Lecture 1A - Evolution of Healthcare, Intro to Health Insurance, and Canada Health Act

RADTH 328 - Healthcare Policy. University of Alberta

How did Canadians advoacate for the equity of a publicly funded health care system?

through social movements

what did the Hospital Insurance and Diagnostic Services Act provide federal dollars to provinces for?

If the provinces were willing to implement a comprehensive hospital insurance plan

What did the Hospital Insurance and Diagnostic Services Act propose?

any province that implements a hospital insurance plan would recive federal dollars covering 50% of the costs incurred by the province for insured services

why were some provinces and territories unable to implement a insurance plan?

because of their population distribution

who is the father of medicare

Tommy Douglas

• campaigned for an affordable comprehensive hospital and medical insurance plan

why were doctors mad that the Saskatchewan Medical Care Insurance Act was passed in 1961?

because they could no longer charge what they wanted

• went on strike - kinda pointless since not unionized

What 3 events led up to the Canada Health Act?

1. The Hall Report (1960)

2. The Medical Care Act (1966)

3. The Established Programs and Financing (EPF) Act (1977)

What were the three key points of the Hall Report?

- supported a national medicare program

- recommended that private health companies in the country be replaced by ten provincial public health insurance plans

- number of physicians needed to be doubled by 1990 to meet the needs of a growing and aging population

What 4 criteria did provincinal and territorial health plans have to meet to recive the benefits of the Medical Care Act of 1966?

1. universality

2. Portability

3. Comprehensive Coverage

4. Public Administration

What benefits did the Medical Care Act of 1966 have?

Covered in-hospital care and physicians’ services (only)

What did the Medical Care Act of 1966 cause the governments to recognize?

Recognize the need for community-based care and restructuring of the funding formula due to increased costs of physcian and hospital care

What was the Established Programs Financing (EPF) Act of 1977

An act that introduced a new funding formula to allocate money to health care and postsecondary education; introduced block transfer of cash and tax points, reduced restrictions on how money could be spent and provided more money for an extended health care services program (such as nursing homes and residential care)

What occurred to health care spending and hospital staff/services spending after the EPF act was passed?

health care spending increased dramatically

hospitals cut spending on staff and services by having it delisted, as a result, doctors began extra billing

What is the The Canada Health Act of 1984

The act that governs, guides, and limits out health care delivery system

Primary Goal of the Canada Health Act of 1984

provide equal, prepaid, and acessivle health care to eligible Canadians

• lawful residents of a province/territory

2025 update to the Canada Health Act (important)

provinces and territories can not charge patients for services that are medically necessary that are provided by non-physcian health profressionals (pharmacists, NPs)

What are the five criteria of the Canada Health Act of 1984

1. Public Administration

2. Comprehensiveness

3. Universality

4. Portability

5. Accessibility

What are the two conditions of Canada Health Act

1. Information

2. Recognition

What is Public Administration (criteria 1) within the Canada Health Act?

health care insurance plans are to be administered and operated on a non-profit basis by a public authority, responsible to the provincial/territorial governments and subject to audits of their accounts and financial transactions

who oversees the health plans created by the public authority?

Ministry of health or Department of Health

What is Comprehensive Coverage (criteria two) within the Canada Health Act?

provincial health insurance plans allow eligible persons with a medical need to access prepaid, medically necessary services provided by physicians and hospitals; without any barriers to access

Who has the latitude or territory to select which services are covered under it’s specific plan?

The provincial or territorial government

• can choose to cover: chiropractic care, eye care, pharma care, etc

What is Universality (Criteria three) within the Canada Health Act?

all eligible residents of a province or territory must be entitled to the insured health services provided by the plans on uniform terms and conditions

Does the federal government allow the provinces or territories to charge insurance premiums?

Yes, they are also able to subsidize premiums for those with low incomes

Which two provinces charge health insurance premiums?

British Columbia and Ontario

What is Portability (criteria four) within the Canada Health Act?

residents moving from one province to another must continue to be covered for insured health care services by the "home" province during any minimum waiting period, not to exceed 3 months

• after the waiting period, the new province assumes the health caer coverage

Individuals moving to Canafa have a waiting period to get insurance of up to _______ months and are encouraged to ….

three months, encourage to purchase private insurance

What is Accessibility (Criteria 5) within the Canada Health Act?

