The Role of Provincial and Territorial Governments in Health Care

Health Care Plans

Division of Powers

• Canada does not have a national Health Care plan
  • They have 10 provincial and 3 territorial single-pay insurance plans
• Universal Health Care- all eligible citizens have insured health coverage aka medicare
• Under the Constitution Act, the governments oversee matters relating to the personal health of their respective populations

Structure of the Health Plans

• Within the governments of the provinces, there is a department of health that’s assigned to manage the healthcare
  • Each is headed by an elected Member of the Parliament appointed by the premiere
  • Also appoints a deputy minister
• One of the ministries’ responsibilities is implementing and regulating the provincial or territorial health insurance plan
• All provinces have the 3 general categories of healthcare
  • Primary Care: first contact
  • Secondary Care: sent to see a specialist (consultation); short-term
  • Tertiary Care: highly specialized, referred by a specialist
  • Quandary care: experimental care
• Regional Health Authorities were the most common method of delivering care across Canada

Regionalization Initiatives Across Canada

• It was decided in the 1990s to decentralize decisions about healthcare issues through regionalization
  • To assess the need for specific types of care and deliver that care which is best suited to a population group within an area
• PEI, NS, and AB have single administrative bodies
• BC
  • The MOH works with five regional authorities
  • Minister of Health establishes performance and evaluations for health care delivery
  • Each RHA has an appointed board and is managed by a community of health councils
• AB
  • Alberta reduced 9 regional health authorities to one
  • It is responsible for the governance of the Alberta Health Services
• SK
  • Partnered with 3sHealth
  • With the purpose to improve healthcare
  • Services and spending healthcare dollars more effectively
  • Dissolved 12 regional health authorities to one
• MT
  • Manitoba’s 11 RHA’s were reassigned creating 5 regions
  • Each overseen by a board of directors
  • Headed by a chairman
• ON
  • Implemented sweeping change
  • Previously 14 corporations called the Local Health Integration Networks were responsible for healthcare services
  • These nonprofits were operating within their scope to negotiate with the ministry
  • They now have a super agency called the “Ontario Health”
  • Headed by an executive chief officer and board of directors
  • Goals of restructuring
  • Provide residents with simplified access and navigation of the healthcare system
  • To promote integrated healthcare, improve connectivity services, reduce costs, and improve efficiencies among healthcare agencies
• QC
  • MSSS is responsible for both health and social services
  • Shared responsibilities with the 18 RHA’s and the 15 health and social agencies
  • Local service networks were established within the province by merging the community health centers
• NB
  • The Department of Health is responsible for healthcare in the province
  • A board of directors oversees the operation of the two RHA’s
• NS
  • 9 health districts merged to 1
  • NSHA works with IWK Health Center
• PEI
  • One Island Health Care System
  • Overseen by a board of directors with 2 divisions
  • Frontline services
  • System supports
• NF&LD
  • Has 4 RHA’s
  • The medical services division is responsible for the delivery of medical, pharmaceutical, and dental services
• NT
  • 6 districts merged to 1
  • Goal: improve coordination and delivery of health services
• YT
  • The population of 38 641
  • Does not have RHA or anything similar
  • Department of Health manages everything
  • Total of 3 hospitals
  • Managed by the Yukon Hospital Association
• NT
  • Department of Health manages the delivery of healthcare
  • Only has one hospital

Who Pays for Health Care? Roles

Health Care Premiums

• Alberta, British Columbia, and Ontario all charge premiums
• Based on the size of the family and collectively how much they make
• Premiums paid for public plans are not tax deductible

Payroll Tax

• Certain province levy a payroll tax
  • A tax collected from employers that specifically raise funds for healthcare
  • Aka dedicated tax

Funds

• In addition, governments provide some funds for services such as preventative health care measures, medical and hospital-based services, treatment of chronic diseases, rehabilitation, long-term care
• RHA’s typically distribute the money
• Different provinces allocate money a little differently

Public/ Private Health Insurance

Provincial Insurance Plans

• Criteria must be met
  • Canadian citizen; permanent residence
  • A resident of the province
  • Physically reside in a jurisdiction for at least 5 months of the year
• No Canadian can be denied medically necessary hospital or physician care under any circumstances
• To prove citizenship
  • Proof of residency
  • Proof of personal identification
• Must wait 3 months if applying for health care
• Health Cards are given out to keep track of people
  • Cannot be used as a source of id since there is no verification on it
  • Health card fraud is a big problem costing provinces millions

Private Health Care

• Can be tailored to your lifestyle and needs
• Ex. counselling, physiotherapy, sports medicine, travel health assessment, , genetic testing,

Medical Services

• In the hospital standard procedure are included as medically necessary and are paid for by the federal government
• Provincial/territorial do not cover private nursing care
• After receiving a second opinion the patient would have to pay for further consultations
• Ambulance Services
  • Typically under regional management
  • Or costs are shared medically necessary or not
  • Trips between hospitals are covered
• Public insurance does not typically pay for supplemental services
  • Unless referred by your physician
• Optometrists are covered nationals

Extended Health Care Services

• Long-term care homes have comprehensive care
• Are accredited
• Provinces decide their own funding
• These services are also offered
  • Home care: helps individuals with basic personal care, meals, and household maintenance, allowing them to remain at home even when taking care of themself becomes hard
  • Adult Day Programs: provide community day activities as well as respite care and in-home support to individuals with disabilities
  • Respite Care: allows non-professional caregivers relief from caring for a high-needs individual
  • Assisted living accommodation: helps keep a person in their home by providing individualized support and care
  • Group Homes: allows ones with disabilities to live in an environment that provides supervision and assistance
  • Hospice Care: They receive palliative care in a home-like setting for those unable to die at home. Paid for by both the municipal and provincial governments
  • Palliative Care: provides care, medication, and some medical supplies for dying individuals
  • Medical Assistance in Dying- overseen and paid for by the provincial government

Drug Plans

• Medications come second price-wise only to hospital spending.
• Canada offers publicly offered prescriptions called PharmaCare to those unable to pay for it otherwise
• Public insurance plans typically only cover the generic brand of drug
  • Some brand names may be covered if there is not a cheaper viable option
• Most drug plans one is expected to pay a copay

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