health care in crisis

Question 1

what are the influential factors in shaping Canada’s HC system (3)

Answer 1

1. Gov’t sponsored health insurance, with costs shared btw fed + province
2. hospital insurance implemented decade before medical
3. medical dominance established prior to hospital+medical insurance

Question 2

implication of gov’t sponsored HI

Answer 2

open-ended nature of sharing costs - create conflict btw province + fed

hard for fed to control cost. province does what it wants and sends bill to fed.

Question 3

implication of hospital insurance b4 medical care insurance

Answer 3

orientation of medical system is curative not preventative.

-> hospital has power and influence. less flexibility to deal with changes.

Question 4

implication of medical dominance established pre-insurance

Answer 4

entrenched autonomy + power in physicians

-> national health insurance plan gave power to physicians

Question 5

1977 - Established Programs Financing Act (EPF)

Answer 5

• shared cost to block funding
• uncoupled fed costs from provincial expenditures
• reduced fed share from 50% to 25%
• transfer of tax points from fed to province allowed for increased capacity of province to use income tax to offset reduced fed taxes. (province generates revenue on its own to pay for HC)

Question 6

four phases of health care from 1975-

Answer 6

1975-1991: growth phase
1992-1996: concern about HC grows
1997-2010: growth phase
2011-2017: restraint phase

Question 7

what is the first phase?

Answer 7

1975-1991

• growth phase. average annual growth of 2.7%
• because of econo crisis, as GDP shrinks, proportion of GDP to HC increases

Question 8

what is second phase?

Answer 8

concern about costs of HC (cost over 10% of GSP - concern, psychological boundary)
fiscal deficits
retrenchment + disinvestment = pulling back from system
expenditures decline by an annual average rate of 0.5%

Question 9

how does province contain costs?

Answer 9

slash budget, cap salar, wage rollback, hiring freeze

• close hospital beds + shut entire hospitals
• delist medical services
• shift from hospital to community care
• regionalization
• centralize health authority.

Question 10

what is delisting?

Answer 10

the removal of a specific medical procedure or health care service from the list of services covered under provincial heath care plan

Question 11

what is regionalization

Answer 11

organization of all health care institutions and agencies in a given geographical area under a single administrative board

Question 12

centralization of health authority - what is it? implications?

Answer 12

centralize under 1, health board has all responsibility. cost saving.
implication: local providers/regions have little control over system. over-arching authority has power
implication of regionalization: control cost of HC, sacrifice flexibility, opportunity to have voice in community

Question 13

Canada Health and Social Transfer

Answer 13

1996 - replaces HCA.
intended to help fed reduce responsibility and lower costs
- introduce floor + increase freedom of provinces to decide how to spend transfer payments
net result: fed control deficits + pays more to provinces.

Question 14

third phase of HC?

Answer 14

1997-2010 growth phase
- major investments made in HC, including physicians, drugs, hospitals, advanced diagnostics
- growth raate 3.3%
cost peaks at 11.6% GDP in 2010
2008 recession increases HC cost/GDP

Question 15

CHST split into ? when?

Answer 15

Canada Health Transfer + Canada Social Transfer

2004

Question 16

what does CHT and CST do?

Answer 16

splits HC cast from social transfer to increase transparency
-> 6% annual increase in funding for 10 years, negotiated on year-to-year. = stability + communication btw provinces
-> funding improves = wait time reduction, tech, etc.
net result: stability + widespread investment

Question 17

fourth phase

Answer 17

2011-2017
restraint
expenditure decllinesno systematic increases in expenditures.

Question 18

renewing health accord

Answer 18

Jan 2012, Harper accounced details of health accord.
6% annual increase until 2016 -> after tied to economic growth w floor of 3%
-> per capita payment > equalization
-> hands-off approach: no investment in system-wide improvements

Question 19

liberal govt in 2016

Answer 19

agreement with each province separately.
-> talk individually, PM sets standard. provinces agreed instead of standing together against.
ends 6% escalator, to 3% escalator.
more money for home care, mental health, reduce drug costs

Question 20

3 biggest pressures/cost drivers

Answer 20

hospital: spending accounts is most of HC spending.
hospital based care declining

physician: number of docs increase. concern about fees, cost increase for patients.
drugs: spening moderately. costs supposed to rise. fed controls cost of drugs. drugs is significant component of budget. drug cost on province >feds