The health insurance plans of provinces and territories must provide reasonable access to insured health care services on uniform terms and conditions

• there’s no definition as to what defines reasonable access however …

Under the CHA, reasonable access is interpreted under the ‘where and as available’ rule. what is that?

residents of a province are entitile to have access to insure health care services at the setting where the services are provided and as the services are available in that setting

Reminder, what are the two conditions of the CHA?

1. information

2. recognition

Information (condition one of the CHA)

the provincial and territorial governments are to provide information to the Minister of Health, in relation to insured health care services and extended health care services, for the purposes identified in the Canada Health Act

recognition (condition two of the CHA)

the governments are to publicly recognize the federal contributions toward both insured and extended health care services

• basically kiss the government’s ass

What is extra billing

when a physcian/dentist directly charges an insured person for an insured person in addition to the amount that would normally be paid for by the provincial heatlh pla

Does the CHA allow for extra billing, and what happens?

No, CHA does not allow it, the federal government will total the amount of money that the province has collected and will deduct that amount from the next transfer of funds

What are user charges

a fee imposed for an insured health service that the provincial or territorial health care insurance plan does not cover

• direct charges to patients for insured services of a provincial health plan that are not payable by the health plan

Examples of health care services that are considered medically necessary

• intermediate nursing home care

• adult residential care services

• home care services

• services provided in ambulatory care centres

• hospital stays and surgeries, physician visits, diagnostic tests, and emergency services.

Examples of optional services that the province can choose to be covered or not

• massage therapy

• physio

• dental care

• drug plans

• chiropractic

6 goals of Primary Health Care Reform

1. team-oriented care (as opposed to physician-based)

2. emphasis on health (as opposed to illness focused)

3. community-based care (as opposed to hospital based care)

4. focus on health promotion and disease prevention (as opposed to curative focus)

5. care is comprehensive and integrated (as opposed to isolated problems)

6. collaborative care involving patient, family and loved ones (as oppose to HCP dominated)

What was the Social Union of 1997

Ministers met to press the federal government for a funding increase to improve healthcare services

what was the result of the Social Union

the federal goverment promised to increase healthcare spending by $11.5 billion dollars over the next 5 years assuming the provinces maintain the five criteria of the health act.

purpose of the Mazankowski Report (2001)

to provide strategic advice to the premier on the preservation and future enhancement of quality health services for Albertans

key points of the Mazankowski Report

- supported some aspects of private health care

- recommended delisting selected services

- recommended implementing electronic health records

- suggested that Albertans pay high health premiums

outcome of the Mazankowski Report

Alberta became the first province to implement electronic health records in 2003

purpose of the Kirby Report

to examine the state of the Canadian health care system and the role of the federal government in it

key points of the Kirby Report

- health care system was unsustainable with existing funding

- implementation of new taxes and insurance preiums that were geared to income

- setting limits to wait times - once reached, government should pay for patient to receive treatment elsewhere

- set-up assistance for medication costs - related to income

- invest $2 billion for information technology

- invest $2.5 billion in advanced medical equipment

- provide incentives to encourage health care professionals to return to Canada

- provide funds to recruit, train and retain doctors and nurses

outcomes of the Kirby Report

not widely accepted, but Ontario did adopt payment premiums for health care

purpose of Romanow Report

to present recommendations to ensure the survival of Canada's health care system and to consider health promotion and disease prevention initiatives

key points of the Romanow Report

- believed health care was sustainable

- opposed privatization of health care

- creation of the Health Council of Canada to oversee improvements to health care

- reform initiatives be paid for by the federal government's surplus or by raising taxes

- recommended adding the criterion of accountability to the Canada Health Act

- extending coverage for home care, diagnostic testing, palliative care and mental health care

- catastrophic drug costs, subject to terms and conditions, be covered

- provide a centralized list of drugs covered by public health plans

- establishment of another independent agency to review and approve prescription drugs

- organization of a central body to monitor and streamline wait lists

outcomes of the Romanow report

- federal government distributed $10 billion over 10 years to address problems identified in report

- Canada Health Transfer and Canada Social Transfer (set amount of money - block transfer payment - from the federal goverment to the provinces to pay for health care, postsecondary education, and welfare)

- Health promotion campaigns

- limits on wait times, required wait times be posted on internet

- funds made available for information technology and electronic health records in all jurisdictions