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Principles of Professional Practise > 1 - Canadian Healthcare System > Flashcards

1 - Canadian Healthcare System Flashcards

1
Q

What is public policy?

How does it affect the health system?

A
  • the conduct of public affairs
  • a means for the administration (government) to achieve public goals & objectives
  • should be reflective of the populations’ values and expectations
  • “a statement of principle or intent that guides the selection of priorities and sets the direction of programs and actions of an individual, or organization or government”
  • public policy drives the health system
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2
Q

Does Canada have a universal health care system?

A

Yes and No.

-It’s not as straight forward as say the UK (they definitely have universal health care system)

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3
Q

Who are two “grandfathers” of our healthcare system?

A
  • Pierre Trudeau

- Tommy Douglas

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4
Q

What happened in Canada in 1867?

A

Confederation:
-BNA Act (British North American Act)

-Created and defined a federal dominion and provincial jurisdictions

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5
Q

What was included in Federal dominion of BNA act in 1867?

A
  • Immigration
  • Currency
  • Defence
  • Regulation of trade, banking, commerce, patents
  • Revenue and taxation (Any mode or system of taxation, for any purpose)
  • Indians and reserves
  • Criminal law and penitentiaries
  • Quarantine and marine hospitals
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6
Q

What was included in the provincial jurisdictions of BNA act in 1867?

A
  • Revenue
    • Via “direct taxation”, “licenses”, or from non-renewable resources, forestry, and “electrical energy”
    • For provincial purposes only
  • Education
  • Hospitals
  • Healthcare
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7
Q

Provincial jurisdiction was delegated health care authority, but …

A
  • Paid little direct attention to health care
  • Health was viewed as a private matter
  • Municipalities, religious organizations and charities played central role in building hospitals and supporting the poor
  • Actual provincial role of negligible
  • Immediately prior to WWI, over 50% of national health and welfare costs were borne by municipalities
  • at this time, no real medicines existed, penicillin wasn’t even invented yet.
  • no management of chronic diseases
  • ppl only sought medical attention if they had a trauma or needed surgery
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8
Q

1910’s to 1940’s:

What happened in between 1910’s to 1940’s ?

A
  • Two world wars

- Great depression

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9
Q

1910’s to 1940’s:

Post WWI, there was high prevalence of ?

A

general disease amongst returning soldiers

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10
Q

1910’s to 1940’s:

Post WII, provinces did what?

A

pressured feds for help!

Feds began providing conditional grants for v.d. prevention and treatment

  • First precedence for use of federal spending power on health care
  • The peculiar origin of fed-proc fiscal “relations” for health care
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11
Q

1910’s to 1940’s:
In 1930’s came the ______, where provinces and municipalities were treated by bankruptcy due to burden of unemployment relief

A

depression

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12
Q

1910’s to 1940’s:

How were physician incomes affected during the depression?

A

they plummeted

*provinces such as SK had to guarantee minimum reimbursements to Dr’s to prevent them from leaving

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13
Q

1910’s to 1940’s:

Many provinces set up commissions that recommended establishing public health _____ ______

A

insurance plans

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14
Q

1910’s to 1940’s:
Which 2 provinces first passed legislation for provincial public health insurance plans? (note: it was never implemented)

A

Alberta (1935)

BC (1937)

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15
Q

1910’s to 1940’s:
Leadership was left to _____ where municipally-funded insurance programs were already in existence in many parts of the province. These became the foundations for the first provincial public health insurance program.

A

Saskatchewan

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16
Q

1910’s to 1940’s:

In the meantime, federal, provincial, and municipal governments faced financing chaos. Give 3 examples.

A
  • All three were levying income taxes
  • All governments in dire financial crisis
  • Jurisdictional responsibility for health care financing unclear
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17
Q

What did the 1940 Report of Royal Commission on Dominion-Provincial Relations do?

A

Recognized imbalance:

  • Feds had most of revenue generating power
  • Provinces had disproportionate amount of spending responsibility

Called for federal role in:

  • Unemployment insurance and income security (pensions)
  • National standards for programs under provincial jurisdiction
  • Equalization to recognize provincial disparities
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18
Q

What happened post WWII?

