Canadian Federalism, the Canadian Social Union, and Health Policy Flashcards
Timeline of federalism and health policy
pre-1980
1980-1984: maintaining government roles
1984-1988: retraining social program costs
1988-1997: restructuring the role of the government
1997-present: repairing the social union
1957
hospital insurance and diagnostic services act
- based on similar legislation Saskatchewan has passed earlier
- established a government sponsored single payer system for hospital based care that covered all Canadians
1966
Medical Care act (MCA)
* extended the system services from hospital based to also include physician services outside of hospital settings
- funded through the Canada Assistance plan and involved 50/50 cost sharing
- Fed gov paid half and provincial gov paid half of health care costs
1977
established programs financing (EPF)
– important shift from cost sharing to block funding
block funding: the federal government provides provinces and territories a particular set amount of money each year to fund their health care systems regardless of what it actually costs the provinces to administer their programs
– EPF also transferred tax points from fed gov to provincial Govs
* meant that taxes would stay the same but provinces would be responsible for a greater share of their health care budgets
linking increases to economic growth in the form of GDP
– doesn’t make sense logically if people require more health due to stress in economic contractions, funding from federal gov during recessions should go up
1980-1984
maintaining government roles
- funding and providing social services and programs were seen as important and was therefore stable – even with two recessions
1984-1988
restraining social program costs
– period when neoliberalism strongly influenced government policy is the US
* meant shrinking of funding for all social programs including HC
* decrease in overall government funding
1988-1997
Restructuring the role of the government
*restructuring government and also restraining costs
* economic recession in early 90s meant that policy makers were concerned with deficits in their budgets and as a consequence that affected spending on services
* significant decrease of federal health care spending
1986-1988
restructuring period
* cut health transfer costs by 41.2$ billion
policy of austerity
strict reductions in government spending and in services provided to citizens is knows as a policy of austerity
1995
Canada health and social transfer
– established programs financing mechanism was replaced with the Canada Health and Social Transfer
1997-2016
repairing the social union
- recognition that the social union was deteriorating
- relationship between levels of government was becoming less cooperative and less constructive
– fed and provincial governments made negotiations and concluded agreements known as the social union framework initiative and agreement with three separate health accords in 2000, 2003, and 2004
* increased payments from fed to provincial governments
2000 health accord
increase of 21.2$ billion over 5 years
2003 health accord
established the health council of canada, separated CHST into CHT and CST
2004 health accord
increase of 41$ billion over 10 years
2011
federal conservative government unilaterally announced scaling back of increases starting in 2014
Harper elected and announced that when the 2004 health accord expired, they would keep the 6% increase in health transfers until 2016 after which they would tie increases to economic growth, including inflation, which they estimated would e about 3.5% to 4% per year
* they promised the increases would never be less than 3%
