Political Aspects Politics of Health

Political Aspects

Politics of Health Care in Canada

Health care is one of the most important things that people worry about in their lives. There is always a need for there to be reliable and affordable healthcare to which everyone has access. Canada has always had some form of socialized medicine throughout history. The role that the government has played in this area has varied over the years. In the beginning the federal government played a central role in developing public health care in Canada. The Government of Canada contributed almost 50% of the total government health care costs, in addition to exerting strong controls over how the provinces operated their health care insurance schemes. But in the late 1970s the government announced that it would no longer keep its commitment to pay one-half of the public health costs, and ended the practice of placing restrictions on how the provinces and territories operated their health insurance schemes. Once the government stopped regulating federal money many shady practices began to emerge -- none of which were in the best interests of the Canadian people. Because of this reaction a good argument that can be made for governmental regulation of this money.

Canadian's want to have access to the best possible health care that there is. They want to be able to get it in a timely manner and pay a little for it as possible. If federal funding is to be used in order to provide this care to the citizens then there should be stipulations on how the medical programs are carried out. There should be some monitoring in order to make sure that they money is spent in the best interest of the people and that unethical practices are not going on that jeopardize the integrity of the entire system.

The modern health care system in Canada is characterized by an administration of provincial and territorial health insurance system which is commonly referred to as Medicare. All provinces and territories provide their residents with a mandatory health insurance plan. When a person obtains basic medical treatment, the cost of that treatment is billed to the provincial or territorial health insurance plan, rather than to the patient. These provincial or territorial insurance plans operate in a public rather than private manner. In private insurance arrangements, the costs of medical services are covered through a system of insurance premiums, which are paid by individuals to their private insurance company. In public insurance plans the costs of medical services are covered through general government revenues. Canadians do not pay health premiums in order to receive their health insurance. Instead, costs are paid for through general government revenues, such as income and consumption taxes and government lotteries (Makarenko, 2007).

After the 1977 decision to stop paying for one-half of health care costs the federal government announced it would no longer place any conditions on federal funding in support of health care. This resulted in the provinces being free to administer their health care plans as they saw fit. This led to the beginning of a number of controversial measures by some provinces during the late 1970s and early 1980s, particularly those of user fees and extra-billing. User fees are the charges that a patient is billed for specific medical services, such as a hospital visit. Extra-billing or double-billing consists of a practice where doctors charge patients fees for services in addition to seeking reimbursement for the provision of those services from the provincial government (Makarenko, 2007).

One important development that has taken place in the health care arena was the introduction of the Canada Health Act in 1984. This legislation re-established the conditions that the provinces would have to follow in order to receive federal health care funds. Essential to the Act was the prohibition of user fees and extra-billing, and the establishment of five basic criteria deemed essential for the operation of provincial health care services. These criteria closely corresponded to those first introduced under the 1966 Medical Care Act which required provincial plans to be: publicly administered, comprehensive, universal, portable and as accessible as possible (Makarenko, 2007).

The Canada Health Act also included a penalty regime, under which the federal government would hold back funding to those provinces that failed to meet any of the Act's criteria. While not extensively used, this penalty regime has been applied in several instances. Immediately after the Act's introduction in 1984, the federal government announced it would be applying penalties to those provinces that permitted user fees and extra-billing. During the 1990s, the federal government applied the penalties on several occasions, mostly when provinces permitted the application of user fees in private medical clinics (Makarenko, 2007).

This Act signifies a key element of federal influence in the provincial jurisdiction of health care insurance. Not only does it set down national standards for the operation of health insurance plans, but it also commits the federal government to using its spending powers to promote those standards. If a province or territory wants its full share of federal funding, then the Act requires that province operate its health insurance plan in a manner that is consistent with national principles and standards that have been set down.

It is important to look at the fact that the Act represents only a financial means of federal influence. As health care is predominately a provincial jurisdiction, the federal government does not possess the constitutional authority to directly regulate health care insurance. All the federal government can do is use federal funding, as well as legislation such as the Canada Health Act, in an attempt to influence provinces to voluntarily meet national standards concerning health insurance (Makarenko, 2007).

The Act sets down a total of nine requirements that the provinces and territories must follow in order to qualify for full federal health funding. The requirements can be divided into three types: general criteria for insured health services, federal conditions on information and recognition and prohibitions on extra-billing and user charges. The Act also provides for two types of financial penalties: mandatory penalties for violation of the prohibition on extra-billing and user fees and discretionary penalties for violation of the general criteria insured health services (Makarenko, 2007).

