primer on canada's healthcare system Flashcards
how does federalism allocate power?
divides authority among levels of government
intentionally restricts the power of the central (federal) government
allowing provinces to have more power/autonomy
what is the constitution act? when was it made?
1867; the law passed by the british parliament that created canada on indigenous lands.
specifies the responsibilities of the national and provincial governments.
why can’t canada have a national health care system?
constitutional responsibility for health care largely rests at the provincial/territorial level
how do provinces decide which health services they provide? when was this determined?
canada health act 1984
describe the canada health act
basically medicare/universal health coverage
sets out the primary objective of canadian health care policy: “to protect, promote, and restore the physical and mental well-being of residences of canada and to facilitate reasonable access to health services without financial or 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
free at the point of care
provision of health care based on need, not ability to pay
provinces are able to fund health care beyond the requirements of the canada health act if they so choose
what is canada health transfer?
the transfer of cash from the federal government to provinical governments ($42 billion in 2020/2021)
made on an equal per capita basis
funds have at times been withheld for violations of the canada health act
what are the 5 conditions that provincial health insurance plans must meet when delivering health care to receive the canada health transfer?
comprehensiveness
universality
portability
public administration
accessibility
CUPPA
in regards to the provincial health insurance plan, define comprehensiveness
provincial insurance plans must insure (financially cover) all “insured health services” provided by physicians or within hospitals
in regards to the provincial health insurance plan, define universality
provincial insurance plans must cover 100% of insured health services for all insured persons under uniform terms and conditions
in regards to the provincial health insurance plan, define portability
requires certain coverage for insured residents when temporarily out of province, and specifies the waiting period before a residence moving to a new province/territory is eligible for insured health services (can’t exceed 3 months)
in regards to the provincial health insurance plan, define public administration
provincial insurance plans must be administered and operated on a non-profit basis by a public authority
in regards to the provincial health insurance plan, define 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 billings/fees)
must also provide reasonable compensation to its health professionals
how is OHIP funded?
from taxes paid by ontario residents and businesses, as well as from transfer payments by the government of canada
what are some health policy implications of the provincial health insurance plan?
variation in coverage exists between provinces
canadians can be charged for things like dental care in dentists’ offices, nursing homes, ambulances, etc, but provinces/territories could insure these
if non physician care shifts from hospitals to clinics, these services are no longer required to be insured even if they are considered medically necessary (e.g. outpatient pharmaceuticals, rehab, home care, optometry, etc). must be paid for via private insurance (e.g through an employer) or out of pocket
describe the source of health care expenditures for citizens of ontario
70.9% of total health expenditures are publicly sourced (through taxes, etc)
15% are paid out of pocket
15% paid via private health insurance
what percentage of canadians have private health insurance
only 65% of canadians have this insurance
what are some conditions set for ontario physicians in regards to OHIP
ontario physicians may opt out of the public plan but if they do, they are prohibited from charging fees greater than the amount payable under public plan.
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)
why is it unlikely to get privately financed, medically necessary health care in ontario?
ontario prohibits private insurance to cover services that are publicly funded (by OHIP)
what are the types of health care delivery
public delivery (government owned hospital)
private/not for profit (hospitals that are independent corporations)
private/for profit (pharmaceutical company)
describe canada’s health care delivery
mainly publicly financed and privately delivered
they use a public-contract model
what type of payer health care system does ontario have?
single-payer health care system
health care costs of essential health care covered by a single public system (e.g. OHIP)
what are the 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
what are the branches of canadian government?
legislative
judiciary
executive
describe the legislative branch of the government
elected officials who make up the house of commons and appointed senators who make up the senate.
they make laws
describe the judiciary branch of the government
made up of judges appointed.
they interpret laws
describe the executive branch of the government
they set policy directions implement laws and programs.
broken down into ministries. each ministry has a political leader (elected) and a civil service leader.
ministers (among others) form a group called the cabinet.
cabinets change when government change, civil service does not
what is ontario health?
super agency (under the ministry of health) 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. includes many smaller organizations
do policies achieve their goals?
policy involves intentions, rather than results. may not always succeed in achieving their goals
set of problems could be replaced by new set of problems that are more preferable over the first
what are ministries further divided into?
branches and divisions
what type of leaders do ministries/departments have?
political and civil service head
how are cabinet members chosen?
by the leader of the executive branch