A

-Feds began mapping out legislation for post-war social reconstruction

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19
Q

What did the Heagerty Committee do ? (1942)

A

Recommended comprehensive national public health insurance plan through shared prov-fed contribution
-Legislation was drafted with consultation of CMA - never implemented due to dissent from multiple parties (ex. CMA vs CFA)

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20
Q

How did public respond in 1944 when asked if they would be willing to contribute a small portion of their income to national health plan that would provide medical and hospital care when they needed it?

A

Majority were willing (slide 13)

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21
Q

Describe Tommy Douglas’s involvement in SK healthcare?

A
  • In 1944, Tommy Douglas and the co-operative commonwealth federation (CCF) party win provincial election
  • In 1947, Douglas introduced a province-wide, universal hospital care plan
  • BC and AB followed in 1949 and 1950

-In 1957, “Hospital Insurance & diagnostic Services Act”

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22
Q

What is the “Hospital Insurance & diagnostic Services Act” (1957) ?

A
  • Federal legislation
  • “50-50 cost sharing” of provincial and territorial costs for specified hospital and diagnostic services
  • Provided universal coverage for a specific set of services under uniform terms and conditions (national standards)
  • By 1961, all provinces have universal hospital insurance
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23
Q

Describe “Medical Care Insurance Act”. (1962)

A
  • Introduced by Tommy Douglas (premier of SK)
  • Province-wide universal insurance plan to provide doctor’s services to all its residents with no user fees
  • Opposition by the physician group - Doctors on strike for 3 weeks
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24
Q

Describe the establishing national standards for medical insurance (slide 17)

A

1961-1964: Royal Commission on Health Services (the hall commission) recommended national “medicare” based on the SK model

1966: Federal “Medical Care Act”
- Cost share provincial and territorial costs for medical services provided by doctors outside hospitals
- 50-50 cost sharing subject to national standards
- 4 principles: universality, public administration, portability and comprehensiveness
- By 1972, all provinces and territories joined Medicare

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25
Q

What are the 4 principles we have to know ? EXAM

A
  • Universality
  • Public administration
  • Portability
  • Comprehensiveness
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26
Q

Universality:
___% of the insured residents of a province or territory must be entitled to the insurance services provided by the plans under uniform terms and conditions

A

100

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27
Q

Universality:

Provinces and territories generally require what?

A

that residents register with the plans to establish entitlement

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28
Q

Public administration:

Describe it

A

Health care insurance plans are to be administered and operated on a non-profit basis by the public authority, responsible to the provincial/territorial government and subject to audits of their accounts and financial transactions

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29
Q

Portability:

Describe it

A

A resident moving from one province/territory to another must continue to be covered for insured services by their home province during a minimum waiting period. This also applies to residents leaving the country

30
Q

Comprehensiveness:

Describe it

A

All medically necessary services provided by hospitals and physicians must be insured

*Drugs are essential but they are not always covered

31
Q

Describe the energy crisis in 1970

A

Energy crisis as a result of oil embargos:

  • Significant inflation, rising unemployment, federal government in large deficits
  • Tension between liberal-majority fed government (Trudeau) and conservative-majority provinces
32
Q

What is the “Established Programs Financing Act” - 1977 ?

A
  • Replaced 50-50 cost sharing with a block transfer that now includes both cash and tax points
  • Transfer was bundled with education
  • Transfer tied to federal economic growth
33
Q

What is a tax point ?

slide 23

A

1) Fed lowers its tax rate to allow provinces to collect that “tax-point” themselves
2) “Tax-point contribution” is the cash equivalent: $100 per capita in this case
3) In theory, this is “contributed” in every year after the change

34
Q

Describe block funding

A
  • Removed feds from the business of determining the eligibility of provincial expenditures
  • Acknowledge provincial constitutional authority in health
  • Broke link between cash contributions by feds and provincial spending
  • Weakened Ottawa’s ability to enforce pan-Canadian principles
  • Problem in 1980s - overfilling by physicians and patients getting charged extra fees
35
Q

Describe “Canada’s National-Provincial Health Program for the 1980s”

A
  • To review how medicare had evolved since it’s introduction.
  • Condemned extra billing and other user charges.

