Search tips
Search criteria 


Logo of hsresearchLink to Publisher's site
Health Serv Res. 1996 December; 31(5): 517–532.
PMCID: PMC1070139

"Medical effectiveness" in Canadian and U.S. health policy: the comparative politics of inferential ambiguity.


OBJECTIVE: To compare Canadian and U.S. policymaking to determine how different health care systems may use health services research differently in responding to the common problem of ineffective medical care. DATA SOURCES/STUDY DESIGN/DATA COLLECTION: Not applicable. PRINCIPAL FINDINGS: The United States and Canada are making surprisingly divergent responses to the problem of medical ineffectiveness: reinforcement of the solidarity principle and deprivatization in Canada, and reinforcement of market competition and privatization in the United States. In doing so, Canadian policymakers overstate the societal applicability and U.S. policymakers the individual applicability of outcomes research findings. CONCLUSIONS: Probabilistic findings of medical effectiveness are fundamentally ambiguous as they relate to action. They therefore invite divergent policy responses from different policy regimes. Health services researchers must not imagine that research findings are sufficient to determine the course of health policy.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Barer ML, Evans RG, Labelle RJ. Fee controls as cost control: tales from the frozen North. Milbank Q. 1988;66(1):1–64. [PubMed]
  • Blendon RJ, Altman DE, Benson J, Brodie M, James M, Chervinsky G. Health care policy implications of the 1994 congressional elections. JAMA. 1995 Feb 22;273(8):671–674. [PubMed]
  • Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. [PubMed]
  • Brown LD. Political evolution of federal health care regulation. Health Aff (Millwood) 1992 Winter;11(4):17–37. [PubMed]
  • Chalmers I, Enkin M, Keirse MJ. Preparing and updating systematic reviews of randomized controlled trials of health care. Milbank Q. 1993;71(3):411–437. [PubMed]
  • Charles C, DeMaio S. Lay participation in health care decision making: a conceptual framework. J Health Polit Policy Law. 1993 Winter;18(4):881–904. [PubMed]
  • Davidoff F, Case K, Fried PW. Evidence-based medicine: why all the fuss? Ann Intern Med. 1995 May 1;122(9):727–727. [PubMed]
  • Eddy DM. Variations in physician practice: the role of uncertainty. Health Aff (Millwood) 1984 Summer;3(2):74–89. [PubMed]
  • Ellwood PM. Shattuck lecture--outcomes management. A technology of patient experience. N Engl J Med. 1988 Jun 9;318(23):1549–1556. [PubMed]
  • Epstein AM. The outcomes movement--will it get us where we want to go? N Engl J Med. 1990 Jul 26;323(4):266–270. [PubMed]
  • Evans RG. "We'll take care of it for you". Health care in the Canadian community. Daedalus. 1988 Fall;:155–189. [PubMed]
  • Fried BJ, Deber RB, Leatt P. Corporatization and deprivatization of health services in Canada. Int J Health Serv. 1987;17(4):567–584. [PubMed]
  • Geehr EC. Outcomes management. The search for what works. Healthc Forum J. 1992 Jul-Aug;35(4):28–33. [PubMed]
  • Jecker NS, Meslin EM. United States and Canadian approaches to justice in health care: a comparative analysis of health care systems and values. Theor Med. 1994 Jun;15(2):181–200. [PubMed]
  • Lomas J. Retailing research: increasing the role of evidence in clinical services for childbirth. Milbank Q. 1993;71(3):439–475. [PubMed]
  • Morone JA. The health care bureaucracy: small changes, big consequences. J Health Polit Policy Law. 1993 Fall;18(3 Pt 2):723–739. [PubMed]
  • Naylor CD. Grey zones of clinical practice: some limits to evidence-based medicine. Lancet. 1995 Apr 1;345(8953):840–842. [PubMed]
  • Rathwell T. Health care in Canada: a system in turmoil. Health Policy. 1994 Jan 31;27(1):5–17. [PubMed]
  • Relman AS. Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988 Nov 3;319(18):1220–1222. [PubMed]
  • Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988 Nov 3;319(18):1197–1202. [PubMed]
  • Shapiro DW, Lasker RD, Bindman AB, Lee PR. Containing costs while improving quality of care: the role of profiling and practice guidelines. Annu Rev Public Health. 1993;14:219–241. [PubMed]
  • Tanenbaum SJ. Knowing and acting in medical practice: the epistemological politics of outcomes research. J Health Polit Policy Law. 1994 Spring;19(1):27–44. [PubMed]
  • Weber DO. Outcry over outcomes. Healthc Forum J. 1992 Jul-Aug;35(4):16–26. [PubMed]
  • Weller GR. The determinants of Canadian health policy. J Health Polit Policy Law. 1980 Fall;5(3):405–418. [PubMed]
  • Wennberg JE. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984 Summer;3(2):6–32. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust