WEEK 6: HEALTH CARE REFORM

Question 1

Political ideology and health care

Answer 1

• libertarian vs collectivist ideologies
• neoliberal vs social democratic welfare state model
• resulting conflicts: healthcare seen as commodity, privatization vs public administration and delivery, user fees vs tax revenues

Question 2

Mazankowski report

Answer 2

Main recommendations:
- increase role of private sector
- provide choices for citizens
- require more direct payments from citizens
- ensure sustainability
Private vs Public:
- private preferred to public
- encourage competition, innovation
- cost reductions
Role of federal govt:
- minimal role of fed govt, less taxation
User fees:
- yes
- encourage people to be healthier
- deter pointless service seeking
- improve quality and timeliness of care

Question 3

Kirby report

Answer 3

Main recommendations
- reduce dependency on govt
- expand role of private sector
- introduce market mechanisms
- stabilize financing
- ensure sustainability
Public vs Private:
- not important who delivers services
Role of federal govt:
- provide greater funding
- set national standards
User fees:
- no
- will decrease access to care
- increase inequities
- supportive of medical savings accounts

Question 4

Romanow report

Answer 4

Main recommendations:
- ensure long-term sustainability of universally accessible
- publicly funded system
- recommit to principle of need over income
- health care as a right
Public vs Private:
- retain public over private care
Role of federal govt:
- system is under-resourced and needs more federal funds
User fees:
- no
- will decrease access to care and increase inequities (same as Kirby)

Question 5

What are medical savings accounts?

Answer 5

• employer or govt puts money into MSA
• the policy pays a significant portion of initial costs
• when funds are used up, people assume full responsibility for paying for their medical care up to a designated cap at which catastrophic insurance would be provided
• would reduce demand for services by making people financially responsible for their consumption of health services

Question 6

What is regionalization?

Answer 6

• administration devolved to municipal or regional govt

Theory
- local control
- better targeted services
- citizen involvement
- compatible with public health

Reality
- seen as way to reduce funding
- could increase costs

Question 7

Public-private partnerships

Answer 7

• privatization by stealth?
• lack of accountability?
• Violation of Canada Health Act principles

Question 8

What are health care guarantees?

Answer 8

• wait times for specialist care perceived as an issue
• pre-determined wait-time deadlines for various procedures
• after deadline –> services provided by other public or private provider

Question 9

Primary health reform (Kirby)

Answer 9

• goal = make service provision more streamlined to control costs

Suggestions
- create multidisciplinary health care teams
- alternatives to fee for service like capitation or blended approaches
- incorporate health promotion and disease prevention into primary care

Question 10

What is policy?

Answer 10

• plans/procedures developed and implemented by govt, agencies, organizations, to achieve desired goals

Question 11

What is public policy?

Answer 11

• course of action or inaction chosen by public authorities to address a given problem or interrelated set of problems that is anchored in a set of beliefs about the best way to achieve the goals

Question 12

What is health policy?

Answer 12

• can be narrowly focused on health care delivery or broadly focused on SDOH

Question 13

Mazankowski reform suggestions in the report

Answer 13

Medical savings accounts:
- yes
- save money
- reduce demand for services
Regional health authorities:
- yes
- encourage specialization
- revenue generation
P3:
- yes
- build hospitals
- provide services
Health care guarantee:
- yes
- provide better service
- encourage system reform

Question 14

Kirby reform suggestions in the report

Answer 14

Medical savings accounts:
- yes
- make system more efficient/effective
Regional health authorities:
- yes
- make management more effective
Health care guarantee:
- yes
- provide evidence of responsible spending of health care funds
- prevent Supreme Court from allowing privatization
Other:
- reduce health care expenditures
- introduce independent health commission to monitor operation of system and health

Question 15

Romanow reform suggestions in the report

Answer 15

Medical savings accounts:
- no
- will decrease access and quality of care
P3:
- no
- will decrease access and quality of care
Health care guarantee:
- caution
- ensure funds aren’t directed away from life saving surgery/treatments to meet guarantees for other
- less urgent services
Other:
- expand medicare to include home/palliative care