(S.14) Canada's Healthcare System Flashcards
What is the Constitution Act of 1867
- Law passed by the British parliament that created Canada
- law specifies shared/individual responsibilities of the federal government and the provinces/territories they were bringing together
Federalism
divides authority among levels of government, and intentionally restricts the powers of the central government
T or F: federalism provides the provinces & territories with no power
F: Gives more power to provinces & territories
T or F: most of health care is under provincial jurisdiction
T
what powers do sections 92(a) and 92(16) of the constitution act set out for provinces
○ Section 92(a): “The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province, other than Marine Hospitals”
○ 92(16): “Generally all Matters of a merely local or private Nature in the Province.”
Why can’t Canada have a national health care system
because constitutional responsibility for health care largely rests at the provincial/territorial level
Assisted Human Reproduction Act
federal act prohibiting IVF & cloning
- Quebec immediately challenged
- 2010: Supreme Court of Canada and they agreed
- IVF was scrapped, prohibition against cloning remains
what is an example of tension between provincial healthcare & federal criminalization
Safe injection site
○ Federal: criminal prohibitions against these narcotics
○ Provincial: doing a healthcare service, which is a provincial matter
- Argued prohibition of these sites were a violation of people’s charter rights to the security of person
Canada Health Act (1984)
○ federal legislation for publicly funded health care insurance
○ framework to find consistency and standards for provinces to adhere to
T or F: Canada health act is a direct consequence of federalism
T
Canada Health Act sets out the primary objective of Canadian health care policy:
to _____, _____ and _____ the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers
protect, promote and restore
what is the federal governments primary purpose in healthcare
funding
Canada Health Act sets out criteria and conditions related to insured health services/ extended health care services that the provinces and territories must fulfill to receive the full federal cash contribution under the ______
Canada Health Transfer
Five conditions that provincial health insurance plans must meet when delivering health care to receive Canada Health Transfer
- comprehensiveness
- universality
- accessibility
- portability
- public administration
Comprehensiveness
= Provincial insurance plans must insure all “insured health services” provided by physicians or within hospitals
○ Insured health services: hospital/physician/surgical dental services
○ Uninsured = prescription renewals by phone, cosmetic services, doctors note
Under comprehensiveness condition, services must be deemed medically ____ to be insured
= necessary
○ Fight between provincial and federal gov. to determine what is necessary
○ Up to provincial health insurance plans (OHIP .etc) to determine
Universality
= Provincial insurance plans must cover 100% of insured health services for ALL insured persons under uniform terms and conditions
- Insured person (citizen)
- Can’t change conditions based on arbitrary factors
Accessibility
= Provincial insurance plans must provide insured health services in a manner that is “reasonably accessible” to all insured persons
· Ex. no user charges or extra billing/fees
· Must also provide reasonable compensation to its health professionals
Most debates around what “reasonably” means regards the absence or provision of ______ or ______
user charges or extra billing/fees
- Stop being reasonable when you can get an MRI in 24hrs if you pay 1k - excludes those who cannot afford
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 (can’t exceed 3 months)
T or F: portability is covered if you travel across provinces and get sick
T: other province will bill Ontario
T or F: Portability condition does not apply outside of Canada
F: can bill OHIP for what they would have paid if you get injured in the US
Taken together, the 5 conditions in the Canada Health Act ensure what is referred to as ________ or ________
(Generally referred to as _______)
= universal health coverage’ or ‘universal health care’
Generally referred to as ‘Medicare’
Ontario Health Insurance Plan (OHIP)
Government-run health insurance plan for Ontario
- Pays for a wide range of health services by funding hospitals, reimbursing physicians for their services, etc
○ They bill OHIP and OHIP pays for their services
How is OHIP funded
- taxes paid by Ontario residents and businesses
- ‘transfer payments’ by the Government of Canada
Canada health transfer
the transfer of cash from the federal government to provincial / territorial governments
- Made on an equal per capita basis based on population
Canada health transfer funds have been withheld for violations of the ______
Canada Health Act
○ Way for federal gov. to ensure healthcare is held to national standard
○ Province doesn’t get $ if you don’t meet the criteria
Patient Charge
If an enrolled physician or dentist charges an insured resident for an insured service
An amount in addition to the amount paid by the provincial or territorial health insurance plan = ________
extra-billing
Other charges (supplies .etc) related to the provision of insured health services = ______
user charges
T or F: patient charges are permitted under the Canada Health Act
F: prohibited
key features of Canada Health Act (3)
- Free at the point of care (pay through taxes)
- 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
Variation in coverage exists between provinces/territories, many give leniency to ______ & _______
children and seniors (optometry, dentistry .etc)
Canadians can be charged for things like ______, _______ _______ .etc, but provinces/territories could choose to insure these
- dental care in dentists’ offices
- nursing homes
- ambulances .etc
If non-physician care shifts from hospitals to clinics/the community, these services are no longer required to be insured even if they are considered medically necessary
- examples of services
- how are they paid
○ outpatient pharmaceuticals, rehab, home care, optometry, etc.
