Primer on Canada's Healthcare System Flashcards
If Alan Shepard says: “Students do not need to wear masks on campus?” Is that a policy?
Being encouraged to take action or not take action both count as policies.
What is the Constitution Act, 1867?
- The piece of legislation that CREATED Canada
- law passed by British parliament (on indigenous lands)
- Outlines the responsibilities’ of the national government that bring the provinces and territories together
- sets out exclusive powers of provinces
What are the exclusive powers of provinces as outlined by the constitution act 1867?
Section 92(a): “The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province, other than Marine Hospitals”
- Subsequent court decisions have interpreted these clauses as placing most of health care under provincial jurisdiction
What is Federalism?
- Divides authority among levels of government
- intentionally restricts the powers of the central government
- Gives the most power to the provincial and territorial governments; they have more autonomy to do what the want regarding specific issues
- The federal government has no authority to intervene in these matters
Federalism in Canada
- Canada does not, can NOT, have a national health care system because constitutional responsibility rests at the provincial and territorial level
Is Canadas health care system provincial or federal?
Provincial
Why cant federal government control health policies?
- Starts arguements between governments on who shuld be allowed to create policies
- ex. IVF policy was made by federal government and conflict arised
Purpose of Injection Sites
- Provided space for people to use drugs under supervisor of professionals
- Provides free-checking services (ie. For fentanyl)
- a form of healthcare
(Trying to reduce harm) - does not matter if the federal government is in support of them or not, because HEALTH is a PROVINCIAL matter
Canada Health Act, 1984
- an overarching framework for what healthy policy ought to do
- Canada health act is a direct consequence of federalism
- Since provinces have most authority on health, we needed consistency and standards that provinces must meet in regards to healthcare
- Sets out the objective of Canadian health care policy: “to protect, promote and restore the physical/mental well-being of residents of Canada and to facilitate access to health services without financial/ other barriers
- Establishes criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer
What is the Canada Health Transfer?
- The transfer of cash from the federal government to provincial /territorial governments
- Transfers money based on their population
- Provinces decide what they want to do with this money (w/in the boundaries of the Canada health act)
5 conditions provincial health insurance plans must meet when delivering health care to receive CHT:
- Comprehensiveness
- Universality
- Accessibility
- Portability
- Public administration
** the conditions ensure
‘universal health care’
(aka Medicare)
What is Comprehensiveness?
Provincial insurance plans must insure/ financially cover) all “insured health services” provided
by physicians or within hospitals
- insure services: hospital/physician services, surgical/dental services
- For services to be insured, they must be deemed “medically necessary”
- it is up to provincial plans to determine which services are necessary for health insurance purposes
- Uninsured services: “ prescription renewals by telephone (not in person), medical notes for school, cosmetic services
What is Universality?
Provincial insurance plans (ie. OHIP) must cover 100% of insured health services for all insured persons under uniform terms and conditions
What is Accessibility?
Provincial insurance plans must provide insured
health services in a manner that is “reasonably accessible” to
all insured persons (e.g., no user charges or extra billing/fees)
**Must also provide reasonable compensation to its health
professionals
- Extra fees (ie. Paying a doctor to do an MRI sooner than you are planned to have one)
What is Portability?
Requires certain coverage for insured residents
when temporarily out of province, and specifies the waiting period before a resident moving to a new province/territory is eligible for insured health services
- You are covered if you travel across provinces effectively for under 3 months
- If you stay for over 3 months, you need to be under the new provinces health insurance system
What is Public Adminsitration?
Provincial insurance plans must be administered and operated on a non-profit basis by a public authority (i.e OHIP)
- government can not make profit
What is OHIP?
- Government-run health insurance plan for Ontario
- Pays for health services by
funding hospitals, by reimbursing physicians for their services, etc. - Funded from taxes paid by Ontario residents and businesses, and from
‘transfer payments’ by the government
Conditions in the canada health act ensure…
universal health care (ie. Medicare)
How does health care differ across provinces?
