Transcript HEALTH POLICY IN CANADA

HEALTH POLICY IN CANADA
Evette Bisard, BSN, RN
Jamie McGuire, BSN, RN
Neeta Monteiro, BSN, RN
Wright State University
April 23, 2012
Canada
 Geographically larger than the United States
 Smaller in population
 Settled by the French and English 1867
 Provincial and territorial boundaries, government model
a result of the British North America (BNA) Act
 BNA Act relinquished responsibility for governance of
health and education to the provinces and territories
 Universal coverage for medically necessary health care
services provided on the basis of need, rather than the
ability to pay
History of Canadian Health Care System
 Canadian Constitution
 Constitutional Act, 1867
 Provinces responsible for maintaining and managing
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Hospitals, asylums, charities and charitable institutions
Federal Government
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Tax, borrow, spend, without infringing on provincial powers
History of Canadian Health Care System (cont.)
 1867-1919
 Department of Agriculture
 1919
 Creation of Department of Health
 Pre-World War II
 Canadian health care
Privately funded
 Privately delivered
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History of Canadian Health Care System (cont.)
 Introduced province-wide, universal hospital care
plan
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1947 – Saskatchewan
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1950 – British Columbia and Alberta
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1957 – Hospital Insurance Diagnostic Services Act
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Provided for publicly administered universal coverage for a
specific set of services, uniform conditions and terms
 4 years later – all provinces and territories
History of Canadian Health Care System (cont.)
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1962 – Saskatchewan
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Universal provincial medical insurance plan to provide physicians’
services to all its residents
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1966 – Medical Care Act
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1972 - All provinces and territories had universal physician
services insurance
History of Canadian Health Care System (cont.)
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1977 – Federal Provincial Fiscal Arrangements and
Established Programs Financing Act
Block fund – money provided from one level of government to
another for an identified purpose
 More flexibility
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1984 – Canada Health Act
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Federal legislation – established criteria on portability,
accessibility, universality, comprehensiveness and public
administration
1995-1997 – Canada Health and Social Transfer (CHST)
History of Canadian Health Care System (cont.)
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2000 – 2003 Accord on Health Care Renewal
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Agreement reached by federal, provincial and territorial
government leaders that committed governments to work toward
targeted reforms
 Accelerated primary health care renewal
 Information technology (EHR, telehealth)
 Home care services
 Drugs
 Enhanced access to diagnostic and medical equipment
 Better accountability from governments
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Increased cash transfers in support of health
History of Canadian Health Care System (cont.)
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2004 – CHST now split
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10 Year Plan to Strengthen Care
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Canada Health Transfer for Health
Canada Social Transfer for post-secondary education, social services and
social assistance
Supported by federal governments increased health care cash transfers
2007 – Patient Wait Times Guarantee
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Offers alternative care options
Starting in one priority clinical area by 2010
Undertaking pilot projects to test guarantees and inform of their
implementation
Comparing to US Health History
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Prior to 1800 – medicine in US was “family affair”, midwifery (women), home remedies
1765 University of Pennsylvania – 1st medical college
Mid-1800’s – hospitals, first built by city governments to treat the poor began to treat the not-so-poor.
Patients who could pay were treated in private rooms
1846 American Medical Association
1865 – post Civil War, hospitals became either public or private, nursing became professionalized
with the establishment of training schools for nurses
1899 American Hospital Association founded, employers began offering benefits, including paid
medical care. National health insurance, such as provided by many European nations, became
associated with socialism and the concept became unpopular in the United States, opening the door
for private health insurance to cover the rising cost of medical care
End of 1920’s – 1st large medical insurance company was established, Blue Cross
1930’s – Doctors paid by fee-for-service, new insurance plans – Blue Cross and Blue Shield. During
this time, a medical plan started by Henry J. Kaiser for his employees featured pre-paid program.
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Paved the way for Health Maintenance Organizations (HMO’s)
1940’s – establishment of the Centers for Disease Control and Prevention
1960’s – initiation of social programs to aid the medical care of the aged (Medicare) and the poor
(Medicaid)
2000’s – The Medicare Prescription Drug Improvement and Modernization Act of 2003; the
Affordable Care Act was signed into law, putting in place comprehensive U.S. health insurance reforms
Health Care Service Delivery
 Canada has a universal health care system.
