How does the way doctors are paid affect health-care costs and quality? How can we fund the need for long-term care of Canada’s growing population of seniors efficiently? How do we make sure care is delivered according to the best available scientific evidence, in a manner that is consistent with professional autonomy and responsive to patients' needs?
Those are the kind of questions that have been studied for the past 25 years by faculty at the Centre for Health Economics and Policy Analysis (CHEPA) at McMaster University, which this year celebrates its silver anniversary.
CHEPA, a world-leading health systems research centre that produces knowledge used to shape and understand health policy, was officially opened on May 26, 1988, and has grown to encompass the largest concentration of health economists and health policy analysts in Canada. CHEPA faculty members bring together the tools and methods of social sciences (economics, sociology, political science), humanities (philosophy, ethics), management, and clinical sciences to understand and evaluate system-wide interventions and policies.
The founding and growth of CHEPA parallels the genesis and growth of health economics as a research field. CHEPA researchers have directly helped to shape Canada’s health-care system, driving the development of the internationally-recognized Health Utilities Index and implementing methods for the economic evaluation of health-care services, systems and programs, as well as pioneering the field of health policy analysis.
Over the years, CHEPA researchers have, among many other things:
- Pioneered the use of research to support evidence-informed decision-making in the health-care field and studied how to make evidence-based medical decision-making more widespread in the health-care system
- Advised the federal government on proposed revisions to the Canada Health Act
- Researched and developed ways to ensure the public has a say in health policy decision-making
- Studied the consequences of pay-for-performance and other payment schemes on doctors and other health-care providers’ behaviours and on the quality of care delivered to the population
- Evaluated the impact of aging on health care use and expenditures
- Studied and advised governments on the provision of palliative and end-of-life care
- Analyzed the costs and benefits of educating, retraining and bringing international medical graduates into Canada’s health-care system
- Offered expert advice to the federal government on options for a system to finance long-term care in Canada
- Become world-leaders in the study of ethics and equity in health care
- Developed and implemented a Knowledge Exchange program to facilitate the efficient dissemination of research findings
CHEPA’s origins date back to 1976 when McMaster’s Department of Clinical Epidemiology and Biostatistics recruited Greg Stoddart to be the health economist in what was then a very young department. The efforts of a growing team of academics and supporters that included Jonathan Lomas, George Torrance, Amiram Gafni, Christel Woodward, David Feeny, Roberta Labelle, Michael Drummond and others including Peter Tugwell at McMaster University and Mary Catherine Lindberg at the Ontario Ministry of Health led to the announcement in February, 1987 that the Ministry of Health was awarding a five-year, $1,375,000 development grant for a Centre for Health Economics and Policy Analysis at McMaster. The Centre was to be managed by a coordinator (Stoddart) and associate coordinator (Lomas). For a full account of CHEPA’s history and founding, click here.
The Centre’s initial goals were:
- to develop and apply methods to evaluate the costs, risks, benefits and utility of specific health and health-care services,
- to design and evaluate different systems of organization and financing for the delivery of health and health-care services,
- to study the behaviour of consumers, producers, and other decision-makers in the health and health-care systems, and
- to create an effective information exchange among academic researchers, health professionals, and government policymakers
With much development work left to do, and wanting to have completed products to display, CHEPA faculty decided to operate for a year before announcing the Centre’s opening. “We did not want to be telling people what we were going to do, rather we wanted to show them what we had done and were doing already,” Stoddart says.
The Centre was officially opened on May 26, 1988 by the Honourable Murray Elston, the Chairman of Management Board of Cabinet of the Province of Ontario, in a ceremony attended by 200 guests including Dr. Alvin A. Lee, McMaster University president, and Dr. Stuart MacLeod, Dean of Health Sciences at McMaster.
The Centre’s interdisciplinary base of researchers has continued to grow in the quarter-century since, and it has earned international and national recognition for its significant contributions to health policy research and education, including the development of the PhD in Health Policy programme.
CHEPA ensures the knowledge generated through the work of its members is effectively communicated to health system decision-makers and other stakeholders through its highly-regarded Knowledge Exchange program, which uses multiple platforms and strategies for communicating and sharing information.