primer on canada's healthcare system

Question 1

how does federalism allocate power?

Answer 1

divides authority among levels of government

intentionally restricts the power of the central (federal) government

allowing provinces to have more power/autonomy

Question 2

what is the constitution act? when was it made?

Answer 2

1867; the law passed by the british parliament that created canada on indigenous lands.

specifies the responsibilities of the national and provincial governments.

Question 3

why can’t canada have a national health care system?

Answer 3

constitutional responsibility for health care largely rests at the provincial/territorial level

Question 4

how do provinces decide which health services they provide? when was this determined?

Answer 4

canada health act 1984

Question 5

describe the canada health act

Answer 5

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

Question 6

what is canada health transfer?

Answer 6

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

Question 7

what are the 5 conditions that provincial health insurance plans must meet when delivering health care to receive the canada health transfer?

Answer 7

comprehensiveness

universality

portability

public administration

accessibility

CUPPA

Question 8

in regards to the provincial health insurance plan, define comprehensiveness

Answer 8

provincial insurance plans must insure (financially cover) all “insured health services” provided by physicians or within hospitals

Question 9

in regards to the provincial health insurance plan, define universality

Answer 9

provincial insurance plans must cover 100% of insured health services for all insured persons under uniform terms and conditions

Question 10

in regards to the provincial health insurance plan, define portability

Answer 10

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)

Question 11

in regards to the provincial health insurance plan, define public administration

Answer 11

provincial insurance plans must be administered and operated on a non-profit basis by a public authority

Question 12

in regards to the provincial health insurance plan, define accessibility

Answer 12

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

Question 13

how is OHIP funded?

Answer 13

from taxes paid by ontario residents and businesses, as well as from transfer payments by the government of canada

Question 14

what are some health policy implications of the provincial health insurance plan?

Answer 14

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

Question 15

describe the source of health care expenditures for citizens of ontario

Answer 15

70.9% of total health expenditures are publicly sourced (through taxes, etc)

15% are paid out of pocket

15% paid via private health insurance

Question 16

what percentage of canadians have private health insurance

Answer 16

only 65% of canadians have this insurance

Question 17

what are some conditions set for ontario physicians in regards to OHIP

Answer 17

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)

Question 18

why is it unlikely to get privately financed, medically necessary health care in ontario?

Answer 18

ontario prohibits private insurance to cover services that are publicly funded (by OHIP)

Question 19

what are the types of health care delivery

Answer 19

public delivery (government owned hospital)

private/not for profit (hospitals that are independent corporations)

private/for profit (pharmaceutical company)

Question 20

describe canada’s health care delivery

Answer 20

mainly publicly financed and privately delivered

they use a public-contract model

Question 21

what type of payer health care system does ontario have?

Answer 21

single-payer health care system

health care costs of essential health care covered by a single public system (e.g. OHIP)

Question 22

what are the federal responsibilities for health care?

Answer 22

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

Question 23

what are the branches of canadian government?

Answer 23

legislative

judiciary

executive

Question 24

describe the legislative branch of the government

Answer 24

elected officials who make up the house of commons and appointed senators who make up the senate.

they make laws

Question 25

describe the judiciary branch of the government

Answer 25

made up of judges appointed.

they interpret laws

Question 26

describe the executive branch of the government

Answer 26

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

Question 27

what is ontario health?

Answer 27

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

Question 28

do policies achieve their goals?

Answer 28

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

Question 29

what are ministries further divided into?

Answer 29

branches and divisions

Question 30

what type of leaders do ministries/departments have?

Answer 30

political and civil service head

Question 31

how are cabinet members chosen?

Answer 31

by the leader of the executive branch