○ uncovered services are paid for via private insurance (through an employer, being a student) or out of pocket
3 types of Health care financing
- Public ( taxes)
- Private insurance (work or school)
- Out-of-pocket
Canada is touted as having a ‘public’ health care system. Roughly how much of Ontario’s health expenditures (e.g., paying for hospitals and physician services, etc.) are paid from public sources (e.g., taxes)?
70.9%
- ~15% are paid out-of-pocket by patients
- ~15% are paid via private health insurance
____% of Canadians have private health insurance insurance
____% have to cover dentistry, optometry, pharmaceuticals
~65%
35%
If Ontario physicians opt-out of the public plan (i.e., OHIP), they are prohibited from doing what?
charging fees greater than the amounts payable under the public plan
T or F: Ontario physicians can practice in both the public and private sectors
F: CANNOT
T or F: Ontario permits private insurance to cover services that are publicly funded (i.e., by OHIP)
F: prohibits
-> Will have to pay out of pocket to go to a physician to get faster primary care
3 types of healthcare delivery
- Public delivery (government-owned hospital)
- Private, not-for-profit delivery (hospitals independent of corporations)
3.Private, for-profit
(pharmaceutical company)
Canada’s healthcare system runs on a public-contract model, wtf does this mean?
most hospital and physician services are publicly financed but privately delivered
○ Government is just involved in financing, not delivering (public)
○ Delivered privately by non-government employees
Typically, when people talk about a ‘public’ health system they are referring to ______
who pays for it
Single-payer health care system
= health care costs of essential health care covered by a single public system (OHIP)
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 (pharmaceuticals, food and medical devices), consumer safety, and disease surveillance and prevention
3 Branches of Canadian government
- Legislative
- Judiciary
- Executive
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, not elected)
= Interprets laws
Executive
- Sets policy directions and implements laws and programs
Policy is a statement of what they want to achieve … ______ will create those laws but ______ gov. will set the direction of where we want to go while making laws
legislature will create those laws but executive gov. will set the direction of where we want to go while making laws
Leader of executive branch = ______
leader = Prime Minister
Executive branch is broken down into ______
Ministries
(Ministry of Health/Health Canada)
Each Ministry has an elected political leader and a______ leader
civil service leader (bureaucrat)
*not elected
*Person with expertise/ability to do policy analysis necessary to think about policy in the given area that the ministry is responsible for
Civil service leader = bureaucrat
elected, PM chooses who in his party will serve as ministers for any given portfolio
* doesn’t always have history in knowledge
minister
Ministers (among others) form a group called the ‘_______’
Cabinet
○ Where gov. makes most important decisions
○ Have conservative, NDP .etc members of parliament, yet only party in power gets to form cabinet to make decisions/set direction of where we want to go
_________ change when governments change; _______ does not
Cabinets change when governments change; civil service does not
________ = Health Canada
_________ = Ministry of Health
Federal = Health Canada
Provincial = Ministry of Health
Under Ministry of Health, have created a super agency agency in Ontario (2019) called ________ : whose mandate is “to implement the health system strategies developed by the Ministry of Health” and “manage health service needs across Ontario…” (among other things)
Ontario Health
Ontario Health Teams
n = 57
○ voluntary collaborations between health service providers
○ intended to integrate services for a regional population
Ontario Health Regions
n = 6
○ Formerly ‘Local Health Integration Networks’ (n = 14)
Ontario Health teams and regions provide regional “_______” for the majority of Ontario’s health care system
& are responsible for the ______ planning of health services
infrastructure
local = regions and teams work on a more regional level to administer healthcare to meet needs of their communities
Federal gov. provides transfers in cash to provinces to finance healthcare, then ________ divis it up and coordinates between regions and teams
Ontario Health
Public Health Units
n = 34
* disease prevention and health promotion programs to all members of community
○ e.g., sexual health clinics, vaccinations, addictions, etc
* Population-level health protection & promotion
