Lecture 3 Flashcards
Total health expenditure per Canadian in 2019
$7068 per Canadian
Health expenditure percent of GDP?
11.6%
Where is most of the money for healthcare being spent in Canada?
Hospitals
Where do the feds get money for health care?
General taxation.
Where do the feds direct money for health care?
Transfers to provinces. Direct payments for: armed forces, correctional facilities, and First Nations and Inuit.
Eligible persons for the Non-Insured Health Benefits Program
A First Nations person who is registered under the Indian Act. An Inuk recognized by an Inuit land claim organization. A child less than 18 months old whose parent is registered First Nations or Inuk.
Where do the Provinces get money for health care?
The feds. General taxation. Premiums.
Where do Provinces direct their money for health care?
Service provision (physicians, hospitals, regional health authorities)
Fee-for-service
Health professional paid set amount for each service provided.
Salary
Health professional is employee of organization and responsible for services as outlined in employment contract.
Capitation
Payment according to number of patients. Fee structure can include premium for complex cases. Pays practice whether consult occurs or not. Practice team may include number of disciplines.
Incentive payments/pay-for-performance
Payment for reaching target outcome
In Canada, how are primary care physicians paid?
Fee-for-service except in Ontario where they are now primarily reimbursed through capitation.
In Canada, how are specialists paid?
Fee-for-service, with some exceptions.
Block funding/global budgets
Institution paid certain amount per year to provide service. Generally calculated based on previous year’s amount and types of services offered, adjusted for demographic change, health care costs, and inflation.
Activity-based funding
Payments are allocated funds based on the type and volume of services provided, and the complexity of the patient served.
How are long-term care homes paid?
Global budgets. Sometimes per diem adjustment funding in Ontario and Alberta.
How is home and community care paid?
Mix of global budgets and a variety of other payment mechanisms.
How are pharmacists paid?
Prescription and dispensing fees (essentially fee-for-service)
How are hospitals paid?
Global budgets. Ontario uses an activity-based funding model.
Bundled payments
Single payments that are disbursed to groups of provider entities involved in delivering a defined “episode” of care for a particular health condition or procedure.
Population-based integrated payment model
A single, time-defined payment to groups of providers for a population of enrolled patients or residents of a particular geographic area, regardless of whether they use health service or not.
Insurance
Guarantee of compensation for specified risk in exchange for payment of premium. A mechanism for “risk pooling”.
Health insurance
Programs that pool resources to provide protection against the cost of medical services.
Information asymmetry (feature of health care and health insurance)
Providers know more about how health services will affect patients than patients do.
Mandate of the Hall Commission
To recommend such measures, consistent with the constitutional division of legislative powers in Canada, as the Commissioners believe will ensure the best possible health care is available to all Canadians.”
