Medicare and the Funding of health in Canada Flashcards
1
Q
What is medicare
A
A public funded single payer system which provides medically necessary services from hospitals and physicians without financial cost to insured persons
2
Q
Medicare milestones
A
- First provincial public plan for hospital insurance
- Sask 1947
- Covers all residents of the province at no cost to the patient
- Out of pocket and pre paid insurance programs previously dominated the funding of these services (some public funding)
2. The free market and health care - Need/ want HC and able to pay for HC
- Consumption base on ability to pay
- Need/ want HC but unable to pay for HC
- Insurance covers all hospital care with
3. Federal govt follows in 1957 with hospital insurance and diagnostic services : 50-50 cost sharing agreement between feds and provinces and all provinces sign on by 1961
4. First provincial public medical care insurance - Sask 1962,
- Physician services outside the hospital covered 100% by govt
- Sask doctor strike
- Report of the hall commission (1964): recommends public funded health care, and including prescription drugs
5. Medical services act - National medical service program to compliment HIDS (50-50 funding), all provinces sign by 1972 (HIDS + MSA= medicare)
- Most prescription meds remain outside of funding
6. Established programs financing act - 1977
- Block funding vs dollar for dollar matching
- Single payment to province for health and post secondary educaation
- Ends open ended funding of health services (more flexible for provincial govt) provinces start to cover proportionately more to the cost of medicare funded services
7. Canada health act (CHA) - 1984
- Discourages user fees and extra billing
- Summarizes and reaffirms the principles of medicare
8. More federal funding changes - 1995
- Replaces the EPEF and other federal social supports
- Govt cuts to cash transfers by the provinces
- In 2004 the CHST is divided into Canada health transfer and canada social transfer
9. National pharmacare - 2018
- A prescription for canada (was a want to achieve pharmacare for all)
- Little progress on the recommendations that were made
10. The canada dental benefit - Up to 650 per child for families that make < 90,000 per year and no dental coverage
- To be implemented december 1, 2022
- Not a part of medicare as it is not provided to everyone (not universal)
3
Q
Implicit principles are explicitly defined by the CHA
A
- Publicly administered
- Comprehensive
- Universal
- Accessible
- Portable
4
Q
What does publicly administered mean
A
- The health plan for each province must be used on a non profit basis by a public authority accountable to the provincial govt
Ensures accountability for public funds as well as eliminating the profit motivation
5
Q
Comprehensive
A
- The plan must cover all medically necessary services provided by hospitals/ physicians (medically necessary is seen as problematic)
- Limited and inconsisted coverage for prescription drugs, home care and medically necessary health care services (private insurance is still on the market for not covered by public insurance
6
Q
Universal
A
- The plan must entitle 100% of the insured population to all insured services based on uniform terms and conditions
- No intened role private insurance or for profit care for services which are covered by medicare
- Elective services covered by medicare can be provided by facilites working outside medicare but patients must pay out of pocket and cant use private insurance
7
Q
Accessible
A
- Must provide reasonable access to insured services without barriers
- Cant have additional charges for insured services
8
Q
What is Canadas health care debate about
A
- Mostly a funding debate
- How much should we spend, what should be paid for by public, what role should the private sector have
9
Q
- How are medicare and healthcare demands related
A
- When price goes down quantity goes up and vice versa
- Since medicare is perceived as “Free” this makes the demand very high
- Since canadian health care is “free” we cant rely on a pricing system which ca determine price and quanity
- Steady push to increase funding to supply the quantity demanded
- Health care expenditure per capita steadily goes up ( GDP)
- Canada spent 2021 308 billion which was 12.7% GDP
10
Q
How much % of GDP did canada spend in 2021
A
-12.7%
-308 billion
11
Q
Different layers in health care coverage
A
- Layer 1: public services (medicare), all public funding (hospitals, physicians, diagnostics
- Layer 2: mixed services, combination of public/private funding ( prescription drugs, home care, long term care, mental health care)
- Layer 3: private services, almost all private funding
( dental, vision care, complementary medcine)
12
Q
What is the role of the private sector
A
- The role has been pretty stable since the 1970
- Represents approximately 30% of spending in canada
- Paid through OOP or private insurance
- Medicare does not allow for private insurance for health services which are covered by health care. The result from this is that private insurance is only for services which arent covered by medicare (such as prescription drugs) but has started to change
13
Q
What is the chaoulli decision
A
- June 9, 2005
- The supreme court of canada
- It strikes down quebecs law which prohibited private health insurance for medically necessary physician and hospital services
- New/ larger role for private insurance: private insurance can be provided if the public system is inadequate
- Quebec only
- Higher quality and access to care comes from this as the public system wants to keep their monopoly
14
Q
What is the Cambie surgery centre vs the govt of BC
A
- Whether BC allows private insurers to pay for services under the public system (same as the Chaoulli)
- Also whether if doctors can charge privately and publicly (this challenges the rule of exclusivity)
- Was not accepted
15
Q
What is the current state of the cambie case
A
- 2020 was dismissed by BC court
- Appeal in july 2022 and dismissed
Appeal to supreme court most likely
- Appeal in july 2022 and dismissed