-Efforts made by Monique Begin (Minister of Health and Welfare) to end extra-billing and user fees were in vain. CMA saw extra-billing as a fundamental right.

36
Q

Describe the Canada Health Act (1984)

A
  • Consolidated preceding acts; added “accessibility” as the 5th principle.
  • Accessibility: reasonable access by insured persons to medically necessary hospital and physician services must not be impeded by financial or other barriers (UPPAC = universality, portability, public administration, accessibility, comprehensiveness)
  • Specified criteria that provinces must satisfy to quality for federal transfer payments
  • Penalties for extra billings and user charges:
    • Provinces fined $1 for every $1 in disallowed charges

-Legacy left by Pierre Trudeau

37
Q

What are some federal roles of governments in health care?

A
  • Setting and administering national principles for the system under the Canada Health Act
  • Financial support to the provinces and territories
  • Other functions, including the delivery of primary and supplementary services to certain groups of people (i.e. First nations living on reserve, veterans, etc.)
38
Q

What are some provincial roles of governments in health care?

A
  • Administration of their health insurance plans
  • Planning and funding of care in hospitals and other health facilities
  • Services provided by doctors and other health professionals
  • Planning and implementation of health promotion and public health initiatives
  • Negotiation of fee schedules with health professionals
39
Q

Under the Canada Health Act, all necessary drug therapy administered within a Canadian ______ setting is insured and publicly funded

A

hospital

40
Q

Under the Canada Health Act:

Outside of the hospital setting, who is responsible for administration of publicly-funded Rx drug benefit programs?

A

provincial and territorial governments

41
Q

Canada Health Act, initially met with opposition, provide an example.

A

Ontario physician’s strike 1986 for 25 days

42
Q

Post-CHA (Canada Health Act), all provinces/territories faced _____ health care cost.

A

rising

43
Q

What was another problem post CHA?

A

-the public saw declining quality of care as a result of lack of funding and active supervision by the feds to enforce national standards

44
Q

Describe the 1989-1992 economic recession

and how this changed in 1995

A
  • Cash transfer to provinces diminished and eventually froze from 1990 to 1994
  • By mid-1900’s transfers to provinces dropped by more than 10%

-In 1995, feds established Canada Health and Social Transfer (CHST) - new block grant bundled health, education and social services

45
Q

Describe the 1997 Report of National Forum on Health

A
  • Advocates re-investment of cash in federal health transfer

- Also calls for expansion of medicare coverage to include homecare and pharmacare

46
Q

Describe the 1999 Social Union Framework Agreement signed by all provinces except for Quebec

A
  • Broad reinvestment in social services that had been cut in 1990’s
  • $11.5 billion injected back into CHST over 5 y ears, specifically for health care
  • Feds agreed not to engage in exercising their spending authority without support of majority of provinces - end unilateral authority
  • All parties reaffirm commitment to principles in CHA
47
Q

Describe the 2002 The Romanow Report

A
  • By Roy Romanow, head of the Commission on the Future of Health Care in Canada
  • Total of 47 recommendations, with 3 underlying themes:
  • Strong leadership and improved governance is needed to keep medicare a national asset
  • The system needs to become more responsive and efficient as well as more accountable to Canadians
  • Need to make strategic investments over the short term to address priority concerns, as well as over the long term to place the system on a more sustainable footing
48
Q

Describe the 2003 Accord on Health Care Renewal

A
  • $34 billion new federal transfers
  • CHST broken into 2 separate transfers: Canada Health Transfer, Canada Social Transfer (includes education)
  • Created the Health Council of Canada (“watchdog” to assess reforms/performance, Alberta opposed because of concerns about “federal intrusion”)
49
Q

Describe the 2004 Health Accord

A
  • Negotiated by federal and provincial governments
  • Top up of the 2003 accord to a total of $41 billion funding in health care over 10 years, plus annual 6% increase of CHT (the ‘escalator’)
  • Brings federal government’s share in health care back up to 25% from a low of 10.2% in 1998/1999
  • $4.5 billion for meeting “meaningful reductions” in wait times in priority areas by March 2007
  • Priority areas: cancer, cardiac, diagnostic imaging, joint replacements, sight restoration
  • Provided long term funding for health care reform
  • Commitments by federal/provincial/territorial governments to reaffirm values of the CHA
50
Q

