Module 3, The Canadian Health Care System

Question 1

What is ‘Medicare’ (in Canada)?

Answer 1

• refers to the healthcare system we have in Canada today
• has a particular significance in Canadian nationality and identity - the healthcare system comes out as first response for Canadian identity (people say healthcare over hockey for example

for many Canadians today, Medicare has become a defining icon of their society. understanding the origin and evolution of the concept, the views and values of its champions and critics, and the historical events that influenced its implementation will demonstrate that medicare is ever-changing – a delicate balance between public expectations, medical knowledge, technological change, economic and human resources, and political will

Question 2

British North America Act of 1867

Answer 2

• this is the act that creates Canada where are no longer a colony of the British
• the act outlines what is the responsibility of the federal government and what is the responsibility for the provincial jurisdiction (what they are responsible for and what they cannot touch) - arrangement that governs all operations of different parties

Question 3

The BNAA of 1867

Answer 3

federal jurisdiction
- banking
- criminal law
- armed forces
provincial jurisdiction
- property
- local works
- education
- health care

Question 4

Consequences of the BNAA 1867

Answer 4

• each province had own health care system
• no universal health insurance
• people paid hospitals and doctors directly (use the service and pay for it)
• poor, elderly and chronically ill often couldn’t afford care (they could not access and if they could, they could not afford it)
• major illness could reduce even well-off to poverty (quite expensive to access when it was available)

my notes:
- most provinces did not have health care at all at this time
- it was not a system that was accessible to most people

Question 5

Canada Medical Act 1912

Answer 5

• introduced by Sir Thomas Roddick – a physician and Member of Parliament
• aim of standardizing a qualification in medicine
• oversee the licensing of medical doctors
• there are going to be some standards for physicians that you must have a license and the licensing could be a federal (medical schools appeared and governing bodies overseed stuff)

Question 6

Department of Health 1919

Answer 6

first federal Department of Health established under Prime Minister Borden to address…
- quarantine (spread of infectious diseases) - this has to do with borders, imports etc. (federal)

• food and drug standards and inspections - production of different food sources (inspections of things that are being imported, made in Canada)
• campaigns against spread of of STIs - broader campaign around hygiene (education piece not treating STI’s)
• promote and protect child welfare - child labour laws and what industries they can and cannot work in, and protect children from abusive situations
  NOT INVOLVED IN DELIVERY OF HEALTH CARE!!!

Question 7

Some signs of change… 1916 to 1930 (approx.)

Answer 7

• Saskatchewan communities start hiring doctors on contracts (1916) - some signs of change across prarie communities - what if we hired a doctor and we paid them a salary
• union hospitals open in Alberta and Saskatchewan paid for by taxes – 1 cent/acre of land - you were taxed based on how much land you owned and then you could use the hospital
• still many families cannot afford care and avoid calling a doctor - was not widespread as they knew they did not have money to pay the bill

Question 8

The Great Depression - 1930s

Answer 8

• lack of adequate nutrition and housing
• increased rates of tuberculosis, pneumonia, influenza, etc.
• patients unable to pay medical bill - very little cash in circulation
• the economy completely tanked across north america (period of extreme droughts)
• people are leaving their farms because there is no food around
• people cannot pay their medical bills as they did not have crops to sell

Question 9

Health policy in the 1930s – provincial governments

Answer 9

• 1934 – United Farmers of Alberta government pass health insurance legislation (they proposed health care insurance)
• 1935 – Social Credit Party overthrow UFA and legislation is never implemented (UFA lost election)
• 1935 – Patullo Liberal government in BC pass health insurance act – due to opposition from physicians and conservative party it is never funded/implemented
• seeing governments think there is better way to represent health care

Question 10

Health Policy in the 1930s - national

Answer 10

• 1935 – Prime Minister Bennett introduces ‘New Deal’ – legislation providing a system of social welfare (including health insurance and employment insurance - payments when you lose your job)
• under Prime Minister Mackenzie King – legislation is declared unconstitutional as it violated the provincial/federal division of jurisdiction (this is against the british north america act as federal cannot deliver healthcare so it did not happen)

Question 11

Tommy Douglas

Answer 11

• baptist minister turned politician (in 1930’s)
• joined the Cooperative Commonwealth Federation (CCF)
  ◦ humanity first and 70%
  budget to social services
  ◦ they believed that government
  should be able to collect taxes
  but citizens should have access
  to social services
• premier of Saskatchewan from 1944 to 1961
• leader of federal New Democratic Party from 1961 to 1979

Question 12

While T. Douglas was Sask Premier

Answer 12

• 1946 CCF government passes hospital insurance (paid an additional tax)
• collected a ‘premium’ at tax time (assuming you were paying your taxes, and a resident of the province it was assumed you had access)
• individuals received hospital services card (can take the card to the hospital - built more hospitals as a result)
• increased # of hospitals and primary care facilities
• people started to think of hospitals as first resort (increase in woman delivering babies in hospitals, telling people to use it more not only in severe situations like death)
• 1962 implements plan to pay for physician services
• first health care insurance

