HLTA03 Week 4 - Politics of Health Policy

What is the main goal of Canadian Medicare?

To provide equal access to essential health care for everyone.

What is universality?

Health care is available equally to all residents, regardless of income or background.

What is portability?

Health coverage continues when residents move between provinces.

What is comprehensive coverage?

Coverage of a broad range of medically necessary health services.

What is non-profit administration?

Health care is administered to provide public services rather than generate private profit.

What is accessibility?

Reducing financial barriers so people can access necessary health care regardless of income.

What is income redistribution in Medicare?

Sharing health care costs across governments and taxpayers to reduce inequalities.

How does Medicare reflect social democratic values?

It promotes equal access, shared costs, and reduced financial barriers to health care.

What is decommodification, and how does Medicare demonstrate it?

• Decommodification means accessing essential services without depending on ability to pay market prices.

• Medicare reduces the link between income and access to insured care.

What forces shape health policy in Canada

Political ideologies, economic pressures, public values, healthcare costs, interest groups, and government priorities.

Why is health policy political?

It involves decisions about how resources are distributed, who receives services, who pays, and which social values are prioritized.

What are the four main health policy objectives?

• Security: meeting basic needs.

• Liberty: protecting individual freedom.

• Equity: promoting fairness.

• Efficiency: maximizing benefits from available resources.

How can health policy objectives conflict?

Individual freedom to buy private healthcare may conflict with equity because access can depend on income. Efficiency may also conflict with fairness.

What economic, political, and ideological pressures threaten Medicare?

• Rising healthcare costs and limited budgets

• Government policies expanding privatization

• Growing support for market-based healthcare solutions

What is privatization?

Increase in private-sector involvement in healthcare

What is creeping privatization?

Creeping privatization is the gradual expansion of private-sector involvement within a mainly publicly funded system

What are examples of healthcare privatization?

• Private facilities

• Contracting out

• Outsourcing services

• Private insurance

• Expansion of privately paid services

What factors encourage healthcare privatization?

• Government cost-cutting

• Budget pressures

• Long wait times

• Industry lobbying

• Technological advances

• Market-oriented political ideologies

What is contracting out?

When governments hire private companies to provide services instead of providing them directly

What is one argument in favour of privatization?

Private providers may increase capacity, offer more choice, and reduce wait times or surgical backlogs.

What are the main risks of privatization?

Higher costs, staff leaving public hospitals, unequal access based on income, and weakened public-sector capacity.

How can privatization affect equity and taxpayer costs?

Wealthier peoplemay access care faster, while private clinics may charge the public system more for services that public hospitals provide for less.

What is an example of privatization in Ontario?

Some for-profit clinics have received higher payments than public hospitals for certain OHIP-covered procedures, raising concerns about costs and resource diversion.

What did Dr. Brian Day argue in his lawsuit against British Columbia?

He argued that restrictions on private healthcare violated Charter rights to life, liberty, and security of the person because of long wait times.

What was the outcome of the Supreme Court of Canada’s 2023 decision?

The Court dismissed the appeal, leaving the restrictions on private healthcare in place.

What was British Columbia’s argument for restricting private healthcare?

Healthcare access should be based on medical need rather than ability to pay, protecting equitable access to the public system.

What is Canada’s Health Policy Paradox?

Canada supports universal healthcare, but unequal social conditions and gaps in coverage mean access and health outcomes are still unequal.

Why doesn’t universal Medicare guarantee equal health outcomes?

Income, housing, education, employment, and other social determinants affect health. Services such as dental care and outpatient prescriptions are not universally covered by Medicare.

What are the social determinants of health (SDOH)?

The conditions in which people are born, grow, live, work, and age, including income, housing, education, employment, and social support.

What is a welfare state, and what is its purpose?

A system where government provides social protection through programs such as healthcare, pensions, employment insurance, and social assistance to reduce hardship.

What is the guiding principle of a welfare state?

Social programs can be rights of citizenship rather than services people must purchase through the market.

What determines the extent of a welfare state?

