Intergenerational transfers are the essence of societal continuity, and yet not at all well conceptualized or analysed. Intergenerational transfers are also at the core of the welfare state concept of redistribution of resources and hence, of current social policy changes/challenges. In making a difference to policy choices and in linking research to policy, attention to intergenerational transfers focusses on the fundamental policy questions of guiding belief systems, family (or private) transfers versus public transfers among generations, and issues of intergenerational and cohort equity in the short and longer terms. This paper has four objectives: (1) Situating intergenerational transfers in socio-historical, international comparative, and current social policy contexts; (2) Developing a typology of intergenerational transfers that could provide the basis for answering thus far unanswerable key policy questions, such as whether the situations of seniors into future generations will be like those of seniors today; (3) Encouraging the collection of more complete and integrated data on intergenerational transfers in Canada, which would provide for more informed policy choices; and (4) Enumerating key policy questions that emerge from research and remain to be addressed. From analysis of what is known about intergenerational transfers and what remains to be known, an agenda for an information system, for future research and for addressing policy questions is outlined.

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another.

In times of health reform, fiscal restraint and population aging, it becomes increasingly imperative to understand what must be done to better link research and policy in the health area. In this paper, the major determinants of healthy aging are discussed in terms of current conceptual frameworks of health, measurement, methodologies, and data sources. In order to maximize the benefit for the health of current and future Canadian seniors, policy recommendations are made to Statistics Canada, Health Canada, and the Seniors Independence Research Program (SIRP) which cover a range of issues related to measurement and data sources, health services, health status, economic status, and education.

Researchers and policy-makers interested in the needs of the frail elderly in community and institutional settings have had limited success in forming policy based on empirical evidence. The reasons for this have included a variety of organizational and political considerations (e.g., lack of effective communication mechanisms), conceptual and methodological issues (e.g., problems with reliability and validity of existing data sources) and limitations in knowledge (e.g., lack of longitudinal data across health care sectors). The Minimum Data Set (MDS) series of instruments may prove useful in dealing with these difficulties. The MDS instruments have multiple uses for different audiences (e.g., care provision, funding and quality improvement). Extensive international testing has shown the MDS to be valid and reliable, and translations are available in 11 different languages. As implementation of the MDS begins in Canada, a number of new concerns will need to be addressed (e.g., confidentiality and access to data).

As policy emerges from the interplay of economic, political, and social forces, determining whether research has made a difference to policy choices on aging issues is extremely difficult. Such a determination demands attention to the "black box" of the policy process, and the setting within which policy ultimately operates. This paper presents a Seniors' Independence Research Program as a case illustration of how research has made a difference to policy choices by stakeholder involvement throughout the research process. Strategies ensure stakeholder collaboration in policy issue search, filtration, definition, and prioritization; involvement in the design, implementation, and evaluation of health services models; and participation in achieving long-term evidence-based changes in policy and practice.

Social gerontologists have observed that economic determinism is problematic to the policy-making process and that there are too few inputs from other sources. The purpose of this research is to illustrate how social research can inform the current pension debate which revolves around the issues of raising the age of retirement, the merits of partial retirement and the adequacy of the new Seniors Benefit. An analysis of data on post-retirement workers is presented using the Survey of Ageing and Independence as an example of how social research can make a difference to choices about public pension policies.

Escalating medication prices are forcing drug benefit programs worldwide to change their payment policies. Physicians object that this intrudes on their long established authority to prescribe medications they judge best for their patients. This paper reports data from focus groups and a large random sample of seniors in British Columbia who were asked for their views towards Pharmacare's reference based pricing (RBP) policy. Seniors expressed the desire for physicians to be more knowledgeable and more involved in all aspects of medical care including policy changes. They have confidence in physicians as a credible source of information, but they also have as much confidence in pharmacists and almost as much in the Ministry of Health. Seniors overwhelmingly accept, and the majority support government's efforts with their cost-saving Pharmacare policies. Furthermore, those who know more about the policy are more likely to support it. The paper closes with a discussion of the feedback process with decision-makers.