Question 13

National Health Grants - 1948

Answer 13

• money to provinces to pay for specific projects such as hospital infrastructure, research training, tuberculosis control, cancer control (there is a loophole as the federal cannot deliver it but nothing say they cannot fund it)
• funding for provincial health surveys - 1st overall look at health of Canadians
• there are not telling provinces how to spend the money but they are transferring the money

Question 14

Hospital Insurance and Diagnostic Services Act - 1957

Answer 14

• start of federal government reimbursing provinces for ½ cost of hospital care and diagnostic services
• federal shares cost but provinces determine what is provided
• they cannot deliver it but they can pay for it
• federal government is paying for half the cost but the decisions is all on province

Question 15

Royal Commission on Health Services - 1964

Answer 15

• report recommends universal health insurance to cover physician services (what is the state of health care) - one nation wide system
• similar to what has just been implemented in Saskatchewan

Question 16

Medical Care Act - 1966

Answer 16

• start of what now think of as Canadian ‘Medicare’
• 50/50 cost sharing between federal and provincial governments
• pays for services provided by physicians and in hospitals
• (included previous ‘hospital act’ + physician care)
• we are going to instituitionalize this cost sharing
• combining that previous hospital act with physician care that saskatchewan had

Question 17

Medical Care Act (cont.) - 1966

Answer 17

• ‘transfer payments’ made from feds to provinces to deliver the care
• provinces decide how much is spent and where

my notes:
- this a bad plan considering provinces do not necessarily have to spend it on health care as there is very little accountability in the system (no proof it is being spent on health care)
- perhaps you are only spending the money the federal is giving on health care and using your money on something else
- sets up provinces to compete and compare
- does not promote responsible spending
- could benefit some provinces more than other
- designed to encourage provinces to overspend as the more they spend the more they get

Question 18

Medical Care Act (cont.) - 1966 (4 criteria must be maintained to get the payments)

Answer 18

1. universality - principle that every citizen needs to be covered whether or not they paid their taxes
2. comprehensiveness - what you are providing now you need to keep providing - cannot see limits
3. public administration - non profitable hospitals
4. portability - if a resident of one province from another province they need to be treated as it is one system that is controlling all this

Question 19

New Financing Act - 1977

Answer 19

• change in cost sharing (closer to 25% federal and 75% provincial)
• federal taxes lowered, provincial taxes raised (federal sales and income taxes are decreased but individuals are paying more amount of tax so province has more money now)
• portion of transfer payment tied to population size/population growth (lump sum payment) - allows for provinces that are less wealthy are allowed to get sum of money according to their size
• provinces have flexibility in how they spend but cap on total money from federal government - cap on total amount of money (limit and need to keep it within the budget)
• changes some of the incentives but the money comes out to be almost the same
• they cannot get more if they spend more now

Question 20

Canada Health Act – 1984 (ie. current system) - 5 criteria

Answer 20

federal government will continue transfer payments to provinces as long as the provincial health insurance programs meet 5 criteria:
1. universal
2. comprehensive
3. accessible (this was the added one)
4. portable
5. publicly administered
* if the province agrees to all 5 then federal will continue to give payments

Question 21

2. Comprehensive

Answer 21

all conventional hospital and medical care must be included:
- different treatments covered by each province but…
- generally needs to cover all ‘standard’ medical treatments from birth to death
- some provinces can cover all treatments some might cover only 1 (it really depends)
- but they are expected to cover everything however they do not have to agree to cover all standard treatments (this is instance where one treatment can be covered in one hospital but not the other as not all treatment options are expected to be covered)

Question 22

1. Universal

Answer 22

all Canadians must be covered – some examples:
- if you move provinces, your province of origin must provide coverage during ‘wait period’ for new province (you have to be covered by your province of orginin while you wait to move - no province can deny you service)
- students maintain coverage from home province (do not change your place of residence or have a MSP card - whatever card you have works just fine with some limits)
- applies to citizens and permanent residents – cannot be refused coverage

Question 23

3. Accessible

Answer 23

there can be no limits or additional charges on services:
- you can’t ‘use up’ your coverage for a year
- you can’t be charged for services covered under the act and there can be no ‘add on’ fee
- cannot use up your coverage as there is no limit and there cannot be add on fees for things that are covered until the act
- something that can be charged can be crutches, wheelchair, bandage, medications (except when they are administered in hospital), ambulance transportation costs, doctor’s note, form for travel insurance (can charge you for paperwork that is not necessary to your health)
- we are the only country that has a universal health care system that does not cover medication - fun fact

Question 24

4. Portable

Answer 24

each province must recognize the other’s coverage:
- when travelling in Canada, you can still access services
- host province will bill home province
- some limits – depends on urgency (quebec is an exception as they will pay the other province what it would cost them in their province but they may much less in their province so it can create issues as it does not satisfy the other provinces)
- when you do not have the capacity to give individuals the health care they can send them to another province