*Metabolic syndrome, plant-based diets, economics of chronic disease prevention*Determinants of drug misuse, decriminalization, harm reduction strategies*Health care financing, incentives for healthy lifestyles within a public insurance scheme*Social determinants of health, distributional effects of taxation, equality of access to health care
My advice: Keep up with the readings, come to class, attempt all quizzes, and shoot me an email when you will be absent (for good reason)
Feds also responsible for the health care of FNs, military, and federal inmates
Under Premier Tommy Douglas, Saskatchewan took advantage of its influx of HIDS funds to begin insuring physician services too (1961). Physicians are livid; they strike for 3 weeks. Douglas’ idea catches on; the Medical Care Act (1968)Amends cost-sharing agreement between Feds and Provinces to include non-hospital physician servicesMaintains the 5 criteria to be met for the receipt of federal $$$
Lecture 1 - Introduction to Canadian Health Care
Introduction toHealth Care in Canada HLTH 405 / Canadian Health Policy Winter 2012 School of Kinesiology and Health Studies Course Instructor: Alex Mayer, MPA
Introductions• Instructor: o Alex Mayer, MPA (Health Policy) • About me • Office Hours: Tuesdays, 12pm – 5pm (KHS 301B), or by appointment • Contact info: email@example.com• TAs: o Jenna Brady • firstname.lastname@example.org o Catalina Medina • email@example.com o Adele Pontone • firstname.lastname@example.org
Class Business…• Course Textbook o “Health Care in Canada: A Citizen‟s Guide to Policy and Politics” • By Katherine Fierlbeck o Available on Amazon for $25 o It will also be available for free on the Queen‟s E-brary • To register for an ebrary account, go to: http://library.queensu.ca/research/databases/record/5298
Class Business…• You will need an iClicker o Available for purchase at the Campus Bookstore o Be sure to register your iClicker on Moodle (under “My Clickers”) before next Monday o We will be using it regularly, so always bring it to class
Class Business…• Our Facebook Group: “HLTH 405 – Canadian Health Policy” o Join it to access the Course Syllabus, Schedule, Lecture Slides, Class Announcements o Etiquette: “I like you, but please don‟t friend me.” o Privacy: If you have privacy concerns, check your privacy settings. **Joining the group will not give others access to your profile information, unless they are your friends and/or your settings allow anyone to see your profile.**
Evaluation Schedule• iClicker Quizzes (30%) o Every week, except Week 1 and Week 7 o 10 questions, 10 minutes; Open-book o Quiz will be a review of weekly readings • i.e. if the lecture is about Wait Times, you will be quizzed on readings about Wait Times. o Your 8 best scores out of 10 possible quizzes will determine 30% of your final grade • 2% bonus for attempting every quiz.• Assignment 1: Briefing Note (20% + 0%) o Due Monday Feb 27th (Week 7) o Presentations: Week 7 tutorial (Feb 28th)• Assignment 2: Policy Options Paper (40% + 10%) o Due Monday April 9th (Week “13”) o Presentations: April 3rd tutorial (Week 12)• Participation o Possibility of raising your final mark by one letter grade (e.g. B to B+) o Passion for course material; evidence of preparedness; ability to enhance the educational experience for others
Introduction to Canadian Health Care• Key points on Canadian health care o Intergovernmental relations are defined by fiscal federalism • Health care system is the domain of the provinces/territories • The Federal Government lends fiscal support ($) o The Canada Health Act (1984) sets out rules and a national „minimum standard‟ for provincial/territorial insurance plans• The result is 13 public single-payer insurance schemes that are distinct but similar. o Together, these provincial/territorial plans pay for ~70% of health care costs incurred in Canada (Marchildon, 2005).
Fiscal Federalism• The 1867 Constitution did not specify what level of government has constitutional authority over the health care system. • It did state that the federal government was responsible for maintaining „Peace, Order and Good Governance‟ (POGG).• Roles of the Federation and Provinces have thus been clarified through a series of court rulings. o Judicial interpretation of POGG: Federal government is responsible for… • 1) food, pharmaceutical, consumer product, and health technology regulations and standards (Health Canada) • 2) the maintenance of a national health information database (CIHI) • 3) public health and infectious disease surveillance (PHAC) o Court decisions by the Judicial Committee of the Privy Council set precedents that gradually cemented the autonomy of the provinces in the administration and organization of the health care system.
