Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada.

This commentary explores public health (PH) investments in Quebec and underlines the challenge of tracking PH resources across Canada. We analyzed governmental data to compare investments across all health and social programs in Quebec from 2004-2005 to 2017-2018. The province's PH budgets suffered from disproportionately low investments and abrupt cuts. These cuts were the largest among all health programs in 2015-2016 (- 7.1%). PH budgets did not keep up with inflation and, in constant dollars, have declined over the last decade. Furthermore, their evolution over the span of 14 years significantly differed from other health programs. On average, programs providing direct services experienced overall budget increases of 81%, whereas PH budgets had the lowest increase of all such programs at only 46%. PH suffers from serious erosion of its capacity. Unfortunately, there is a dire lack of comparable data for provincial, national, and international PH budgets, which further complicates the monitoring of PH erosion. We contend that systematic tracking of PH budgets remains profoundly inadequate across Canada. We recommend (1) regular, comprehensive, and publicly reported analyses of PH budgets; (2) in-depth comparisons of PH investments across Canadian jurisdictions; and (3) a strong PH systems and services research agenda for Canada.

History of hospital care in São Paulo: State grants to the misericórdia charitable associations. / História da assistência hospitalar em São Paulo: a subvenção do Estado às misericórdias paulistas.

This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.

O artigo analisa como as santas casas de misericórdia do estado de São Paulo foram subvencionadas pelos governos municipais, provincial e estadual na passagem do século XIX para o XX. Para tanto, são discutidas as dotações orçamentárias realizadas de 1838 a 1915, com o fim de avaliar o repasse e a ampliação de verbas nesse ínterim. É possível notar que foi criada uma rede de assistência fortemente apoiada pelo Estado, mas efetivada pela assistência filantrópica. Essa rede de atendimento hospitalar permanece com o mesmo formato até pelo menos o primeiro terço do século XX, contexto em que se incluíam as misericórdias criadas pelo interior do estado paulista.

História da assistência hospitalar em São Paulo: a subvenção do Estado às misericórdias paulistas / History of hospital care in São Paulo: State grants to the misericórdia charitable associations

Resumo O artigo analisa como as santas casas de misericórdia do estado de São Paulo foram subvencionadas pelos governos municipais, provincial e estadual na passagem do século XIX para o XX. Para tanto, são discutidas as dotações orçamentárias realizadas de 1838 a 1915, com o fim de avaliar o repasse e a ampliação de verbas nesse ínterim. É possível notar que foi criada uma rede de assistência fortemente apoiada pelo Estado, mas efetivada pela assistência filantrópica. Essa rede de atendimento hospitalar permanece com o mesmo formato até pelo menos o primeiro terço do século XX, contexto em que se incluíam as misericórdias criadas pelo interior do estado paulista.

Abstract This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.

Two strikes: limited NIH R55 and R56 retooling funds and abolishment of the A2 grant mechanism.

The U.S. National Institutes of Health (NIH) are facing significant budgetary challenges as a result of the current economic climate. The recent sunset of investigator-initiated R01-type research grants after one revised submission, coupled with the present lack of an NIH retooling funding mechanism for such grant applicants, creates a concerning risk that talented and well-trained investigators may be forced to give up their research careers. Existing NIH retooling mechanisms include the R55 Shannon Award, which was established in 1991 and was essentially replaced in 2005 by the R56 award. There is an urgent need to either significantly expand the R55/R56 mechanisms and definition of NIH grant bridging/retooling support for unfunded meritorious proposals or introduce a new mechanism that provides specific support to investigators with competitive but unfunded R01 revised grants. An expanded retooling funding mechanism deserves implementation during continuing assessment of whether allowance of only one revision of research proposals has achieved its initial intended goals.

The problem of dependency: immigration, gender, and the welfare state.

This article discusses the regulation of marriage migration to Norway through an analysis of the subsistence requirement rule which entails that a person who wants to bring a spouse to Norway must achieve a certain level of income. Policy-makers present two main arguments for this regulation. First, the subsistence requirement is a means to prevent forced marriage. Second, its aim is to prevent family immigrants from becoming a burden on welfare budgets. The major concern of both these arguments is that of dependency, either on the family or on the welfare state. The article investigates the representations of the "problems" underpinning this specific policy proposal and argues that the rule in question, and immigration policy more generally, needs to be analyzed with reference to the broader concerns and aims of welfare state policy and gender equality policy.

Does the Congressional Budget Office underestimate savings from reform? A review of the historical record.

When the Congressional Budget Office (CBO) "scores" legislation, or assesses the likely cost impact, it requires substantial evidence that a cost-saving initiative has historically achieved savings. The agency has difficulty addressing the impact of multiple changes made simultaneously without historical precedent where there is an interaction effect among proposed changes. This study examines CBO scoring of major reform legislation enacted during each of the past three decades, including the prospective payment system for hospitals in the 1980s, the Balanced Budget Act of the 1990s, and the Medicare Modernization Act of 2003. In contrasting actual spending with predicted spending, CBO, in all three cases, substantially underestimated savings from these reform measures.

Forty six years of health financing in Fiji (1962 - 2008).

This paper provides an analysis of the Fiji Ministry of Health (MoH) budget for the last 46 years, its share of the national budget and annual percentage of GDP, its revenues, per-capita health expenditure, staff costs, and the performance on key population health indicators and Millennium Development Goals (MDGs). Despite annual increases in dollar terms, the proportion of GDP allocated to the national public health system has fallen from 4% to 2.6% over the last 15 years. Consequently the national performance on key health service indicators and MDGs is declining and health staff are migrating. We outline factors to retrieve the public health system in Fiji, such as the need for political commitment to the health of the people, public policy debate on the nature of the health system, the revision of hospital charges, the need to protect the poor by strengthening means testing, and propose compulsory health insurance for the employed.

Vessels of progressivism? Tasmanian state girls and eugenics, 1900-1940.

In the early twentieth century the notion of state children as a "burden on the state", born of a liberal bourgeois philanthropic tradition, was gradually replaced in Tasmania by a modernising notion of intervention in the name of national efficiency. Eugenic principles can be shown to have influenced child welfare ideas and laws, notably the Tasmanian Mental Deficiency Act (1920). However, despite public debate and legislative changes, the bureaucrats in charge of state children maintained their liberal philanthropic practices. In many cases the Children of the State Department clashed with the Mental Deficiency Board. State direction of children was also frustrated by children's agency. Girls were the target of many eugenicist (and liberal evangelical) reforms, but they resisted attempts to control their sexuality and make them "useful". In Tasmania, the modernising impetus of progressive arguments was offset by bureaucratic stasis, and the agency of the subjects.

Biomedical research in Quebec: the history of the Fonds de la recherche en santé du Québec.

The author describes the history of the Fonds de la recherche en santé du Québec, from after World War II to the present day. The Conseil de la recherche médicale du Québec (Quebec Medical Research Council) was created in 1964 to bring Quebec up to speed in biomedical research through programs that complemented those of the Medical Research Council of Canada. The council progressively evolved, becoming the Conseil de la recherche en santé du Québec (Quebec Health Research Council) in 1974 and the Fonds de la recherche en santé du Québec (FRSQ) in 1982. The FRSQ covers all aspects of medical research, in its broadest sense. Quebec's progress in biomedical research has been spectacular and has had direct and considerable influence on the quality of medical education and patient care. From 1982 to 1996, various Quebec governments have devoted more than +500 million to the FRSQ, a testimony to their comprehension of the importance of this area and to their farsightedness. The FRSQ and its predecessor organizations have been a major force in improving and maintaining the quality of medical teaching and care in Quebec during the last three decades.