 Canada’s publicly funded health care system is best
described as an interlocking set of ten provincial and
three territorial health insurance plans. Known to
Canadians as “Medicare”, which provides universal
coverage for medically necessary health care services
provided on the basis of need, rather than the ability
to pay.
Social Organization
 The organization ‘Canada’s Health Care System’ is
largely determined by the Canadian Constitution.
 Roles and responsibilities for delivering health and
social services are divided between the federal, and
provincial and territorial governments.
 Publicly funded health care is financed with general
revenue raised through federal, provincial and
territorial taxation.
The Federal Government
 The federal government’s role in health care:
* Setting and administering national principles for
the system under the Canada Health Act
* Financial support to the provinces and territories
* Delivery of primary and supplementary services
* Health protection and regulation, consumer safety,
and disease surveillance and prevention.
The Canada Health Act
 The Canada Health Act
* Objective is to protect, promote and restore the
physical & mental well-being of Canadians
* Facilitate reasonable access to health services
without financial barriers
*Establishes criteria and conditions for health
insurance plans that must be met by provinces
and territories to receive federal funds.
*Discourages extra-billing and user fee.
The Provincial and Territorial Government
 The provinces and territories administer and deliver
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most of Canada’s health care services.
Administer health insurance plans that meet principles
set by the Canada Health Act. (Public administration,
comprehensiveness, universality, accessibility,
portability).
Covers medically necessary services.
Plan and fund care in hospitals and other health care
facilities by doctors and other health professionals
Planning and implementation of health promotion
Negotiation of fee schedules with health professionals.
Health Care Service Delivery
 A health card is issued by the provincial ministry of
health to each individual who enrolls in the program and
everyone receives the same level of care.
 Depending on the province dental and vision may not be
covered but are often insured by employers through
private companies (private insurance).
 Cosmetic surgeries are generally not covered. These can
be paid out-of-pocket or through private insurance.
 Family physicians are chosen by individuals in their
province. If specialist care is needed the physician can
make a referral.
Health Care Service Delivery
 What Happens First (Primary Health Care Services)
 What Happens Next (Secondary Services)
 Additional (Supplementary) Services
 Trends/Changes in Health Care
Health Care Service Delivery
Primary Health Care Services
 First point of contact
 Serves a dual function
1. Provides first-contact health care services
2. Coordinates services to ensure continuity of care and
more specialized service such as referral to specialists,
nurse practitioners, and palliative and end-of-life care.
 Most doctors work in independent or group practices,
and are not employed by the government. Doctors are
paid through fee-for-service that is negotiated between
provincial and territorial government.
Secondary Service
 After primary contact a patient may be referred for
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specialized care at a hospital, at a long-term care facility
or in the community.
Hospitals are operated by boards of trustees, voluntary
organizations or regional authorities established by
provincial/territorial government.
Hospital reimbursement is mainly by global funding.
Home care and long term care facilities services are paid
for by the provinces and territories; room and board cost
for long term care is paid by the individual.
Palliative care is delivered in hospitals, long-term care
facilities, hospices, community and at home.
Supplementary Services
 The provinces and territories provide coverage to certain
people (seniors, children and low income residents) for
services that are not generally covered by the publicly funded
health care system.
 Supplementary health benefits include prescription drugs
outside hospitals, dental care, vision care, medical equipment
and appliances (prosthesis, wheelchairs, etc.), and the services
of other health professionals such as physiotherapists. The
level of coverage varies across the country.
 Those who do not qualify for supplementary benefits pay for
these services through out-of pocket payments or through
private insurance plans.
 Many Canadians, either through their employers or on their
own, are covered by private health insurance and the level of
coverage provided varies according to the plan purchased.
Trends/Changes in Health Care
 Challenges in the health care delivery due to
*Changes in the way services are delivered
*Financial constraints
*Aging of the baby boom generation
*High cost of new technology
 There is a greater emphasis on public health and health
promotion.
 Medical advances have led to more procedures being
done on an out-patient basis, and to a rise in the number
of day surgeries.
