PPN101 Week 10 Canadian Healthcare 2025

Discuss the history of the Canadian Health Care system and its evolution, including the role of Tommy Douglas.
Describe key principles and implications of the Canada Health Act (1984).
Discuss current healthcare system issues faced at provincial and national levels, relating these to the nursing profession and addressing crucial issues requiring urgent action.
Analyze the Canadian Health Care System in terms of social justice.
Identify the roles of various levels of Canadian government in funding and delivery of health services.
Explain layers of coverage in the Canadian Health Care system: Services, Funding, Administration, and Delivery.

Focus was primarily on local communities and essential services.
Health care was responsive to crises, predominantly managed by local churches and families.
Problems included poor sanitation and infectious diseases (P&P, 2024, p.20).

Marked the birth of Canada.
The Act allocated specific powers to the federal and provincial governments (four provinces initially).
Health, education, and social services fell under provincial responsibility, while the federal government maintained some health oversight:
- Health care for Indigenous persons,
- Services for Canadian Forces and veterans,
- Pharmaceutical safety (Potter & Perry, 2024, p.21).

The industrial revolution caused urbanization leading to substandard living conditions, poor sanitation, and increased diseases.
Patients unable to pay for health care relied on charity, resulting in the growth of charitable health agencies.
1916: Federal government authorized municipalities to tax for physician payments (Municipality Act).
Health responsibilities were managed by the federal Department of Agriculture until 1919, when the Department of Health was formed.
Pre-World War II, health care was mostly privately delivered and funded.
1930s: Heaviness of the Great Depression and its effects.
1940s: Provinces began developing prepaid medical and hospitalization insurance plans.

Establishment of the first universal social programs in Canada.
Post-war economic growth positively affected population health determinants.
Continued institutional shift in health care practices and initiation of immunization programs after the war (www150.statcan.gc.ca/n1/pub/11-516-x/sectionc/4057749-eng.htm).

Tommy Douglas:
- Premier of Saskatchewan (1944-1961) and leader of the NDP (1961-1971).
- Played a crucial role in establishing Canada’s first government health insurance.
- Introduced over 100 important laws to build the social safety net for all Canadians, particularly during the Depression.
- One of his notable quotes:
  > "Sometimes people say to me, 'Do you feel your life has been wasted? … I look back… and think that a boy from a poor home… was given the privilege of being part of a movement that has changed Canada." (Tommy Douglas, 1970)
- Also known as the Father of Medicare (1947).

Post-1950 progress included significant strides in assisting the poor, elderly, and disabled through social safety nets:
- Canada Pension Plan,
- Canada Assistance Plan,
- Guaranteed Income Supplement.
Resulted in increased system costs for healthcare programs.

By 1961, all provinces and territories covered inpatient hospital care.
By 1972, coverage extended for medical services outside hospitals, allowing free access to hospital and medical care for all Canadians.
Cost-sharing between federal and provincial/territorial governments until 1977, after which federal contributions were reduced leading to extra-billing and user fees (Potter & Perry, 2024).

Emerged as a response to concerns about extra billing threatening the universality and access of medical insurance programs.
Established 5 principles:
- Public Administration: Operated by a public authority on a non-profit basis.
- Comprehensiveness: Coverage for all insured health services by hospitals and physicians.
- Universality: All insured residents are entitled to insurance plans.
- Portability: Coverage maintained when moving across provinces or traveling.
- Accessibility: Services must be accessible without discrimination based on age, health status, or financial circumstances (Potter & Perry, 2024).

Federal Responsibilities include:
- Setting and administering national principles through the Canada Health Act.
- Financing provincial health care through transfer payments.
- Health services for specific populations (Veterans, Indigenous peoples, etc.) (Potter & Perry, 2024).
Provincial/Territorial Responsibilities include:
- Developing and administering health care insurance plans.
- Planning and funding care in health facilities.
- Managing prescription care and public health aspects (Potter & Perry, 2024).

Funding: Health care funding at both levels—approximately 70% of revenue is public, sourced mainly from taxation (personal, corporate).
Private funding: Comprising around 30% (dental care, vision care, etc.), often through out-of-pocket expenses or private insurance.

Sustainability of health care costs.
Long wait times and accessibility to services for Indigenous peoples.
Shortages in nursing, NP, and physician workforce, exacerbated by an aging population.
Bureaucratic challenges, affecting efficient delivery of care.

Long wait times, particularly for elective care.
Services outside Medicare not being accessible.
A significant shortage of family physicians, impacting 6.5 million Canadians (approx. 1 in 5).

Serves as the foundation of the Canadian health care system.
Emphasizes health promotion and disease prevention, rooted in social justice and equity.
Comprised of four pillars: Teams, Access, Information, and Healthy Living (Potter & Perry, 2024).

Health care services delivered across various levels, including:
- Primary care: First point of contact for non-urgent care.
- Secondary & Tertiary care: Specialized care, requiring referrals.
Facilities include hospitals, community health centers, private clinics, etc.

A two-tiered system allows patients who can afford it to access faster, sometimes better health services, vis-à-vis those reliant on the public system. Countries with such systems include the UK, Australia, and Germany (Tunstall, 2016).

Raises questions of social justice and adherence to the Canada Health Act principles.
Ethical concerns on equitable access to healthcare.

Need for reforms to adapt delivery methods reflecting current needs (e.g., more focus on primary care instead of hospitals).
Emphasis on social determinants of health, including aging population, geography, and cultural diversity influencing healthcare access and quality.