Chapter 6: Overview of the Canadian health care system Flashcards
History: Saskatchewan 1947
Tommy Douglas establishes universal hospital care program
Services billed to provincial government
History: Saskatchewan 1961
Law establishing universal health care coverage passed
History: Saskatchewan 1962
Doctor’s strike and Saskatoon agreement
Why did doctor’s strike in 1962?
In opposition to the public medical insurance in the province bc citizens associated it with socialism
Saskatoon agreement
Permitted doctors to charge patients more than what they were reimbursed from the government
They could extra-bill their patients for the services provided
History: Canada 1957
Hospital insurance and diagnostic services act
- provided cost-sharing of hospital and physician services
History: Canada 1965
Hall commission report 1
- calls for a universal and comprehensive national insurance program
History: Canada 1966
Medical care act
Provinces paying 50% and federal government paying 50%
History: Canada 1979
Hall commission act 2
- Abolition of extra-billing and user fees
History: Canada 1984
Canada health act
- combined hospital insurance and medical care act
Federalism
Divides political authority btwn federal and regional/sub-national governments (provinces and territories)
Why is federalism a source of tension?
Federal and provincial governments deciding what they’re required to fund, regulate and reform
Structure of Canada’s health care system
- 13 single payer provincial/territorial health insurance plans
- Private fee-for-service
- Fees negotiated btwn provinces and provincial medical associations
- Primary care is gatekeeper to specialized care
Single payer system
Each province and territory has a single government insurance plan that provides a comprehensive range of medical and hospital services
Private fee-for-service
Physicians send claims for payment to provincial and territorial health insurance plans and they are reimbursed on basis on the fee schedule
Fee negotiation
Provincial government and medical associations of each province or territory get together and decide cost of service
Why is primary care a gatekeeper to specialized care?
Family doctors see you first and then can refer you to specialists to reduce costs
How do Canadians access care- primary health care?
ie. family doctors
- Direct provision of care
- Coordinates patient’s access to health care system for specialized care
How do Canadians access care- secondary services?
Delivered at hospital, LTC, clinics
Provinces pay for certain home care services
Secondary services for veterans
Veterans affairs Canada provides home care services to veterans
Secondary services for First Nations
Federal government provides home care services to First Nations on reserve and some Inuit communities
5 principles of medicare (Canada health act)
- Universality of coverage
- Portability of coverage
- Reasonable accessibility to services
- Comprehensiveness of services
- Public administration
Universality of coverage
Provinces cover 100 percent of their residents hospital and physicians’ services
Portability of coverage
Residents are covered when they travel outside the country
Reasonable accessibility to services
Financial charges or other barriers should not impede access to health services
Reasonable compensation to health professionals
Comprehensiveness of services
Provinces cover all medically necessary services provided
Public administration
The provinces have to administer their health insurance programs themselves
Laws governing funding
- Sections 91 and 92 of constitution
- Medical care act (1966)
- Established programs financing act (1977)
- Canada health and social transfer (1995)
- Canada health transfer (2004)
Sections 91 and 92 of the constitution
Provinces and territories have primary control over the organization, administration and delivery of health care
Federal government can intervene in health care only through its spending power
Established programs financing act (1977)
50:50 cost-sharing is replaced with block funding
Block fund
Sum of money given by one level of government to another for a specific purpose
What did block funding lead to?
Decreased percentage of funding paid by federal government
Canadian health and social transfer (1995)
Replaced EPF funding
Single block transfer that empowers federal government to freeze and cap transfers to provinces and territories
Canada health transfer (2004)
It was recognized that the Canadian health and social transfer was too broad, so they split it up into the Canada health transfer and Canada social transfer
Why did they split up the Canada health and social transfer?
To provide a certain amount of funding for health care, separately from social funding
When it is grouped together as one lump-sum it is hard to know how money is distributed
Current issues with Canadian health care
Growing costs
Decreased federal contributions
Tension btwn federal and provincial governments
Wait times
Calls to privatize and charge user fees
Lack of focus on prevention of social determinants of health
Drugs, mental health not covered
What should health care reforms focus on?
Not only providing more money to the system, but deploying existing resources more efficiently
How can health care reform deploy existing resources more efficiently?
Centralized intake of patients
Interdisciplinary groups
Doctors working in groups
More after hours primary care clinics to relieve burden on emergency department
Why does the US spend so much on health care but see the worst outcomes?
Spending money on expensive treatments and technologies
Multi-payer system
Current health care funding provided to provinces by federal government?
Canada health transfer