 Decentralizing decision making to the regional or local
board level to control cost and improve delivery.
Challenges in Health Care
 Wait Times Reduction
* Training and hiring more health care professionals
* Clearing backlogs of patients requiring treatment
* Building capacity for regional centers of excellence
* Expanding ambulatory and community care
programs
* Developing and implementing tools to better
manage wait times.
 Patient Safety: Avoiding medical errors or adverse
events to improve patient safety and quality of care.
Changes in Health Care
 Primary care: Due to the changes in care delivery
there is more focus on increasing the number of
primary health care centers, primary health teams,
promoting health, preventing illness and injury and
managing chronic diseases; increasing coordination
and integration of comprehensive health services;
and improving the work environments of primary
health care providers.
 eHealth: Electronic health records and telehealthimprove access to services, patient safety,
quality of care, and productivity.
Comparing with the US
 Health care in the US is provided by many separate legal entities.
 Health care facilities are largely owned and operated by the private sector.
 Private and employer sponsored insurance is the primary source of
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insurance in the US covering more than 60% of Americans. (lose job  lose
health insurance).
Canadian Health care is not affected by job status.
< 9% purchase individual health insurance
The government accounts for nearly 46% (Medicare, Medicaid, TRICARE
the Children's Health Insurance Program, and the VA.
16.7% of the population were uninsured in 2009.
More money per person is spent on health care in the USA than in any
other nation in the world.
Health Care Funding
• Canada's health care system is a group of socialized health
insurance plans that provides coverage to all Canadian
citizens. It is publicly funded and administered on a
provincial or territorial basis, within guidelines set by the
federal government.
* Funded at both the provincial and federal levels
* Financing of health care is provided via taxation both
from personal and corporate income taxes
* Additional funds from other financial sources like sales
tax and lottery proceeds are also used by some provinces
Health Care Funding Continued
 While the health care system in Canada covers basic
services, including primary care physicians and hospitals,
there are many services that are not covered. These
include things like dental services, optometrists, and
prescription medications.
 Alberta, British Columbia, and Ontario also charge
health premiums to supplement health funding, but such
premiums are not required for health coverage as per the
Canada Health Act.
 At a federal level, funds are allocated to provinces and
territories via the Canadian Health and Social Transfer
(CHST). Transfer payments are made as a combination
of tax transfers and cash contributions.
Health Expenditure by Funding Source,
Canada, 2010
Where Does all the Money Go?
Health Care and the Economy
 Canada's health care has a large impact on the Canadian economy.
Here are a few facts and figures about the economy and health care:
* Health care expenditures in Canada topped $100 billion in 2001.
* Approximately 9.5% of Canada's gross domestic product is spent on
health care. In comparison, the United States spends close to 14% of its
GDP on health care.
* Individually, Canadians spend about $3300 per capita on health
care.
* At a provincial level, funding is between one-third and one-half of
what provinces spend on social programs.
* About three-quarters of all funding comes from public sources, with the
remainder from private sources such as businesses and private insurance.
Government Spending
Health Research and Promotion
 In 2010, the Government of Canada provided an estimated
$6.7 billion for health research, health promotion and health
protection, and for health services to populations excluded
from the CHA, First Nations and Inuit, veterans, persons
detained for immigration purposes, and refugees and refugee
claimants. Specifically, to advance the development of
research, the Government of Canada funds organizations like
the Canadian Institutes of Health Research (CIHR). Finally,
as a leader in health care renewal, the Government of Canada
funds independent organizations that support health-related
knowledge development and dissemination, such as CIHI, the
Health Council of Canada, the Mental Health Commission of
Canada, the Canadian Patient Safety Institute, and the
Canadian Agency for Drugs and Technologies in Health.
Prioritize Government Funding
 The Government of Canada makes direct investments to
address health care priorities. For example, in support of
governments' shared commitments to reduce wait times, as
set out in the 2004 10-Year Plan to Strengthen Health Care,
the federal government is providing provinces and territories
with $5.5 billion over ten years (from 2004-05 to 2013-14)
through the Wait Times Reduction Fund. Complementing this
investment, the federal government also provided
jurisdictions with $612 million (from 2007-08 to 2009-10)
through the Patient Wait Times Guarantee Trust, as part of
over $1 billion in new funding to support the development of
guarantees in select areas. Similarly, Budget 2009 provided
$500 million in additional funding to Canada Health Infoway
to encourage greater use of electronic health records.
