week 7- Canadian reform Flashcards
2000-2004: several major reports on health care reform were issued:
- Mazankowski Report
- Romanow Royal Commission on Health Care
- Kirby Report from the Canadian Senate
- Fyke Commission on Medicare in Saskatchewan
- Clair Commission
Mazankowski Report
Government of Alberta
Clair Commission
Study of Health and Social Services in Quebec
Manzankoski report main recommendations
- increase role of private sector
- provide choices for citizens
- require more direct payments from citizens
- ensure sustainability
Manzankoski role of government
- minimal ; less taxation
Manzankoski user fees
yes to encourage people to be healthier and to deter unnecessary service seeking, and to improve quality
kirby report main recommendations
- reduce dependency on government
- expand role of private sector
- introduce market mechanisms
- stabilize financing
- ensure sustainability
Kirby report private VS pubic
not important who delivers health services, Canada health act doesn’t preclude private delivery
Kirby role of government
- needs to ensure sustainability by providing greater funding, and to set national standards
kirby user fees
- no will decrease access to care and increase inequalities (though supportive of medical savings accounts)
Romanow report main recommendations
- ensure long term sustainability of university accessible
- publicly-funded system
- recommit to principle of need over income
- health care as a right, not a commodity
Romanow report private vs public
retain public over private for profit care
- anciliary services like cleaning and food can be contracted to private providers to reduce costs
Romanow report role of government
system is under-resourced and requires more federal funds for sustainability; federal funds for sustainability; federal government share needs to be increased to 25% with escalator clause
Romanow report user fees
- no, will decrease access to care and increase inequities
reform suggestions
- Medical Savings Account
- Regionalization
- Public-Private Partnerships
- Health Care Guarantees
- Primary Health Reform (Kirby)
Medical Savings Account
MSAs are health accounts formed in
conjunction with high-deductible
health insurance—that is, the policy
pays a significant portion of initial
costs—that can be set up by
individuals, employers, or
governments (Ramsay, 1998)
Regionalization theory
- administration devolved to municipal or regional government
theory
- local control
- better targeted services
- citizen involvement
- compatible with public heatlh
Regionalization reality
- seen as a way to reduce funding
- could increase costs
public-private partnerships
- privatization by stealth
- lack of accountability
- violation of canada health act principles
health care guarantees
- Wait times for specialist care perceived as an issue
- Pre-determined wait-time deadlines for various procedures
- After deadline, service provided by other public or private provide
Primary Health Reform (Kirby)- goal
Make service provision more streamlined to control costs
Primary Health Reform (Kirby)-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
Mazankowski medical saving accoutns
yes to save money by reducing demand for services
Mazankowski regional health authorities
yes to encourage specialization and revenue generation
Mazankowski public-private partnership
yes to build hospitals and provide services
Mazankowski health care guarantees
yes to provide better service and to encourage system reform
kirby medical savings
yes to make system more efficicent and effective
kirby regional health authorities
yes to make managment more effective because of “market-like reforms”
kirby health care guarantee
yes as a step to reform the system, restore confidence in it
- and provide evidence of responsible spending of health care funds; also to prevent supreme court from allowing privatization
kirby other
reform primary care system to reduce health care expenditures, and introduce an indepedent health commission to monitor operation of system and health of canadians
romanow medical savings accounts
no will decrease access to and quality of care
Romanow public-private partnerships
no will decrease access to an quality of care
Romanow health care guarantee
approach with caution to ensure funds aren’t directed away from life-savings surgery or treatments to meet guarantees for other, less urgent services
romanow other
expand medicare to include home care and palliative care for people in last 6 months
