaking out against it risked unseen retaliation against those who voiced descent. Union representatives; however, had reasons to feel the legislation posed such a threat that they were willing to take that risk. Through a greater appreciation of the situation that those union representatives were experiencing, it becomes easier to understand and even anticipate their strong reaction. Through this study, I have demonstrated the importance of understanding the perceived situation of those strongly impacted by a policy. Additionally, if public consultation is used under similar future circumstances, I suggest that greater legitimacy can be attained through a longer public consultation period permitting greater opportunities for face-to-face discourse.
Denver’s Five Futures: An Evaluation of the City of Denver’s Climate Readiness, by Max Poelzer, Katie Neale and Mustafa Mustaan (MPA students)
Abstract - Denver, like other cities in Western North America, faces major challenges due to the uncertainty of climate change. These challenges include warmer and drier conditions and greater frequency of hazard events, such as droughts. Policymakers must address these challenges through approaches that consider a range of future scenarios. We assessed Denver’s futures planning strategy through a framework that considered leadership, community participation, robustness, flexibility, and adaptability. This assessment revealed that Denver has initiated progressive and innovative policies and programs to prepare for five possible climate futures. Municipal initiatives include establishing strategies to respond to several degrees of drought severity, cultivating a culture of climate awareness, and bringing a robust approach to thinking about future water management. However, since Denver has only adopted the methods of adaptive planning within the past decade, the city has yet to fully develop all of the key mechanisms that have been identified as necessary for climate readiness. Nevertheless, Denver serves as a model of adaptive planning and decision making under uncertainty that can provide valuable lessons for North American cities that face similar climate-induced problems in the near and long-term futures. The mindset of proactive policy planning found in city hall and Denver Water has potential to provide this community with the flexibility and adaptability required to handle an uncertain water future.
Implementing Universal Credit: Overcoming Opposition through Bundling, by Darcy Overland (MPA student)
Abstract - Welfare policy systems are often created piecemeal over long periods of time due to changing priorities and social pressures. As a result they are often complex, incoherent systems, consisting of many smaller, interrelated policies and programs. Changes to existing social welfare policy systems are often opposed due to loss aversion and status quo preferences. Elected officials can be hesitant to propose changes due to a high potential for both unintended consequences resulting in one policy area from changes in another policy area, and negative political fallout if the changes are not in line with public expectations. In the UK, they have succeeded in implementing a major welfare system change with minimal opposition. Success occurred due to bundling changes to all previous means-tested benefits, allowances and tax credits into one larger policy, and high levels of public consultation. The new system is composed of the Universal Credit, which consists of a base allowance, and additional circumstance based components. Due to bundling, losses in one area are minimized through gains realized from other provisions, neutralizing the capacity of special interest groups and individuals to oppose the changes based on loss aversion. In addition, extensive analysis and consultations have increased acceptance of the changes. The changes also reflect the current values of society by: providing administrative savings over the old system; using technology to streamline process; monitoring expectations of those able to work; and eliminating perverse incentives under the old system.
Income Inequality and Health, by Milo Grimsrud (MPA student)
Abstract - History has proven that over time as the incomes of nations improve, their populations health status improves. Life expectancy in over 190 member states of the World Health Organization are reported at 57 in the poorer group, and 80 within the top income group. Indexes are used to measure the distribution of income. Per capita income fails to capture the distribution impacts, as it simply takes total income divided by the population. The Gini index measures the overall distribution of income between income groups. Research shows that in Canada, approximately 40 per cent of the income is controlled by the top 20 per cent of the population, with this group enjoying four times the perceived health. Economic theory suggests that as incomes rise, health increases but at a diminishing rate. This potentially allows for income redistribution without a significant negative health effect on the high income earners. The amount shifted from high income earners to the poor, improves the general overall health of the entire population. The lack of income and good health can be attributed to such factors as, inadequate housing, low education levels, unstable employment, etc. While Canadian public policy is doing a relatively good job of addressing the needs of low income segments, there remains the disenfranchised in a growing economy that require additional resources, such as sufficient housing, education, and quality employment opportunities.