Fiscal Federalism• The Federal Government has a largely fiscal role, due to its spending power o Health accords are negotiated every 10 years to determine its financial contribution to the provinces o Has historically included cash transfers and/or giving provinces „tax room‟ o The 2004 Health Accord under Paul Martin built in an annual 6% escalator in the Canada Health Transfer ($)• CHT funds from the Feds are contingent on provinces adhering to the Canada Health Act o The CHA sets out a few general rules o Maintains a national „minimum standard‟ of medically necessary services that must be insured under provincial health insurance plans
The Canada Health Act (1984)• Latest in a series of legal statutes affecting health care funding in Canada• Preceded by the Hospital Insurance and Diagnostic Services Act (1957) o a formal 50/50 cost-sharing agreement between Feds and Provinces for hospital care. o HIDS Act was the first to set out the 5 criteria found in the CHA.
The Canada Health Act (1984) Under Premier Woodrow Lloyd, Saskatchewan takes advantage of its influx of HIDS funds to begin insuring physician services too (1962). Physicians are livid; they strike for 3 weeks. But Lloyd‟s idea catches on; the Medical Care Act (1968) is passed • Amends cost-sharing agreement between Feds and Provinces to include non-hospital physician services • Maintains that 5 criteria be met for the receipt of federal $$$
The Canada Health Act (1984)• But physicians soon find a way to increase their earnings beyond provincial reimbursement rates o Extra-billing: Additional service charges tacked onto provincial reimbursement claims by physicians, in an effort to recoup what they were previously earning under the higher rates paid out in their provincial medical association fee schedule. o User fees: Charging patients for the difference between the new provincial reimbursement rates and the old provincial medical association fee schedule.• In 1984, the Canada Medicare Act is amended to address these practices and include 2 more provisions. It is renamed the Canada Health Act.
The Canada Health Act (1984)• In total, the Canada Health Act contains o 5 program criteria (S.8-12) • Public Administration • Comprehensiveness • Universality • Portability • Accessibility o 2 conditions (S.13) • Formal recognition is given to the Federal Government in all health publications • The federal Health Minister has a right to provincial health system information o 2 provisions banning extra-billing and user fees for publicly-insured services (S.20)
The Canada Health Act (1984)• Despite the recommendations of the Hall Report to expand the list of insured services in Canada, to include… o Pharmaceutical drug coverage o Prosthetic services o Home care o Eye care o Dental care for children and welfare recipients… “Comprehensiveness” in the CHA continues to refer only to “medically necessary services” provided in hospitals or by physicians. It is “narrow but deep” coverage,• In all fairness, Canada was in a mountain of debt by 1984. Trudeau had to resign as PM before the CHA was even passed!
“Narrow but Deep” Insurance Coverage • All “Medically necessary” services (diagnostic imaging, treatments, pharmaceuticals, hotel costs) provided in a hospital.• All “Medically necessary” services provided by a physician.
“Narrow but Deep” Insurance Coverage• This leaves many essential health goods and services uninsured (i.e. “privatized”) o Pharmaceutical drugs o Medical devices o Outpatient services not provided by a physician • Eye care • Dental care • Physiotherapy • Home care o List goes on and on!
“Similar but Distinct”• Therefore, provincial plans typically insure many additional services beyond their CHA-mandated coverage.• Some municipalities will also work with regional health care providers to subsidize specific health services.
“Similar but Distinct”• In Ontario, for example, OHIP will offer selective coverage for: o Ambulatory Services • Partial subsidy (patients are billed a copayment fee of $45, compared to $500-$1000 for basic ambulatory life support services in U.S. jurisdictions). o Pharmaceuticals • Ontario Drug Benefit offers complete drug subsidy for ODSP recipients and seniors; partial subsidy of catastrophic drug costs for every Ontarian; special outpatient coverage of pharmaceutical costs for specific conditions. o Dental • Complete subsidy of select services (e.g. check-ups, basic cleaning) for youth, seniors, and ODSP recipients. o Eye Care • Complete subsidy of select services (e.g. check-ups) for youth, seniors, ODSP recipients, and individuals with diagnosed eye conditions.
Recap• Important concepts to understand: o Fiscal Federalism o Health Accords o The 5 Criteria of the Canada Health Act • what do they refer to? o What „narrow but deep‟ Medicare coverage refers to• Food for Thought: How do these concepts relate to the following news stories: “A Canada With No Health Accord? Provinces Grapple With The Possibilities” http://ca.news.yahoo.com/canada-no-health-accord-provinces-grapple-possibilities-164300843.html “Seniors Prefer Hospitals Over Long-Term Care Homes” http://www.cbc.ca/news/canada/windsor/story/2012/01/05/wdr-long-term-care-beds.html• Fill-in-the-blank: o Who is Tommy Douglas and what was his role in Canadian health care?