lecture 1 - introduction to canadian health care
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Introduction to Health Care in
CanadaHLTH 405 / Canadian Health Policy
Winter 2012School of Kinesiology and Health Studies
Course Instructor: Alex Mayer, MPA
Introductions• Instructor:
o Alex Mayer, MPA (Health Policy)• About me• Office Hours: Tuesdays, 12pm – 5pm (KHS 301B), or by appointment• Contact info: [email protected]
• TAs:o Jenna Brady
o Catalina Medina • [email protected]
o Adele Pontone • [email protected]
Class Business…
• Course Textbooko “Health Care in Canada: A Citizen’s Guide to Policy and Politics”
• By Katherine Fierlbecko Available on Amazon for $25o It will also be available for free on the Queen’s E-brary
• To register for an ebrary account, go to: http://library.queensu.ca/research/databases/record/5298
Class Business…
• You will need an iClicker o Available for purchase at the Campus Bookstoreo Be sure to register your iClicker on Moodle (under “My Clickers”) before next Mondayo We will be using it regularly, so always bring it to class
Class Business…
• Our Facebook Group: “HLTH 405 – Canadian Health Policy”o Join it to access the Course Syllabus, Schedule, Lecture Slides, Class
Announcementso Etiquette: “I like you, but please don’t friend me.”o Privacy: If you have privacy concerns, check your privacy settings.
**Joining the group will not give others access to your profile information, unless they are your friends and/or your settings allow anyone to see your profile.**
Evaluation Schedule• iClicker Quizzes (30%)
o Every week, except Week 1 and Week 7 o 10 questions, 10 minutes; Open-book o Quiz will be a review of weekly readings
• i.e. if the lecture is about Wait Times, you will be quizzed on readings about Wait Times.o Your 8 best scores out of 10 possible quizzes will determine 30% of your final grade
• 2% bonus for attempting every quiz.
• Assignment 1: Briefing Note (20% + 0%)o Due Monday Feb 27th (Week 7)o Presentations: Week 7 tutorial (Feb 28th)
• Assignment 2: Policy Options Paper (40% + 10%)o Due Monday April 9th (Week “13”)o Presentations: April 3rd tutorial (Week 12)
• Participationo Possibility of raising your final mark by one letter grade (e.g. B to B+)o Passion for course material; evidence of preparedness; ability to enhance the educational
experience for others
Questions?
Introduction to Canadian Health Care
• Key points on Canadian health care o Intergovernmental relations are defined by fiscal federalism
• Health care system is the domain of the provinces/territories• The Federal Government lends fiscal support ($)
o The Canada Health Act (1984) sets out rules and a national ‘minimum standard’ for provincial/territorial insurance plans
• The result is 13 public single-payer insurance schemes that are distinct but similar. o Together, these provincial/territorial plans pay for ~70% of health care
costs incurred in Canada (Marchildon, 2005).
Fiscal Federalism• The 1867 Constitution did not specify what level of
government has constitutional authority over the health care system. • It did state that the federal government was responsible for maintaining
‘Peace, Order and Good Governance’ (POGG).
• Roles of the Federation and Provinces have thus been clarified through a series of court rulings.o Judicial interpretation of POGG: Federal government is responsible for…
• 1) food, pharmaceutical, consumer product, and health technology regulations and standards (Health Canada)
• 2) the maintenance of a national health information database (CIHI)• 3) public health and infectious disease surveillance (PHAC)
o Court decisions by the Judicial Committee of the Privy Council set precedents that gradually cemented the autonomy of the provinces in the administration and organization of the health care system.
• The Federal Government has a largely fiscal role, due to its spending powero Health accords are negotiated every 10 years to determine its
financial contribution to the provinceso Has historically included cash transfers and/or giving provinces
‘tax room’o The 2004 Health Accord under Paul Martin built in an annual
6% escalator in the Canada Health Transfer ($)
• CHT funds from the Feds are contingent on provinces adhering to the Canada Health Acto The CHA sets out a few general ruleso Maintains a national ‘minimum standard’ of medically necessary
services that must be insured under provincial health insurance plans
Fiscal Federalism
The Canada Health Act (1984)
• Latest in a series of legal statutes affecting health care funding in Canada
• Preceded by the Hospital Insurance and Diagnostic Services Act (1957) o a formal 50/50 cost-sharing agreement between Feds and Provinces for hospital
care.o HIDS Act was the first to set out the 5 criteria found in the CHA.