Describe the national pharmaceutical strategy (also created under the Health Accord of 2004)

A
  • Catastrophic drug coverage
  • Common national drug formulary
  • Accelerated access to breakthrough drugs for unmet health needs
  • Accelerated access to non-patented drugs
  • Purchasing strategies
  • Strengthen evaluation of real-world drug safety and effectiveness
  • Prescribing behavior
  • Develop e-prescribing and electronic health records
  • Enhance analysis of cost-drivers, cost-effectiveness, best practices for drug plan policies
51
Q

The Health Accord Act in 2004 expired in ____

A

2014

52
Q

What did Harper do in 2011 ?

A

May 2011: Harper promised to continue the 6% increases in the CHT as part of the federal election campaign

Dec 2011: Harper administration announced that the federal government will continue to fund health care at 6% increase per year until April 2017, at which point federal health transfer increase tied to economic growth (GDP)

  • Back to unilateral federal authority on health care spending
  • Romanow: It’s a sad day for Canadian health care
53
Q

Provinces always get 3% increase each year for health care. Explain

A

If federal is 5%, then provinces get 5%

If federal is 1%, then provinces still get 3%

54
Q

Do we have universal health care?

A

It’s universal in the sense that it’s centrally funded

but it’s not universal because each province governs it’s own

55
Q

How is health care funding/financing (how services are paid for) done in Canada?

A

predominantly public in Canada through taxation

56
Q

How is health care delivery (how services are organized, managed and provided) in Canada?

A

largely private in Canada

57
Q

What are examples of public funding and public delivery?

A
  • public health (ex. vaccination)
  • provincial psychiatric institutions
  • home care in some provinces
58
Q

What are some examples of public delivery but private financing?

A
  • enhanced non-medical (ex. private room in hospital)

- enhanced medical (ex. prosthesis)

59
Q

What are some examples of private (non profit) delivery but public funding?

A
  • most hospitals

- addiction Tx

60
Q

What are some examples of private (non profit) delivery and private funding?

A

some home care and nursing homes in some provinces

61
Q

What are some examples of private (profit) delivery and public funding ?

A
  • primary health care physicians
  • ancillary services in hospitals (laundry, meal, maintenance, engineers)
  • labs and diagnostic services in most provinces
62
Q

What are some examples of private (profit) delivery and private funding ?

A
  • cosmetic surgery
  • long term care
  • extended health care benefits (ex. Rx drugs, dental care, eye care)
  • MRI and CT scan clinics in some provinces
  • Some surgery clinics
63
Q

What are some ongoing issues in health care system?

A
  • fiscal crisis
  • privatization
  • current system’s emphasis on curative/acute medicine - less attention on prevention, public health or rehab
  • rigid division of labour
  • specialization versus primary care
  • wait times
  • equity
  • national pharmacare
64
Q

Is the Canadian health care system a national system?

A
  • No, its pan-Canadian
  • Single payer (federal), but 10+ provincial systems working in parallel with differences in costs/fees, scheduled items, and drug coverage
65
Q

What are some federal programs in Canada?

A
  • NIHB
  • Veterans Affairs
  • Armed Forces RCMP
  • Corrections
66
Q

Why may provincial programs vary?

A

Populations served, drugs covered - formularies, and cost containment strategies

  • formulary
  • generic substitution
  • tendering
  • reference-based pricing
  • utilization agreements
67
Q

Describe Ontario drug coverage

A

Ontario Drug Benefits Program:

-for over 65 years, special programs, trillium Programs (income based), generics

68
Q

Describe Alberta drug coverage

A

over 65 years and special programs

69
Q

Describe BC drug coverage

A

net family income based deductible, specialty programs, reference-based pricing

70
Q

Describe Quebec drug coverage

A

covers only those ineligible for private insurance

71
Q

Describe Atlantic Canada coverage

A

over 65 years and special programs

72
Q

Describe Manitoba drug coverage

A
  • Incombe based deductible
  • Palliative care drug program
  • Deductible equal payments through Manitoba Hydro
  • EDS
  • Home Cancer Drug Program

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