Income Inequality and Health, by Yang Li (MPA student)
Abstract - The poster reviews the literature on the relationship between income inequality and health status. According to the literature, there is a strong negative correlation between income inequality and health. There are three main economic theories trying to explain this negative relationship. They are the Income Inequality Hypothesis (IIH), the Absolute Income Hypothesis (AIH) and the Relative Income Hypothesis (RIH). The Income Inequality Hypothesis means that income inequality in a society affects everyone’s health, regardless of a person’s particular income level. In other words, individuals, regardless of their individual incomes, tend to have worse health in societies that are more unequal. The Absolute Income Hypothesis means that individual health is affected by own income but not the distribution of incomes. Besides, it also indicates that the relation between individual income and health status is concave rather than linear. The Relative Income Hypothesis points out that health depends on an individual’s income relative to others in his or her group, rather than an individual’s absolute income. The reason for this is that low relative income may cause stress and depression leading to illness. A lot of studies assess the three theories. Data and research from both China and the USA suggests that AIH has strong empirical support while there is no or little evidence for the IIH and RIH. As a result, this poster further analyzes the AIH and draws some possible policy implications of the AIH theory.
Is Rio Water Ready? A Climate Adaptation Scorecard, by Dan Dodd and Matthew Dow (MPA students)
Abstract - Rio de Janeiro, host of the 2014 FIFA World Cup and 2016 Summer Olympics, faces climatic uncertainty. Water is the medium through which humans will experience the impacts of climate change and as these impacts manifest in Rio de Janeiro, the city’s water managers will need to prepare with long term planning and vulnerability reduction. Has the City of Rio de Janeiro adopted adaptive water management to reduce the risk of an uncertain climate future? We developed an assessment framework based on decision making under uncertainty principles and reviewed water policy in Rio relative to relevant criteria. Our review of the current policies using the Adaptation Scorecard concludes that there are significant vulnerabilities in the current water network, especially in low income areas, and little coordination between water sectors. In addition, infrastructure upgrades are focused on the city’s mega-events rather than long-term climate adaptation. Further, corruption and theft undermine effective water governance. Rio de Janeiro needs to revamp water governance to include integrated, long-term, flexible and adaptive water planning.
Is the Promise of Health System Regionalization Being Realized? Preliminary Results from Saskatchewan, Manitoba, New Brunswick, and Nova Scotia, by Johnathan Harris (MPA student)
Abstract - In the late 1980s and early 1990s, Canadian provincial governments embarked on a restructuring of health system governance, transferring decision-making responsibilities from provincial health ministries to regional health authorities (RHAs). This strategy of decentralization, which can be defined as “the transfer of formal responsibility and power to make decisions regarding the management, production, distribution, and/or financing of health services” from one unit to a larger number of smaller, geographically separate actors (Vrangbaek 2007) was expected to better meet the health care needs of Canadians. Specifically, regionalization was expected to improve appropriateness and continuity of care over extensive geographical areas and allow more directed funds for public and population health initiatives. Over the past two decades, provinces have taken divergent paths in their approaches to regionalization and the delivery of health services, with varied results. Regionalization was thought to have the most potential as a mechanism for making health care more responsive to community needs in rural areas (Side and Keefe (2004). Although regionalization and associated decentralization are thought to have had a positive effect on health system performance, this assumption has to date been largely untested. This presentation will examine key policy issues associated with regionalization and discuss future research that will examine the effect of regionalization on health system performance in Saskatchewan, Manitoba, New Brunswick, and Nova Scotia, four provinces with more than 25% of the population residing in census-rural areas.
