Canadian Healthcare System

The Federal government does a lot to help the provinces in healthcare, but it is NOT socialized medicine. Why? (2)

private practitioners paid by public funds fee-for-service

The Canadian constitution says that healthcare is a (1) responsibility.

provincial

Ten years later in 1995, what was introduced?

Canadian Health and Social Transfer- CHST, blamed for problems of todays healthcare system, created to reduce spending on social services, block fund to each province, used to give funding to different areas of social services semi-equally, in this way the province decided what to do with the money (ex: not fund social work programs etc)

Governance of Health Professional by two groups (2)

Colleges Trade Associations

Differences between Colleges and Trade Associations?

Colleges - malpractice, minimum training standards, licencing ("group of colleagues"), focus on internal regulations, mostly professionals Trade associations - unions, represent collective group of members to outside organizations.

4 Basic Principles of Medicare! 1968!

1. Universality 2. Comprehensiveness 3. Portability 4. Non-Profit Administration

Look at pwrpoint

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Is Canada in crisis?

- Canadians' satisfaction with access to service ~81% in 2009 - Canadian spending relative to other countries - CIHI - 'modest' increases in spending -health spending decreasing as share of GDP

Canada Health Act (1984) two conditions? Explain!!!!!!!!

1. Information- provincial organizations had to provide information about services offered 2. Recognition - recognize federal contributions - federal move to get the provinces to get their physicians in line, they were paying 50%

Evolution of Medicare. (3) big sections?

1. Laying the Groundwork 2. Consolidation 3. 'Crisis' and Conflict

Current debates?

1. Provincial-federal responsibility for health care funding 2. Wait times 3. Aging population 4. Prescription drug coverage/costs 5. Sustainability

5 Principles of Medicare and explanations:

1. Universality- Medical care to be provided to all residents of a province, regardless of age, condition, or ability to pay 2. Comprehensiveness - Each provincial plan must cover insured services provided by hospital, private medical providers, and other services provided on request by a physician 3. Portability - Health services must be covered when residents move between provinces 4. Non-Profit Administration - Must be publicly administered and operated on a non-profit basis, subject to public audit 5th principle added 5. Accessibility - provinces must provide reasonable access to health care on uniform terms, regardless of financial status or geographic location

Canada Health Act (1984) two provisions? A dollar-for-dollar penalty deducted from federal transfer payments for (2) -

1. extra billing: a direct charge to an insured person for an insured service over the amount that would normally be paid by the provincial health insurance plan 2. user fees: direct charges to patients, other than extra-billing, for insured services of a province's health insurance plan that are not payable, directly or indirectly by the health insurance plan - ex: going to get surgery, which is covered, but need to pay registration fee to get the service, which they can't bill the government for, so they can charge extra

Laying the Groundwork dates?

1919-1957

Timeline with Laying the Groundwork (1919-1957) and Consolidation (1961-1984) (1919. 1957, 1961, 1964, 1968, 1984)

1919: universal medical insurance first pitched by Liberal leader Mackenzie King (as leader of the opposition) 1945: universal medical insurance pitched by Prime Minister Mackenzie King 1947: CCF introduces public insurance for hospital care in Saskatchewan 1957: First federal health care act 1961: all provinces and territories sign on for hospital insurance 1961: Emmett Hall appointed to head the Royal Commission on Health Services 1962: Saskatchewan introduces universal coverage for medical services 1964: Release of Hall Report 1968: Pearson Government introduces the Medical Care Act ("Medicare") 1979: Hall Commission performs Health Services Review 1984: Trudeau Government passes the Canada Health Act

Consolidation dates?

1961-1984

'Crisis' and Conflict dates?

1985-present

'Crisis' and Conflict in 1985 what was the key event?

1985: Mulroney Government decreases federal funding from 30% to 23.5% 1995: Chretien Government introduces Canada Health and Social Transfer (CHST) 2001: Commission on the Future of Health care in Canada, headed by Roy Romanow 2002: Romanow Report complete

2001 Commision of Health Care in Canada. 2002 Completed what was the findings of Romanow Report?

2002 - Romanow Report complete, to ensure longevity of the Canadian healthcare system, found: Medicare considered the defining aspect of their citizenship, Canadians broadly agreed that healthcare in Canada is a collective responsibility, found problems in the system: disparities in access, particularity indigenous people, increasing waitlist, provinces allocated more money to healthcare leading to deficits in other areas, promoted: increased and renewed federal funding etc.

Two years after 2002 Romanow Report more issues. In 2005 what happened?

2003: First Ministers' Accord on Health Care Renewal 2004: Another First Ministers' meeting re: Health Care 2005: Chaoulli Decision

Chaoulli Decision (2005) what happened?

2005 - Quebec supreme court said you can have both public and private healthcare, the public healthcare wait times too long for the man with the hip replacement, can't deny private insurance if the public insurance isn't doing its job

1984 Trudeau Government passes Canada Health Act! They added one more principle!

5. Accessibility

Drivers in increases in healthcare cost? Modest (1) and Main (2)

Aging population only modest driver of increases in healthcare costs. Health care salaries and drugs main drivers in healthcare cost.

Important Dates (5)

Medical Care Act ("Medicare"): 1968 Canada Health Act: 1984 Canada Health and Social Transfer (CHST): 1995 Romanow Commission Report (2002) Chaouilli Decision (2005)

Difference in governance between profit and non-profit facilities?

Not-for-profit (hospitals, community centers) - board of trusties who are usually community members (well-to-do), funding varies from organization to organization, funding from province, funding used to pay workers, buy equipment etc, political motivations, targets for hospitals to meet For-profit - governed by board of directors, shareholders, business, debate of the balance between these two, pricing $$