How much government support it provides through benefits, services, social spending, and income redistribution

What are the three main welfare-state models?

1. Social democratic

2. Conservative

3. Liberal

What characterizes the social democratic model?

• Extensive universal benefits

• Strong government support

• Efforts to reduce inequality

What are the four countries that have the social democratic welfare-state model?

1. Sweden

2. Denmark

3. Finland

4. Norway

What characterizes the conservative welfare-state model?

Benefits are often linked to employment, occupation, social insurance contributions, and family roles.

What are four examples of countries that use the conservative welfare-state model?

1. Germany

2. France

3. Belgium

4. Netherlands

What characterizes the liberal welfare-state model?

Greater reliance on markets and limited, targeted, often means-tested assistance.

What are five examples of countries that use the liberal welfare-state model?

1. Canada

2. United States

3. Ireland

4. Australia

5. United Kingdom

How do the three welfare-state models differ in their organizing principles?

• Social democratic: universalism and social rights; the state is central.

• Conservative: employment and social insurance; occupation is central.

• Liberal: market reliance (“buy urself or through private insurance” for SOME things, government doesn’t cover everything universally) and residual assistance; the market is central.

What do means-tested and universal benefits mean?

• Means-tested benefits depend on income or financial need.

• Universal benefits are broadly available rather than restricted to people below an income threshold.

Why is Canada considered a hybrid welfare state?

Canada combines universal programs, such as Medicare, with targeted and means-tested benefits.

What are social expenditures and how can they affect health?

• Government spending on social programs and services.

• It can improve income security, housing, education, access to care, and other conditions that influence health.

How does social spending differ between the three welfare-state models?

• Social democratic states have the highest social spending,

• Conservative states tend to fall in the middle

• Liberal states generally have the lowest social spending

Which welfare-state model generally has the lowest poverty and inequality?

The social democratic model

Which welfare-state model generally has the highest poverty and inequality?

The liberal model

How do conservative welfare states compare in poverty and inequality?

They generally fall between social democratic and liberal states

What is the Gini coefficient?

• A measure of income inequality ranging from 0 (perfect equality) to 1 (maximum inequality).

• A higher score means income is less equally distributed.

How does income redistribution affect inequality?

Taxes, transfers, and public services redistribute resources and generally reduce poverty and income inequality.

What are the main categories of social policy?

• Family policies: support families through services and subsidies.

• Labour-market policies: help people enter or maintain employment.

• Pension policies: provide retirement income.

• Incapacity policies: support people with disabilities and participation in work when possible.

What is one concern about Canada’s social policy spending?

Relatively limited support in some areas, including disability support, may leave people with unmet needs.

What is liberalism?

Emphasizes individual freedom, private enterprise, and limited government intervention.

What is laissez-faire?

Argues government should intervene as little as possible in the economy

What is neoliberalism?

Emphasizes markets, competitions, privatization, and market-based solutions across society

What are the main tenets of neoliberalism?

Markets, competition, individual economic self-interest, efficiency, and personal responsibility.

How does neoliberalism change how patients are viewed?

Patients are increasingly described as consumers who choose between competing healthcare providers.

How can neoliberalism reshape healthcare policy?

It can encourage privatization, reduce public spending, market competition, and greater individual responsibility for healthcare

How can neoliberalism affect the SDOH?

Market-based policies and reduced public support may widen inequalities in income, housing, employment, and access to essential services.

Why can focusing on individual responsibility be a problem for health?

It can overlook structural barriers such as poverty, housing insecurity, and unequal access to resources.

What characterizes the East Asian welfare model?

• Emphasize economic growth & productivity

• Welfare responsibilities shared among state, market, family, and employers

• Ex. Japan, South Korea, Taiwan, Hong Kong, Singapore

What is productivist welfare, and what are its strengths and weaknesses?

• Productivist welfare prioritizes economic growth and productivity over universal social welfare.

• Growth can improve living standards and healthcare access, but people without stable employment or family support may face gaps in protection.