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Résumé (français)

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Résumé (anglais)

Human resources are the largest expenditure item in the health sector; labour cost and productivity growth rates therefore strongly influence overall cost trends. Canadian health labour markets, however, are non-competitively structured and extremely complex, making the effects of change difficult to gauge and policy development slow. This paper surveys selected aspects of the economic structure of the labour markets for health professionals, and explores cost and policy trends over recent decades. We observe three possible approaches to cost containment. The first, and least appealing, entails reducing service levels. A second approach involves reducing practitioner remuneration. This is germane since the data show substantial increases in earnings within the health sector both in inflation adjusted per capita terms and compared to the rest of the economy. Increased earnings in healthcare also contribute to rising inequality in Canadian society and raise ethical questions about the distribution of income. finally, proposed reforms to the health care system that improve efficiency and productivity, with constant or improved quality, show great promise for enduring savings, but experience suggests that implementation is difficult and many projects do not achieve their goals. Therefore, while policy and practice reforms have great potential, it is necessary to implement monitoring and evaluation to ensure that the anticipated benefits are attained at the expected prices.