Key Performance Indicators and Ridership: Measuring Success in Western Canada’s Municipal Transit Systems, by Monica Brar, David Cundall, Paul Gauthier and Dongling Yu (MPA students)
Abstract - This poster assesses the impact that four commonly used indicators have on ridership levels in Western Canada’s municipal transit systems. Affordability, frequency, cost recovery ratio, and percent of municipal budget allocated towards transit were chosen as indicators, due to common usage as efficiency and effectiveness indicators in Western Canada. The Municipalities of Edmonton, Regina, Saskatoon, and Winnipeg were chosen based on comparability of geography as well as transit system layout. Our research has shown that efficiency and effectiveness criteria appear to have low correlation with ridership levels. Edmonton fulfills most of the efficiency and effectiveness criteria but has lowest ridership levels, while Winnipeg fulfills least of the criteria but has highest ridership levels. This led us to conclude that although efficiency and effectiveness criteria may play a role in overall customer satisfaction, there are additional factors required for increasing ridership. Transit managers should consider additional indicators such as market penetration when attempting to increase ridership levels.
New Media Consumption and Voter Literacy, by Matthew W. Dow (MPA student)
Abstract - The informed voter is central to many fundamental conceptions of a healthy democracy. Voters with high voter literacy are: more likely to hold ideologically consistent opinions; more tolerant towards opposing opinions and values; and have a greater ability to connect policy to an evaluation of political parties and public officials. They are also more likely to change opinions when compelling evidence is provided. Therefore, the quantity and accuracy of information possessed by voters is critical for democratic citizenship. This study used data gathered during the 2011 Canadian federal election by the Canadian Election Study to determine how rates of media consumption among different mediums influence the accuracy of basic information about current events, politics and government policy among Canadian voters. This work also provides a comparison between the effects of the consumption of traditional forms of media (Television, Radio, and Newspaper) and “new” medias (Internet). The study found a positive relationship between rates of both traditional and “new” media consumption, and information accuracy. This study also demonstrates that, among the different media, frequent use of the Internet had the greatest ability to inform voters.
Realizing the vision: Improving Kidsfirst Performance, by Ben Orr, Lindsay Tokarski, Laura Willcocks and Chloe Miller (MPA students)
Abstract - KidsFirst is an early childhood intervention program operating in nine locations throughout Saskatchewan. The program targets socioeconomically challenged families with children from prenatal to five years of age as this is widely thought to be the most effective time for intervention. In 2010 the program underwent a thorough evaluation. This poster assesses that evaluation in order to determine whether the selected framework and indicators accurately reflects the program’s performance, focusing on the first of the organization’s four goals. Despite the apparent thoroughness of the evaluation, the actual impact of the program is unclear due to a lack of feasible indicators, an overabundance of information for some indicators and a dearth of it for others, and mismatch between measures and results. The resulting evaluation is data rich but information poor and all areas of the performance management process have been negatively affected. The poster concludes with the following recommendations for future evaluations of the program: limit indicators to those that are measurable; shift the focus from reporting to learning; and conduct research and reports on each of the program locations separately.
Saskatchewan Immigration Nominee Program Abstract (SINP), by Kim Shaw, Nick Jow and Oleksandra Kravets (MPA students)
Abstract - The Saskatchewan Immigration Nominee Program is a government run program that nominates selected applicants to the Citizenship Immigration Canada for consideration for a permanent resident visa. Applicants to SINP can qualify under several streams: Skilled Workers, Entrepreneurs, Family referral, Farm owners/operators, Health professionals, Hospitality workers, Long-haul truck drivers and Students. This presentation is an overview of the program as well as critique of the current weaknesses of the program. This poster uses a logic model as well as presents a critical analysis of where improvements could be made in program learning, program controlling and program reporting.
Socio-Economic Determinants of Life Expectancy, by Lokpriy Lokpriy (PhD student)
Abstract - This poster examines the socio-economic determinants of life expectancy at birth in lower-income countries using multiple regressions. The sample used for this study consists of the 90 countries with a per capita Gross National Income below $4,035 in 2011. The primary goal of this paper was to analyze the relationship between the average life expectancy and health expenditure, per capita income, secondary education and access to improved water and sanitation facilities in these countries. The study finds that income, secondary education and access to safe drinking water and sanitation have a positive influence on life expectancy in lower-income countries, while health expenditure does not impact life expectancy. The findings thus suggest that to increase life expectancy, the lower-income countries should formulate a comprehensive policy package including economic development, education policy, and public health initiatives.
Supply Management of the Dairy industry: Missing the boat on trade? by Tom Lynch (MPH student)
Abstract - The current supply management of dairy is limiting the opportunities and efficiency of all Canadian farmers. Canadian supply management controls prices, designates production levels, and places constraints on imports with tariffs. To control production the Canadian Dairy Commission uses quota limits, which are allocated to individual producers. Additional quota is difficult and expensive to purchase, as Canadian production levels over the last 50 years have been relatively constant. This quota problem surfaces with dairy production having a barrier to entry and/or a barrier for production growth. Furthermore, the system enforces a fixed price based on producers’ costs and forecasted national demand, which does not incentivize efficiency or vertical integration. These inefficiencies are reflected in the price to processors and consumers, as the Canadian milk price is 2-3 times that of the world price when looking at farm gate receipts. With regards to current trade negotiations, Canadian dairy regulations are limiting market access for other agricultural products. In Canada, 91% of farms are dependent on exports as they are outside the control of supply management. In an effort to prepare the industry for reform, the Canadian government should consult with the Canadian Dairy Commission, the provinces, and the dairy farmers to create a deregulation plan. This plan can be implemented over a 10-20 year period, allowing for increased production levels, structural changes, and the incorporation of financial adjustment or exit packages within the dairy industry.
The Doctor Is Not In: Why Doctors in Canada Reduce Working Hours, by Julene Restall (MPA student)
Abstract - There are two different issues that are impacting the physician shortage in Canada: (1) Demographic Shifts - In 1978 the average age of a physician in Canada was 45.3 years of age and by 2008 the average age was 49.8 years of age. It is seen that physicians under the age of 35 tend to work less hours per week than older physicians. There are also now more women entering the profession and female physicians tend to work fewer hours per week.; and (2) Remuneration Model - Fee-for-service compensation model is the most dominate in Canada, but the use of salary, capitation, and blending funding are growing. It has been seen that family physicians that are paid through fee-for-service and blended methods provide the most direct patient care. Physicians that are salaried and ones on per diem arrangements spend less direct patient care time. A reduction in the average hours of work for physicians are expected to continue as the median age within the profession increase, younger physicians (<35 years old) enter the labour force, and more women enter the profession. A provincial physician human resource strategy needs to be created to provide a strategic framework to handle the all aspects of physician labour. Provincial governments have to address the physician shortage through shifts in policies as the demographics of the profession change. The evaluation of the remuneration models used and their impacts on the hours of work also must be studied to ensure that they meeting the needs of the community.
Why Acidification is a Potential Threaten to Northern Lakes of Saskatchewan?, by Gulnaz Mambetsadykova (MPA student)
Abstract - Lakes play an important role in nature balance and ecosystem. Last decades the chemical status of the water in Saskatchewan lakes had significantly changed due to air pollutant sources. Oil sands and coal industry are major sources of acidification today. Acid-forming pollutants (sulphur dioxide (SO2) and oxides of nitrogen (NOx) interact with water in the atmosphere and form mild acids that return to the land as mixed with rain/hail/snow. Acid rain flows into lakes after falling on forests, fields, buildings and roads. Acid rain also falls directly on aquatic habitats. Scientific evidence of the acidification of aquatic systems in and North America mounted throughout the 1960's and 1970's. The main reason for that was considered to be natural acidification of soil and water. Between 1972 and 1977, evidence linked acidification to the long-range transport of sulphur dioxide between provinces. Today, Saskatchewan northern lakes are at risk. Developing extraction and production of oil sands industry affects plays key role in this problem. Moreover, Saskatchewan border is very close to Alberta Tar Sands. The development of the tar sands is polluting Saskatchewan's northern lakes and forests. The main sources of acidification are oil sands industries in Alberta. Other concern is the coal mining industries in British Columbia. Acid rain can easily fall as much as 1,000 kilometres away from the original pollution source. It is important to remember that the winds in Canada have west-east direction. Emissions from other provinces blow into Saskatchewan and put the lakes in Saskatchewan at a risk.
(Photo credit: University of Regina Photography Dept.)