Week 2: A primer on Canadas health care 'system' Flashcards
What is the constitution act, 1867? (who was the law passed by?, what does it specify?)
Law passed by the british parliament that created Canada (on indigenous lands)
As a union, the law specifies the responsibilities of the national (federal) government and the provinces and territories
What exclusive powers does the law set out of provinces (Sections)
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.”
Subsequent court decisions have interpreted these clauses as placing most of health care under provincial jurisdiction
Federalism
divides authority among different levels of government, and intentionally restricts the powers of the central government.”
What type of government does Canada fall under
Federal
True or False: Canada does not give a lot of power to the provinces and territories?
False…it DOES
Why does Canada not and cannot have a national health care system?
because constitutional responsibility for health care largely rests at the provincial/ territorial level
Implication
who can and cannot make health policy in Canada
What can we think of policy as?
Decisions taken by those with responsibility for a given policy area
Briefly explain the examples of assisted reproductive technology, safe injection sites and medical assistance in dying
???
Canada Health Act
- Sets out the primary objective of canadian health care policy: “to protect, promote, and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”
- overarching policy that covers everyone
-Establishes criteria and conditions related to insure health services and extended healthcare services that the provinces and territories must fulfill to receive the full federal cash contribution under the canada health transfer.
True or False the Canada health act is a direct consequence pf federalism
True
What are the 5 conditions the provincial health insurance plans must meet when delivering healthcare to receive Canada health transfer. Explain each of them
- Comprehensiveness: provincial insurance plans must insure (ex. ohip) (ie., financially cover) all “insured health services” provided by physicians or within hospitals (must be deemed medically necessary to be covered) (medically necessary not in canada health act so it’s up to provinces/ insurance)
Universality: provincial insurance plans must cover 100% of insured health services for all insured persons under uniform terms and conditions
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
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 healths services (can’t exceed 3 months) (also applies to US, can bill ohip for what ohip would bill u for if those medical services were done in ontario)
If not available in ontario you can apply to ohip and go do it in the us or whatever where its available because “its medically necessary)
Public Administration: provincial insurance plans must be administered and operated on a non-profit basis by a public authority (e.g., OHIP- Ontario Health Insurance Plan)
If taken together what do the conditions in the canada health act ensure
Universal health coverage or health care
What is Ontario health insurance plan (OHIP)
-Government-run health insurance plan for Ontario
-Pays for a wide range of health services by funding hospitals, by reimbursing physicians for their services, etc.
What is OHIP funded from
taxes paid by Ontario residents and businesses, as well as from ‘transfer payments’ by the government of Canada
Canada Health transfer
The transfer of cash from the federal government to provincial/ territorial governments
How much was transferred in 202-2021
42$ billion
What basis is the transfer made on
equal per capita basis
True or false: funds have been withheld for violations of the canada health act
True
Where can the witholds be found
in canada health act annual reports
Patient charge
if an enrolled physician or dentist charges an insured resident for an insured service
Extra billing
An amount in addition to the amount paid by the provincial or territorial health insurance plan
User chargers
Other charges (e.g., for supplies) related to the provision of insured health services
What are the key features of Canada health act, 198
-Free at the point of care
-Provision of healthcare 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
Health Policy implications
-Variation in coverage exists between provinces/territories
-Canadians can be charged for things like dental care in dentists’ offices, nursing homes, ambulances, etc., but provinces/territories could choose to insure these
-If non-physician care shifts from hospitals to clinics or the community, 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. )
-These uncovered services are paid for via private insurance (e.g., through an employer) or out of pocket
Health care financing can be
public
private
out of pocket
Roughly how much of canada’s expenditures (e.g., paying for hospitals and physician services, etc.) are paid from public sources (e.g., taxes?)
70.9 % of total health expenditures are publicly sourced (2018)
True or False: Ontario physicians cannot simultaneously practice in both the public and private sectors
True
True or False: Ontario allows private insurance to cover services that are publicly funded
False; they prohibit
True or false: Ontario physicians may 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
True
True or False: Health care delivery can be public, private, not-for profit and private for-profit
True
True or False: Canada has a “public-contract model”
True
Single-payer healthcare system
-health care costs of essential healthcare covered by a single public system
-not government run healthcare
-delivered privately the government is only involved in financing
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 and explain them
Legislative-made up of elected officials who make up the house of commons, and appointed senators who make up the senate
-make laws
Judiciary- made up of judges (appointed), interprets laws
Executive- sets policy directions and implements laws and programs, leader:prime minister, broken down into ministries (ministry of health/ health canada), each ministry has a political leader (elected) and a ‘civil service’ leader, ministers (among others) form a group called the ‘cabinet’, cabinets change when governments change; civil service does not
What is a civil service person
bureaucrat
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…” (among other things)
What is absorbed in Ontario Health
-Cancer care ontario
-Ehealth ontario
-Trillium gift of life network
-Health quality ontario
-Healthforceontario
-Ontario telemedicine network
-Health shared services ontario
1-4 local health integration networks (LHINs) / home and community care support services
Ontario health teams
voluntary collaborations between health service providers, intended to integrate services of a regional population
(n=57)
How many Ontario health regions
6
how many public health units and are they changing
34 and yes
public health units
Provide disease prevention and health promotion programs to all members of their community, e.g., sexual health clinics, vaccinations, addictions, etc.
-federal government, provincial governments
Ontario health regions was formerly ____
local Health integration networks (n=14)
What are Ontario health teams and regions responsible for
-regional “infrastructure” for the majority of ontario’s health care system
-responsible for the local planning of health services
