1 - Canadian History Flashcards
What is public policy?
- Conduct of public affairs
- Means for the administration (ie: government) to achieve public goals and objectives
- Should be reflective of population’s values and expectations
- Drives the health system
What happened in Canada in 1867?
- Constitution Act created and defined a federal dominion and provincial jurisdictions
- Federal = immigration, defence, revenue and taxation, etc.
- Provincial = education, hospitals, health care, revenue via direct taxation/ licenses/ resource development
Although the provincial jurisdiction was delegated health care authority in the late 1800’s, what actually happened?
- Actual provincial role was negligible and gov’t paid little direct attention to health care
- Health was viewed as private matter
- Municipalities, religious organizations, and charities played central role in building hospitals and supporting the poor
What happened post WWI?
- High prevalence of venereal disease amongst returning soldiers
- Provinces pressured feds for financial help and feds began providing conditional grants for VD prevention and tx (**first precedence for use of federal spending power on health care)
What happened during the depression?
- Provinces and municipalities were threatened by bankruptcy due to burden of unemployment relief
- Physician incomes plummeted
- Many provinces set up commissions that recommended establishing public health insurance plans
- In the meantime, federal, provincial, and municipal governments faced financing chaos
What happened post WWII?
- Feds began mapping out legislation for post-war social reconstruction
- Heagerty committee (1942) recommended comprehensive national public health insurance plan through shared prov-fed contribution
What happened in Saskatchewan in the 1940’s?
- 1944 – Tommy Douglas and the co-operative commonwealth federation (CCF) party win provincial election
- 1947 – Douglas introduces province wide, universal hospital care plan
What did the feds do in 1957? What happened by 1961?
- “Hospital Insurance and Diagnostic Services Act”
- 50/50 cost sharing of provincial and territorial costs for specified hospital and diagnostic services
- By 1961 all provinces have universal hospital insurance
Describe the path to universal insurance for physician services
- Starts in Saskatchewan
- Tommy Douglas introduces “Medical Care Insurance Act” – province-wide universal insurance plan to provide doctors’ services to all residents w/ no user fees
What happened in 1966? What happened by 1972?
- Federal “Medical Care Act”
- Cost share provincial and territorial costs for medical services provided by doctors outside hospitals
- 4 principles -> universality, public administration, portability, and comprehensiveness
- By 1972 all provinces and territories joined Medicare
Describe the universality of the Medical Care Act
- 100% of insured residents of a province/ territory must be entitled to the insured services provided by the plans under uniform terms and conditions
- Provinces and territories generally require that residents register w/ the plans to establish entitlement
Describe the public administration of the Medical Care Act
Health care insurance plans are to be administered and operated on a non-profit basis by public authority
Describe the portability of the Medical Care Act
- 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
- Also applies to residents leaving the country
Describe the comprehensiveness of the Medical Care Act
All medically necessary services provided by hospitals and physicians must be insured
What happened in 1977?
- Fed gov’t passes “Established Programs Financing Act”
- Replaced 50/50 cost sharing w/ a block transfer that includes both cash and taxation power
- Transfer bundled w/ education and tied to national economic growth
Describe the implications of change in funding structure from the Established Programs Financing Act
- Removed feds from the business of determining the eligibility of provincial expenditures
- Broke link between cash contributions by feds and provincial spending
- Made healthcare funding subject to the economic volatility of the national and provincial economies
What was the major problem in the early 1980’s?
Overbilling by physicians and px getting charged extra fees
Describe the Canada Health Act
- Passed in 1984 by federal gov’t under Trudeau
- Added accessibility as 5th principle (reasonable access by insured persons to medically necessary hospital and physician services must not be impeded by financial or other barriers)
- Specified criteria that provinces must satisfy to qualify for fed transfer payments (penalties for extra billing and user charges)
Describe the Canada Health Act w/ respect to drugs
- All necessary drug therapy administered w/in a Canadian hospital setting is insured and publicly funded
- Outside of hospital, provincial and territorial gov’t are responsible for administration of their own publicly-funded Rx drug benefit programs
What occurred in 1995 after cash transfers to provinces decreased?
Feds established Canada Health and Social Transfer (CHST) – block grant bundled health, education, and social services
Describe the 2003 Health Accord
- CHST broke into 2 separate transfers – Health transfer and Social transfer (including education)
- Created Health Council of Canada – “watchdog” to assess reforms/ performance
Describe the 2004 Health Accord
- Brings fed gov’t share in healthcare back up to 25% from a low of 10.2% in 1998/99 (was 50/50 in 1960s/70s)
- $4.5 billion for meeting “meaningful reductions” in wait times in priority areas by March 2007
- Provided long-term funding for health care reform
Which objectives were met of the national pharmaceutical strategy in the Health Accord of 2004?
- Accelerated access to breakthrough drugs for unmet health needs
- Purchasing strategies
- Strengthen evaluation of real-world drug safety and effectiveness
- Prescribing behaviour (partly)
- Enhance analysis of cost-drivers, cost-effectiveness, best practices for drug plan policies
What is CADTH responsible for?
- Common drug review
- pan-Canadian oncology drug review (pCODR)
