Chapter 7: Health care reform in Canada Flashcards
Political ideologies and health care: two main
- Libertarian versus collectivist ideologies
- Neoliberal versus social democratic welfare state
Resulting conflicts of political ideologies
- Health care as a commodity in the marketplace vs as a right
- Privatization vs public administration and delivery
- User fees vs tax revenues
Main recommendations of the Mazankowski report
Increase role of private sector, provide choices for citizens, require more direct payments from citizens (ie. user fees) and ensure sustainability.
Mazankowski private versus public administration and delivery
Private over public to encourage competition, innovation and cost reductions
Role of federal government in Mazankowski report
Minimal, less taxation
Does the Mazankowski report support user fees?
Yes to encourage people to be healthier and to deter unnecessary service seeking
Main recommendations of the Kirby report
Reduce dependency on government, expand role of private sector, introduce market mechanisms, stabilize financing and ensure sustainability
Kirby private versus public administration and delivery
Believes it’s not important who delivers health services and he stresses that under the Canada Health Act, health care services do not have to be delivered by public agencies
Role of federal government in the Kirby report
Strong federal role to ensure sustainability by providing greater funding and to set national standards
Does the Kirby report support uses fees?
No, will decrease access to care and increase inequalities
Main recommendations of the Romanow report
Ensure long term sustainability of universally accessible, publicly funded system, health care as a right not a commodity
Recommit to principle of need over income
Romanow private versus public administration and delivery
Public over private
Ancillary services like cleaning and food can be contracted to private providers to reduce costs
Role of federal government in Romanow report
System is under-resourced and requires more federal funds for sustainability
Federal government share needs to be increased to 25% with escalator clause (increase based on inflation)
What makes the Romanow report different?
He wants to strengthen the existing public system
Does the Romanow report support user fees?
No, will decrease access to care and increase inequalities
Medical savings account
Health accounts formed in conjunction with high-deductible health insurance that can be set up by individuals, employers or governments
Where does money come from for the medical savings account?
Employer or government
What is the citizens responsible for paying for with a medical savings account?
Initial costs–> co-pay and deductibles
Paying for medical care when policy funds run out
Catastrophic insurance
Citizens are responsible for paying for their medical care up to a designated cap, at which coverage will be provided
Regionalization
Administration developed to municipal or regional governments
The theory behind regionalization
Local control
Better targeted services
Citizen involvement
Compatible with public health
Advantage to regionalization
Seen as a way to reduce funding
Limitation to regionalization
Could increase costs bc it places more responsibility on each region
Public-private partnerships (P3S)
An arrangement in which a government contracts with the private sector to finance, develop, construct, own, and operate infrastructure
Limitations of public-private partnerships (P3P)
Privatization by stealth
Lack of accountability
Violation of Canada Health act principles
Health care guarantees
Pre-determined wait-time deadlines for various procedures and after the deadline you can receive that service from a diff public or private provider (ie. diff province or US)
Goal of primary health care reform
Make service provision streamlined to control costs
Suggestions for primary health reform
- Create multidisciplinary health care teams
- Alternatives for fee-for-service like capitation or blended approaches
- Incorporate health promotion and disease prevention into primary care
Capitation
Health care providers being paid a set rate for serving a designated population
Blended approach
Capitation and fee for service above a certain amount
Does Mazanowski support medical savings accounts?
Yes to save money by reducing demand for services
Does Kirby support medical savings accounts?
Yes to make system more efficient and effective
Does Romanow support medical savings accounts?
No will decrease access to and quality of care
Does Mazankowski support regional health authorities?
Yes to encourage specialization and revenue generation
Does Kirby support regional health authorities?
Yes to make mangement more effective bc of market like reforms
Does Mazankowski support public-private partnerships?
Yes to build hospitals and provide services
Does Romanow support public-private partnerships?
No will decrease access to and quality of care
Does Mazankowski support health care guarantees?
Yes to provide better service and to encourage system reform
Does Kirby support health care guarantees?
Yes to restore confidence in the system and provide evidence of responsible spending of health care funds
Does Romanow support health care guarantees?
Approach with caution to ensure funds aren’t directed away from life-saving treatments
Other reform suggestions by Kirby (primary care reform)
Reform primary care system to reduce health care expenditures and introduce independent health commission
Other reform suggestion by Romanow
Expand medicare to include home care and palliative care
Which reform suggestion is unique to Kirby report?
Primary health care reform
Examples of public-private partnership
Brampton civic hospital
Highway 407
User fees
A charge imposed by the government to cover the cost of providing a service
ie. deductibles, co-pays