Variation in coverage - each province chooses what os covered based on need
Key Features of the Health Act
1) free at the point of care
2) Provision of health care is based on need, not ability to pay
- Provinces are able to fund health care beyond the
requirements of the Canada Health Act if they choose
- (ie. If they want to pay for non necessary medical services, it is possible. They can put it under OHIP and say it is under your taxes)
Health Policy Implications
- Variation in coverage exists between provinces/territories
- Canadians can be charged for things (ie. dental care in dentists’ offices, nursing homes, ambulances) but provinces/territories could
choose to insure these - If non-physician care shifts from hospitals to clinics/ community, these services are no longer required to be insured even if they are
considered medically necessary (ie. home care)
- These uncovered services are paid for via private insurance or out of pocket
3 Types of Health Care Financing.
- Public (e.g., through taxes)
- Private insurance (e.g., through your work or school)
- Out-of-pocket
______% Ontario’s health expenditures (e.g.,
paying for hospitals and physician services, etc.) are paid from public sources (e.g., taxes)?
70.9%
Can you get privately financed?
- Ontario physicians can opt-out of the public plan (i.e., OHIP), but if they do, they are prohibited from charging fees greater than the amounts payable under the public plan
- Ontario physicians cannot simultaneously practice in both the public and private sectors (they cannot top up their salaries by doing private work)
- Ontario prohibits private insurance from covering publicly funded services (i.e., by OHIP)
Can you get private financed medically necessary health care in ontario?
yes, but if physicians choose to practice privately, they cannot overcharge patients
- cannot charge more than what OHIP charges
Can doctors in ontario work private and publicly?
Ontario physicians cannot simultaneously practice in both the public and private sectors (e.g., they cannot top up their salaries by doing some private work)
Can private insurance cover services covered by OHIP?
Ontario prohibits private insurance to cover services that are publicly funded (i.e., by OHIP)
3 Types of healthcare delivery.
- Public delivery (e.g., by a government-owned hospital)
- Private, not-for-profit delivery (e.g., hospitals that are independent corporations)
- they are not trying to make money off of services they provide - Private, for-profit (e.g., pharmaceutical company)
- not run by or for the government
- makes money off the service provided
What is Canada’s healthcare system composed of?
Public financing and Private delivery
- Most hospitals and physician services are private
- Are privately delivered
- Not run by the
government
- Publicly funded
through the healthcare
system (ike.taxes)
What is single-payer health care system?
Health care costs of
essential health care covered by a single public system (e.g.,OHIP)
- Single-payer healthcare is not government run healthcare
- Canada does not have multiple insurance systems, only OHIP
- it does NOT imply that the government runs the healthcare facilities, but it does imply that the government finances them
List of Federal responsibilities for health care?
- First Nations populations living on reserves
- Inuit populations
- Serving members of the Canadian Forces
- Eligible veterans
- Inmates in federal penitentiaries
- Some groups of refugee claimants
- Health protection and regulation (e.g., regulation of
pharmaceuticals, food and medical devices), consumer safety, and disease surveillance and prevention
Branches of Government
- Legislative
- Made up of elected officials (e.g., Members of Parliament) who make up the House of Commons, and appointed Senators who make up the Senate
- Makes laws - Judiciary
- Made up of judges (appointed)
- Interprets laws - Executive
Executive Branch of Government
- Sets policy directions and implements laws and programs
- Leader: Prime Minister
- Broken down into ‘Ministries’ (e.g., Ministry of Health)
- Each Ministry has a political leader (elected) and a ‘civil service’ leader
- Ministers form a group - the ‘Cabinet
- Cabinets change when governments change; civil service does not
Cabinet
- Most important people in government
- Set the policy direction
What is Ontario Health?
- A ‘super agency’ established in 2019 whose mandate is “to implement the health system strategies developed by the Ministry [of Health]” and “manage health service needs across Ontario…”
Ontario Health Teams and Regions
- Ontario Health Teams’ are voluntary collaborations
between health service providers, intended to coordinate services at a regional level - there are 57 health teams
- Introduced 6 ‘Ontario Health Regions’
- If the federal government finances healthcare, the provincial government finances health regions and teams
- teams and regions are responsible for local planning of health services
- provides the infrastructure for Ontarios healthcare system
Diffeence between Ontario health regions, teams, units
- Sub-provincial authorities
Regions (6)
- Divide’s the province into smaller chunks to deliver healthcare
- Responsible for the local planning of health services
Teams (57)
- are further divisions of regions (work within regions)
- focuses on compliments of different care and treatment; Clinical sites and services,Physiotherapist clinic, speech clinic
- These groups work together to coordinate care across many services and clinical professions
Public health units (34)
- further divisions of teams
- associated with municipality (ie. Toronto public health)
- They think of population health needs and interventions
- Provide disease prevention and health promotion programs to all (e.g., sexual health clinics, vaccinations, addictions)
