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