Reported Out of Pocket Prescription
Spending
By percentage of after-tax income
U.S. Healthcare Financing
 The U.S. government uses money generated from taxes
to reimburse providers who take care of patients enrolled
in Medicare, Medicaid, SCHIP or VA. There is also a tax
subsidy of employer-based insurance. The government
accounts for nearly 46 percent of the total health
spending in the country.
 Businesses that provide employer-based insurance pay
all or most of the premium and employees pay the
remainder. Patients pay a direct co-payment to the
provider, and cost-sharing provisions vary by type of
insurance. Self-employed or those who purchase private
insurance on their own must pay premiums themselves.
Life Expectancy in Canada
Leading Causes of Death in Canada
 Cardiovascular diseases (CVD) are the most significant cause
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of death in Canada, accounting for about one third of all
deaths
They include, among others, acute myocardial infarction
(AMI) and stroke
Mortality rates for AMI and stroke have been declining for
decades
Mortality rates for both ischemic heart disease and
cerebrovascular diseases were higher for Registered Indians
than for Non-Aboriginals
Ischemic heart disease mortality rates were not found to be
different for residents of Inuit regions and Canadians overall
Cerebrovascular disease mortality rates are higher for
residents of Inuit regions compared to Canada overall
Leading Causes of Death in the US
 Heart disease: 599,413
 Cancer: 567,628
 Chronic lower respiratory diseases: 137,353
 Stroke (cerebrovascular diseases): 128,842
 Accidents (unintentional injuries): 118,021
 Alzheimer's disease: 79,003
 Diabetes: 68,705
 Influenza and Pneumonia: 53,692
 Nephritis, nephrotic syndrome, and nephrosis: 48,935
 Intentional self-harm (suicide): 36,909
Canada vs. U.S.
Population Health Status
Total population
Canada
United States
33,316,000
304,177,000
Life expectancy at birth (years) 80.7
Overweight and obese aged 15
60
and over
78.0
Infant Mortality per 1000
5.1
6.5
Per Capita Spending (2006)
$3673
$6719
68
Note: Many will argue that utilizing vital statistics in comparisons of
countries and regions is unreliable given the vast differences in population
race and genetic dispositions.
Problems With Canadian Healthcare
References
 Canada Department of Health. (2012). Health Canada. Retrieved April
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17, 2012, from http://www.hc-sc.gc.ca/index-eng.php
Canadian Health Care (2012). Health care funding. Retrieved April 17,
2012, from http://www.canadian-healthcare.org/page8.html
Canadian Institute for Health Information. (2011). Canada’s health
care system. Retrieved April 17, 2012, from http://www.hcsc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php
Centers for Disease Control and Prevention. (2009). Leading causes of
death. Retrieved April 17, 2012, from
http://www.cdc.gov/nchs/fastats/lcod.htm
Fillmore, R. (2009). The evolution of the U.S. healthcare system.
Retrieved from
http://www.sciencescribe.net/articles/The_Evolution_of_the_U.S._H
ealthcare_System.pdf
References
 Henry Kaiser Foundation (2012). Health policy explained.
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Retrieved April 17,2012, from
http://www.kaiseredu.org/Topics.aspx
Organization for Economic Co-operation and Development. (2011).
Country statistical profiles: Key tables from OECD.
doi: 10.1787/csp-can-table-2011-1-en
Suarez, R. (2009). Comparing international health care systems
retrieved from http://www.pbs.org/newshour/globalhealth/julydec09/insurance_1006.html
U.S. Department of Health and Human Services (2001).
Achievements in public health, 1900-1999: Changes in the public
health system. Retrieved April 17, 2012, from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4850a1.htm
US Department of Health and Human Services (n.d.). Historical
highlights. Retrieved April 17, 2012, from
http://www.hhs.gov/about/hhshist.html