Chapter 6: Overview of the Canadian health care system

Question 1

History: Saskatchewan 1947

Answer 1

Tommy Douglas establishes universal hospital care program
Services billed to provincial government

Question 2

History: Saskatchewan 1961

Answer 2

Law establishing universal health care coverage passed

Question 3

History: Saskatchewan 1962

Answer 3

Doctor’s strike and Saskatoon agreement

Question 4

Why did doctor’s strike in 1962?

Answer 4

In opposition to the public medical insurance in the province bc citizens associated it with socialism

Question 5

Saskatoon agreement

Answer 5

Permitted doctors to charge patients more than what they were reimbursed from the government
They could extra-bill their patients for the services provided

Question 6

History: Canada 1957

Answer 6

Hospital insurance and diagnostic services act
- provided cost-sharing of hospital and physician services

Question 7

History: Canada 1965

Answer 7

Hall commission report 1
- calls for a universal and comprehensive national insurance program

Question 8

History: Canada 1966

Answer 8

Medical care act
Provinces paying 50% and federal government paying 50%

Question 9

History: Canada 1979

Answer 9

Hall commission act 2
- Abolition of extra-billing and user fees

Question 10

History: Canada 1984

Answer 10

Canada health act
- combined hospital insurance and medical care act

Question 11

Federalism

Answer 11

Divides political authority btwn federal and regional/sub-national governments (provinces and territories)

Question 12

Why is federalism a source of tension?

Answer 12

Federal and provincial governments deciding what they’re required to fund, regulate and reform

Question 13

Structure of Canada’s health care system

Answer 13

• 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

Question 14

Single payer system

Answer 14

Each province and territory has a single government insurance plan that provides a comprehensive range of medical and hospital services

Question 15

Private fee-for-service

Answer 15

Physicians send claims for payment to provincial and territorial health insurance plans and they are reimbursed on basis on the fee schedule

Question 16

Fee negotiation

Answer 16

Provincial government and medical associations of each province or territory get together and decide cost of service

Question 17

Why is primary care a gatekeeper to specialized care?

Answer 17

Family doctors see you first and then can refer you to specialists to reduce costs

Question 18

How do Canadians access care- primary health care?

Answer 18

ie. family doctors
- Direct provision of care
- Coordinates patient’s access to health care system for specialized care

Question 19

How do Canadians access care- secondary services?

Answer 19

Delivered at hospital, LTC, clinics
Provinces pay for certain home care services

Question 20

Secondary services for veterans

Answer 20

Veterans affairs Canada provides home care services to veterans

Question 21

Secondary services for First Nations

Answer 21

Federal government provides home care services to First Nations on reserve and some Inuit communities

Question 22

5 principles of medicare (Canada health act)

Answer 22

1. Universality of coverage
2. Portability of coverage
3. Reasonable accessibility to services
4. Comprehensiveness of services
5. Public administration

Question 23

Universality of coverage

Answer 23

Provinces cover 100 percent of their residents hospital and physicians’ services

Question 24

Portability of coverage

Answer 24

Residents are covered when they travel outside the country

Question 25

Reasonable accessibility to services

Answer 25

Financial charges or other barriers should not impede access to health services Reasonable compensation to health professionals

Question 26

Comprehensiveness of services

Answer 26

Provinces cover all medically necessary services provided

Question 27

Public administration

Answer 27

The provinces have to administer their health insurance programs themselves

Question 28

Laws governing funding

Answer 28

1. Sections 91 and 92 of constitution 2. Medical care act (1966) 3. Established programs financing act (1977) 4. Canada health and social transfer (1995) 5. Canada health transfer (2004)

Question 29

Sections 91 and 92 of the constitution

Answer 29

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

Question 30

Established programs financing act (1977)

Answer 30

50:50 cost-sharing is replaced with block funding

Question 31

Block fund

Answer 31

Sum of money given by one level of government to another for a specific purpose

Question 32

What did block funding lead to?

Answer 32

Decreased percentage of funding paid by federal government

Question 33

Canadian health and social transfer (1995)

Answer 33

Replaced EPF funding Single block transfer that empowers federal government to freeze and cap transfers to provinces and territories

Question 34

Canada health transfer (2004)

Answer 34

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

Question 35

Why did they split up the Canada health and social transfer?

Answer 35

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

Question 36

Current issues with Canadian health care

Answer 36

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

Question 37

What should health care reforms focus on?

Answer 37

Not only providing more money to the system, but deploying existing resources more efficiently

Question 38

How can health care reform deploy existing resources more efficiently?

Answer 38

Centralized intake of patients Interdisciplinary groups Doctors working in groups More after hours primary care clinics to relieve burden on emergency department

Question 39

Why does the US spend so much on health care but see the worst outcomes?

Answer 39

Spending money on expensive treatments and technologies Multi-payer system

Question 40

Current health care funding provided to provinces by federal government?

Answer 40

Canada health transfer