The Canada Health Act specifically prohibits the provinces and territories from instituting extra-billing and user charges in their health insurance schemes in order to attempt to keep unwanted practices from taking place. The Act describes extra-billing as the billing for an insured health service rendered to an insured person by a medical practitioner or a dentist in an amount in addition to any amount paid or to be paid for that service by the health care insurance plan of a province. If a particular medical service is something that is covered by a provincial or territorial health insurance plan, medical practitioners and dentists are prohibited from directly charging the patient any additional fees for that same service. These additional fees must be paid by the patient's insurance plan. Extra-billing is thought to be a barrier for people seeking medical care and is, therefore, contrary to the Act's accessibility requirement (Makarenko, 2007).

The Act says that user charges are any charges for an insured health service that is authorized or permitted by a provincial health care insurance plan that is not payable, directly or indirectly, by a provincial health care insurance plan, but does not include any charge imposed by extra-billing. A user charge is any fee that is charged directly to a patient for using a publicly insured medical service. In the same sense as extra-billing, user charges are seen as a barrier for people seeking medical care (Makarenko, 2007).

There have been some basic fundamental problems that have been discovered in the delivery of health care in Canada in both the area of timely delivery and accessibility. It is thought that if the federal money that was provided to each province and territory were spent to address these issues that the citizens would be much better off. One of the biggest problems is that of long wait times. These waiting times for essential diagnostic services such as MRIs are due in part to an under-investment in diagnostic technologies. The new Diagnostic Services Fund should be used to purchase new equipment and to train the necessary staff and technicians. There should also be greater standardization and cooperation in the management of waiting lists. Steps need to be taken in order to establish centralized approaches within health regions or even on a national basis. Patients should have the right to received good information about expected wait times for treatment and the full range of options that are available to them (Makarenko, 2007).

It is believed that improvement in the health care system cannot be effective without the proper measurement and tracking of results. It has been proposed that the Health Council of Canada be used to work with the provinces and territories to collect comparable information and report regularly to Canadians on their health system. It is also thought that the health care system should match the needs of different groups of Canadians, from men and women, to new Canadians and visible minorities, to different linguistic groups and people with disabilities (Makarenko, 2007).

The people of Canada feel that there are several other areas in which improvements need to be made. There needs to be a process of integrating coverage for prescription drugs within Medicare in a uniform manner across all jurisdictions. Specific recommendations have include using the proposed Catastrophic Drug Transfer to offset the cost of provincial and territorial drug plans and reduce disparities in coverage across the country. Other suggested approaches have include: establishing a National Drug Agency to control costs and to evaluate new and existing drugs, and reviewing aspects of national patent laws to improve access to generic prescription drugs while containing costs.

There needs to be development of homecare as an essential service in the Canadian health care system. Specific recommendations have included using the proposed Home Care Transfer to ensure all Canadians have access to common homecare services. This would consist of revising the Canada Health Act to include three elements of homecare as necessary medical services - home mental health management and intervention services, post-acute homecare, and palliative homecare. It is also felt that there is a need to provide benefits in support informal caregivers such as family and friends who deliver care.

There are serious disparities in health for Canada's Aboriginal peoples as well and there is need these to be addressed. Specific recommendations have include consolidating health funding from all federal, provincial/territorial, municipal, and band sources into a new Aboriginal Health Partnership in order to establish a clear structures and mandates. There is also a need to ensure that ongoing input from Aboriginal peoples into the direction and design of health care services in their respective communities. It is thought that in order to makes these services work for this group of people it is necessary to find out from them exactly what it is that they need.

There is a need to improve health care in rural and remote areas through the proposed Rural and Remote Access Fund by addressing the shortage of qualified health professionals and expanding Telehealth in order to improve access to care. There are also issues regarding Canada's health care system in the global context that need attention. Specific recommendations have include ensuring that Canadians will not be constrained by international law and trade agreements in the organization of their health care system; playing a leadership role in improving health care in developing nations; and solving health professional shortages domestically rather than recruiting from developing nations which in turn has caused shortages in those nations.

These issues are all very important to the citizens of Canada and if health plans are going to take federal funding then they need to make sure that the interests of the people are being taken into account. Having governmental regulations put on the money is the only way that the government can make sure that they money is being spent on the right things. And if agencies are not spending the money to promote the best interests of the citizens then there should be penalties imposed until the regulations are adhered to. This is the only way to keep it fair for everybody involved.