WEEK 5: CANADA'S MEDICARE SYSTEM

Question 1

History of Saskatchewan + the Canadian healthcare system

Answer 1

• 1947: Tommy Douglas establishes universal hospital care system
• 1961: Law establishing universal health care coverage passed
• 1962: Doctor’s strike and Saskatoon Agreement

Question 2

History of Canada’s healthcare system

Answer 2

• 1957: Hospital Insurance and Diagnostic Services Act
• 1965: Hall Commission 1 report
• 1966: Medical Care Act
• 1979: Hall Commission 2 report
• 1984: Canada Health Act

Question 3

Federalism and healthcare

Answer 3

• hugely consequential
• requires cooperation for funding, regulating, reforming
• source of tension
• divides political authority between federal and regional/subnational govt
• property of constitutions
• based on state power

Question 4

What is the structure of Canada’s healthcare system?

Answer 4

• 13 single payer provincial/territorial health insurance plans
• private fee for service
• fees negotiated between provinces and provincial medical associations
• primary care is gatekeeper to specialized care

Question 5

How do Canadians access care? - primary health care

Answer 5

• direct provision of care
• coordinates patient’s access to health care system for specialized care

Question 6

How do Canadians access care? - secondary services

Answer 6

• delivered at hospital, long-term care facility, or other clinic
• provinces pay for certain home care services
• Veterans Affairs Canada provides home care services to veterans
• federal govt provides home care services to First Nations on reserve and some Inuit communities

Question 7

What are the 5 principles of Medicare?

Answer 7

1. universality of coverage
2. portability of coverage
3. reasonable accessibility to services
4. comprehensiveness of services
5. public administration

Question 8

History of federal funding

Answer 8

Laws governing funding
- Sections 91 and 92 of Constitution
- Medical Care Act (1966)
- Established Programs Financing Act (1977)
- Canada Health and Social Transfer (1995)
- Canada Health Transfer (2004)

What has shifted over time
- cost-sharing to block funding
- % of funding paid by federal govt decreased
- whether funds are put together with other social costs

Question 9

Current issues of Canadian healthcare system

Answer 9

• growing costs
• decreased federal contributions
• tension between federal govt and provinces
• wait times for specialist care
• calls to privatize and charge user fees
• lack of focus on prevention, SDOH
• drugs, mental health, dental not covered

Question 10

Health care reforms

Answer 10

• not simply providing more money
• deploying existing resources more efficiently
• centralized intake of patients
• interdisciplinary teams
• doctors working in groups
• more after hours primary care clinics to relieve burden on emergency departments