Under Premier Woodrow Lloyd, Saskatchewan takes advantage of its influx of HIDS funds to begin insuring physician services too (1962). Physicians are livid; they strike for 3 weeks.
But Lloyd’s idea catches on; the Medical Care Act (1968) is passed
• Amends cost-sharing agreement between Feds and Provinces to include non-hospital physician services
• Maintains that 5 criteria be met for the receipt of federal $$$
The Canada Health Act (1984)
• But physicians soon find a way to increase their earnings beyond provincial reimbursement rateso Extra-billing: Additional service charges tacked onto
provincial reimbursement claims by physicians, in an effort to recoup what they were previously earning under the higher rates paid out in their provincial medical association fee schedule.
o User fees: Charging patients for the difference between the new provincial reimbursement rates and the old provincial medical association fee schedule.
• In 1984, the Canada Medicare Act is amended to address these practices and include 2 more provisions. It is renamed the Canada Health Act.
The Canada Health Act (1984)
• In total, the Canada Health Act contains o 5 program criteria (S.8-12)
• Public Administration • Comprehensiveness • Universality • Portability • Accessibility
o 2 conditions (S.13)• Formal recognition is given to the Federal Government in all health
publications • The federal Health Minister has a right to provincial health system
informationo 2 provisions banning extra-billing and user fees for publicly-insured
services (S.20)
The Canada Health Act (1984)
• Despite the recommendations of the Hall Report to expand the list of insured services in Canada, to include…
o Pharmaceutical drug coverageo Prosthetic serviceso Home careo Eye careo Dental care for children and welfare recipients
… “Comprehensiveness” in the CHA continues to refer only to “medically necessary services” provided in hospitals or by physicians. It is “narrow but deep” coverage,
• In all fairness, Canada was in a mountain of debt by 1984. Trudeau had to resign as PM before the CHA was even passed!
The Canada Health Act (1984)
“Narrow but Deep” Insurance Coverage
• All “Medically necessary” services (diagnostic imaging, treatments, pharmaceuticals, hotel costs) provided in a hospital.
• All “Medically necessary” services provided by a physician.
“Narrow but Deep”Insurance Coverage
• This leaves many essential health goods and services uninsured (i.e. “privatized”)o Pharmaceutical drugso Medical deviceso Outpatient services not provided by a physician
• Eye care• Dental care • Physiotherapy • Home care
o List goes on and on!
• Therefore, provincial plans typically insure many additional services beyond their CHA-mandated coverage.
• Some municipalities will also work with regional health care providers to subsidize specific health services.
“Similar but Distinct”
“Similar but Distinct”• In Ontario, for example, OHIP will offer selective
coverage for:o Ambulatory Services
• Partial subsidy (patients are billed a copayment fee of $45, compared to $500-$1000 for basic ambulatory life support services in U.S. jurisdictions).
o Pharmaceuticals • Ontario Drug Benefit offers complete drug subsidy for ODSP
recipients and seniors; partial subsidy of catastrophic drug costs for every Ontarian; special outpatient coverage of pharmaceutical costs for specific conditions.
o Dental • Complete subsidy of select services (e.g. check-ups, basic cleaning)
for youth, seniors, and ODSP recipients.o Eye Care
• Complete subsidy of select services (e.g. check-ups) for youth, seniors, ODSP recipients, and individuals with diagnosed eye conditions.
Recap• Important concepts to understand:
o Fiscal Federalism o Health Accordso The 5 Criteria of the Canada Health Act
• what do they refer to?o What ‘narrow but deep’ Medicare coverage refers to
• Food for Thought:How do these concepts relate to the following news stories:“A Canada With No Health Accord? Provinces Grapple With The Possibilities”http://ca.news.yahoo.com/canada-no-health-accord-provinces-grapple-possibilities-164300843.html
“Seniors Prefer Hospitals Over Long-Term Care Homes”http://www.cbc.ca/news/canada/windsor/story/2012/01/05/wdr-long-term-care-beds.html
• Fill-in-the-blank:o Who is Tommy Douglas and what was his role in Canadian health care?