Drug benefits policy-making for seniors in British Columbia has been increasingly influenced by research since 1993. The "evidence-based medicine" paradigm, which emphasizes the primacy of direct evidence from randomized control trials, inspired key policy-makers and influenced policy concerning coverage of new and existing drugs. New drugs, if more expensive than existing similar drugs, are not covered unless published randomized control trials show superior effectiveness. Indirect evidence of effectiveness, based on surrogates, is given less weight, and non-randomized studies are rarely considered. Evidence of cost-effectiveness of new drugs is reviewed separately. For existing drugs, a new reimbursement policy, Reference Based Pricing (RBP), was introduced, based on both direct and indirect evidence of comparative effectiveness of drugs. Implementation of RBP was complex and necessarily rapid, which meant that independent systematic review of evidence relevant to implementation issues was infeasible, particularly in regard to rapid prior authorization of exemptions to RBP. Contrasts between the processes for new and existing drugs provide insights into the difficulties of applying the idea of direct evidence-based policy-making in practice.

Drug-related illness (DRI) is a common problem in the elderly. Misuse of medications and inappropriate prescribing account for over half of all hospital admissions for DRI and both are potentially preventable. Physicians are the gatekeepers to prescription medication access and, in this role, they have the opportunity to prevent exposure to unnecessary and inappropriate medication and influence the use of medications by their elderly patients. Effective interventions to improve physician prescribing have been identified but they are costly to introduce, they require ongoing maintenance to maintain their effectiveness, they do not address the problems created by multiple prescribers or the challenges of keeping up-to-date on the growing number of new drugs that enter the market each year. Computer-based drug information networks and expert decision-making support systems are proposed as one means of providing (1) an accurate record for the prescribing physicians of drugs currently dispensed to their elderly patients, (2) a review of problems in existing and new prescriptions, and (3) an expert resource to select drug treatment. Canada is in an ideal situation to pioneer the development of these systems, but to do so, policies need to be put in place to address three problems. First, there is inadequate information available about the risks and benefits of drugs in the elderly because older sicker adults are often excluded in clinical trials of drug-effectiveness. Requirements for drug approval need to be amended so that sufficient evaluation of the risks and benefits of new drugs are carried out in the elderly. Second, computerization in the health care sector is central to the development of electronic decision-support systems in health care delivery. Future policy needs to be directed to the development of an effective infrastructure to facilitate the transition to an integrated computerized health sector. Third, the ethical and legal issues related to the access of prescription data through electronic networks need to be identified and clear guidelines for use of this new technology need to be developed.

As Canadian health policy-makers struggle to contain costs while maintaining quality, patient education is promoted as making patients more effective producers of health and consumers of health care. Assessment of existing psychoeducational interventions has concentrated on knowledge enhancement, behaviour modification, and health status while economic outcomes have remained unexplored. Given that such programs are likely to be effective, but costly, economic appraisals are necessary to convince cost-conscious policy-makers. This manuscript describes a cost-effectiveness evaluation of the Arthritis Self-Management Program (ASMP) that I and my collaborators are conducting by randomizing participants to the ASMP as an adjunct to usual medical care versus usual medical care. Direct and indirect costs are evaluated through self-reporting of health services utilization and diminished productivity and effectiveness through a visual analogue scale and the SF-36. To influence health policy, the results must be disseminated to public health authorities, private insurers, and patient and health professional organizations, thereby encouraging funding, increasing awareness, and promoting participation.

The issue of linking research and policy is not unique to health care of the elderly; it has been articulated by numerous stakeholder groups, including those with specific diseases, such as breast cancer. A method of enhancing these links is now being systematically addressed in the Canadian Breast Cancer Initiative with the input of women with breast cancer. The Initiative consists of a number of components and demonstrates a model of consumer participation at multiple levels in setting the agenda for research and policy development, thus enhancing accountability in the transfer of research findings into policy. The concept of consumer participation in linking research and policy is transferable to other diseases and other population groups, such as seniors.