The Canadian Healthcare System

History of Canadian Healthcare

Pre-Confederation Era

Healthcare in Canada prior to the Constitution Act 1867 was primarily privately funded.

Key Legislative Milestones

1867: Constitution Act
- Sections 91 and 92 divided powers between federal and provincial governments.
  - Section 91: Federal Government Responsibilities
  - Direct and indirect taxation.
  - Employment insurance, militia, military, and naval service, and defense.
  - Quarantine and operation of marine hospitals.
  - Administration of federal penitentiaries (for terms of two years or longer).
  - Matters related to Indigenous peoples (including reserve land), naturalization, and aliens.
  - Section 92: Provincial Government Responsibilities
  - Direct taxation for provincial purposes, justice, prisons (for terms of two years less a day), and hospitals and asylums.
1947: Introduction of Province-Wide Insurance in Saskatchewan
- Initiated coverage for hospital care.
1957: Hospital Insurance and Diagnostic Services Act
- Provided federal funds to provinces for insured hospital and diagnostic services.
- Coverage limited to hospital-related and diagnostic services (e.g., labs, radiology).
1962: Province-Wide Insurance for All Doctors' Services Introduced in Saskatchewan
1966: Medical Care Act
- Established 50/50 cost sharing between federal and provincial governments for insured doctors' services.
- Covered services in and out of hospitals.
1977: Federal-Provincial Fiscal Arrangements and Established Programs Financing Act
- Created a system allowing provinces to better fund healthcare through tax arrangements.
- Replaced the previous 50/50 cost sharing approach with block funding (fixed sums of money).
1984: Canada Health Act
- Replaced previous insurance acts. Established five foundational principles of the Canadian healthcare system:
  - Portability: Residents retain home province coverage when moving temporarily for up to three months. Limited coverage is provided when outside Canada.
  - Accessibility: All insured individuals have reasonable access to healthcare facilities and services; hospital and physician compensation must be reasonable.
  - Universality: Same healthcare level provided to all insured persons.
  - Comprehensiveness: Requires insurance for all medically necessary health services including hospitals, physicians, and surgical dentists.
  - Public Administration: Health insurance administration must be managed by public authorities on a non-profit basis, with healthcare providers accountable to provinces and subject to audits.

Coverage Details

What is Covered:
- All medically necessary procedures and treatments by registered healthcare providers in hospitals.
- Includes necessary diagnostic procedures and treatments, pharmaceuticals, and dental procedures when deemed medically necessary.
- Not Covered:
  - Medical notes or certificates required for work, school, or insurance.
  - Cosmetic procedures unless they are reconstructive or medically necessary.
  - Non-medically necessary dental procedures and diagnostics.

Levels of Healthcare

Primary Care:
- General medical issues and preventive treatments.
- First point of access in the healthcare system provided by primary care providers (doctors, nurse practitioners, physiotherapists).
Secondary Care:
- Specialized services obtained through referrals from primary care providers including advanced diagnostic procedures and minor surgeries.
- Provided by specialist physicians, often outpatient care.
Tertiary Care:
- Advanced specialized care delivered in hospitals requiring specialized expertise and equipment (e.g., coronary bypass, neurosurgery).
Quaternary Care:
- Highly specialized care involving unusual or experimental medical treatments and procedures.

Population Health

Objective:
- Improve the health status of the entire population, reducing health disparities among groups.
- Focuses on health promotion and disease prevention.
Strategies:
- Address determinants of health such as social, economic, and environmental factors.
Measurement:
- Aggregate health status indicators influenced by personal health practices, human biology, and access to health services.

Health Expenditures

General Trends:
- Healthcare costs vary significantly between provinces, with the highest per capita costs in territories.
2017 Data:
- Canada spent approximately 11.5% of GDP on healthcare (~$6,604 per person), up from 7% in 1975.

Sources of Funding

Public vs. Private Funding:
- Approximately 70% of healthcare was publicly funded in 2017; 30% from private sources, largely for pharmaceuticals and dental care.
- Private healthcare expenditures rising, with costs increasing annually (4.5% out-of-pocket and 6.5% for private insurance).
Per Person Costs:
- 2015: $902 out-of-pocket and $756 for private insurance.

Expenses Overview

Historical Costs:
- Prescription drugs were the fastest-growing expense from the 1980s to mid-2000s, driven by increased usage and new expensive medications.
Contemporary Costs:
- Current primary expenses include physician remuneration rivaling drug costs, while hospitals remain the largest healthcare expense.

Provider Payment Structures

Physicians:
- Typically private but compensated through public funding, mainly via fee-for-service.
Nurses:
- Commonly private yet funded by public sources, depending on the employment setting (public health authorities or private clinics).
Other Care Providers:
- Payment methods depend on the profession and employer structure.

Current Trends in Canadian Healthcare

Emphasize on promoting primary care services and continuity of care.
Development of community health centers for 24/7 on-call services.
Establishing interdisciplinary primary care teams.
Focused initiatives on health promotion, chronic disease management, and integrated service delivery.
Technological innovations (eHealth, telehealth, electronic medical records) to improve healthcare delivery.
Addressing patient wait time management and training new health professionals to tackle patient backlogs.
Expanding ambulatory and community care programs.