Canadian health care system overview and structure

Health: Canadian Health Care

THE CANADIAN HEALTH CARE SYSTEM Canadian Health Care Philosophy:

Canada maintains a national health care system founded on the principle of providing necessary medical and other health care services to its citizens based on need and without regard to their ability to pay for services. The expressed goal of the Canadian government is for Canada to be one of the countries whose citizens are among the healthiest worldwide. According to the Canadian Royal Commission on Health Services Report (1965):

The principle which has dominated our thinking is that money spent on essential health care is money well spent, an investment in human resources that will pay handsome dividends not only in terms of economics but in human well-being."

Central to achieving this goal is the belief that health services promotion and disease prevention lowers national health care costs in the long run. For this reason, the elements of the integrated health care system includes sanitation, waste management, and medical education, because they contribute to the overall health and welfare issues that impact health. The Canadian health care system is jointly administrated by the federal government, provincial, and local municipalities. The Canada Health Act (CHA) is the legislative authority for the health care system, pursuant to which the federal government establishes qualification criteria for entitlement that must be satisfied by provincial health care insurance plans. At the local level, provincial and territorial municipal governments provide for the actual point-of-service delivery of medical services, and the federal government absorbs their cost through the Canadian Health Transfer (CHT).

Universal health care in Canada is financed by tax revenue generated from federal and local taxes, income tax, corporate tax, as well as payroll tax and sales tax.

Several provinces also impose health care premiums to offset their medical expenses (Madore, 2003).

Historical Background and Legislative History:

The Constitution Act of 1867 established that responsibility for administrating all medical institutions lay with provincial governments, except for marine hospitals and quarantine, which were under the authority of the federal government. The Canadian Health Department was formed in 1919, but medical care was paid for privately until one province, Saskatchewan, established the first universal hospital care plan. Following its success, two other provinces, Alberta and British Columbia, had followed Saskatchewan's lead by introducing similar programs two years later. As early as 1939, prominent Canadian physicians were promoting the philosophy of free universal health care:

our noble tradition that no sick person of any age, sex, race or religion whatsoever, shall ever suffer for need of medical care on account of poverty or any other cause...should be based on our willingness to give, and should be construed as an act of our charity. It should not be exploited: nor should it be assumed as a God-given right by way of its beneficiaries. Least of all should it be a right-of-way for needy and penurious governmental and administrative bodies."

Dr. J.H MacDermot (1939) the federal government promulgated the first national health care program in 1957, with the passage of the Hospital Insurance and Diagnostic Act of 1957. Generally, the 1967 Act authorized federal reimbursement to the provinces through a 50/50 cost- sharing arrangement for a specified set of medical services, conditions, and diagnostic criteria (Madore, 2003).

In 1977, the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act (EPF) transformed the cost-sharing arrangement between the federal and local governments into a combination of direct federal funding and tax points available to the provinces. The principle benefit of the new format was that it enabled provincial and territorial governments to invest health care funding in accordance with their expenses and needs.

The modern Canadian health care system, known as Medicare, took shape following the passage, in 1984, of the Canadian Health Act, and later, a series of legislation culminating, in 1995, in the Canada Health and Social Transfer Act (CHST).

In the last ten years, the Canadian health care system has continued to evolve in adopting further changes to consolidate elements of federal and provincial responsibilities and include funding for medical education within the program (Madore, 2003).

In 2004, a Ten-Year Plan to Strengthen Health Care was announced, primarily intended to improve access to medical services, decrease wait times, and update medical equipment and ensure accurate reporting and enhance public health promotion and prevention programs. Shortly thereafter, the Canadian Supreme Court affirmed the nation's health care philosophy and the immediate need to implement further improvements envisioned by the ambitious 2004 plan in striking down a Quebec law that had prohibited private medical insurance for covered services:

The evidence in this case shows that delays in the public health care system are widespread and that in some serious cases, patients die as a result of waiting lists for public health care...In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."

According to legal experts, the decision could "open the door to a wave of lawsuits challenging the health care system in other provinces" as a result. (New York Times, 2005).

Medicare Service Delivery:

Delivery of free universal medical care through Canadian Medicare is provided by health care plans administrated by the thirteen municipal governments of ten provinces and three territories. The federal government establishes a set of five specific criteria that must be met by provincial and territorial health care plans to qualify for their full share of federal funding. Pursuant to the requirements of the Canadian Health Act, those criteria are:

Comprehensiveness,

Universality,

Portability,

Accessibility, and Public Administration

Health care services are administered through a three-tiered system of primary services, secondary services, and supplementary services. Primary services are furnished by teams of medical practitioners, including physicians, nurse practitioners, nurses, therapists, and pharmacists. In addition to being the actual first point-of-contact medical services, primary care also includes the overall coordination of patients' long-term medical care and ensuring the smooth transition among multiple stages of treatments and therapy (Madore, 2003). Where necessary, primary care providers refer patients to hospitals and long-term care facilities for more specialized medical services. Alternatively, patients may receive secondary care at various short- and long-term community institutions. Whereas the federal government funds primary care and hospital services, secondary services delivered at other facilities or in the home are financed primarily by the territories and provinces.