The document summarizes health care in Canada. It is publicly funded through taxes but privately delivered by organizations like hospitals and doctors. The federal government provides funding to provinces/territories who are responsible for delivering services. Key players include hospitals, doctors, and organizations that set standards or fund research. Current challenges include upcoming funding negotiations and rising costs putting pressure on budgets. The document also provides tips on advocating to politicians and bureaucrats effectively.

1. Health Care in Canada:
Who Does What?
Ryan Clarke
Wednesday, March 27, 2013

2. Overview
• About Advocacy Solutions®
• Overall Structure
• Role of the Federal Government
• Role of the Provincial/Territorial Governments
• Delivery vs. Financing
• Key Players
• Current Challenges
• Advocating to Politicians vs. Bureaucrats

3. Advocacy Solutions®
• Business committed to providing a voice to
organizations and individuals through the
development and implementation of impactful
advocacy strategies
• Three core services:
– Training and development
– Creation of strategic plans
– Implementation of strategies

4. Overall Structure
• In general, health care in Canada is publicly
funded, but privately delivered
• This means that while the vast majority of health
care services are “free” at the point of use, they are
delivered by private providers i.e. physicians
• The provinces are constitutionally responsible for
the administration and delivery of health care
services under s. 92.7 of the Constitution Act, 1867:
– The Establishment, Maintenance, and Management of
Hospitals, Asylums, Charities, and Eleemosynary
(charitable) Institutions in and for the Province, other than
Marine Hospitals

5. Federal Role
• The role of the federal government is to:
– Assist in financing provincial and territorial health
care services through fiscal transfers
– Set standards and principles upon which transfers
are contingent
– Deliver health care services to specific groups
– Provide and fund other health-related functions

6. Canada Health Act, 1984
• The Canada Health Act (1984) is Canada’s
federal health insurance legislation
• It establishes the criteria and conditions related
to insured health care services – the national
standards – which the provinces and territories
must meet in order to receive the full federal
cash transfer contribution
• Historically, insured services are largely
restricted to care delivered in hospitals or by
physicians

7. Canada Health Act, 1984
• The Act states that "the primary objective of
Canadian health care policy is to protect, promote
and restore the physical and mental well-being of
residents of Canada and to facilitate reasonable
access to health services without financial or other
barriers”
• To do so, the Act lists a set of criteria and
conditions that the provinces and territories must
follow to receive their federal transfer payments:
public administration, comprehensiveness,
universality, portability, and accessibility
• There is also a requirement that the provinces
ensure recognition of the federal payments and
provide information to the federal government

8. Provincial/Territorial Role
• Administration of their health insurance plans
• Planning and funding of care in hospitals and
other health facilities
• Services provided by physicians and other
health professionals
• Planning and implementation of health
promotion and public health initiatives
• Negotiation of fee schedules with health
professionals

9. Delivery vs. Financing
• Health care delivery refers to the manner in which
medical services are organized, managed and
provided
• In large measure, health care is delivered through
private providers
• The health care industry is the second largest
employer in Canada (over two million people)
• They can be divided into three types of services:
– Primary care
– Secondary care
– Additional care

10. Delivery vs. Financing
• Health care financing refers to how medical
services are paid for
• In large measure, health care is financed through
public funds, but that is evolving
• Total health care spending in Canada was
expected to reach $207 billion in 2012, averaging
$5,948 per person
• Financing comes from three primary sources:
– Public
– Private
– Out-of-pocket

11. Key Players in Delivery
• Hospitals – representing almost 30% of total health
care expenditures
• While independently operated, all hospitals in
Canada are regulated by the provinces and
territories (even the private ones)
• Drugs – representing almost 16% of total health
care expenditures
• Includes brand and generic, those delivered inside
hospitals (publicly funded) and outside hospitals
(mixed funding)
• Physician services – representing almost 15% of
total health care expenditures

12. Other Key Players
• Canadian Institute of Health Information
– mandate is to lead the development and maintenance of
comprehensive and integrated health information that
enables sound policy and effective health system
management that improve health and health care in
Canada
• Canadian Institutes of Health Research
– mission is to create new scientific knowledge and to enable
its translation into improved health, more effective health
services and products, and a strengthened Canadian
health care system
• Canadian Agency for Drugs and Technologies in
Health
– provides decision-makers with the evidence, analysis,
advice, and recommendations they require to make
informed decisions in health care

13. Other Key Players
• Mental Health Commission of Canada
– a catalyst for improving the mental health system and
changing the attitudes and behaviours of Canadians
around mental health issues
• Canadian Partnership Against Cancer
– an independent organization funded by the federal
government to accelerate action on cancer control for all
Canadians
• Canada Health Infoway
– jointly invests with every province and territory to
accelerate the development and adoption of health
information and communications technology projects in
Canada

14. Other Key Players
• Health Council of Canada
– The Health Council of Canada's role is to let Canadians
and their governments know how progress towards the
vision laid out in the health accords is coming along, to
better enable decision-making at all levels
• Canadian Patient Safety Institute
– provides a coordinating and leadership role across health
sectors and systems, promotes leading practices and
raises awareness with stakeholders, patients and the
general public about patient safety
• Provincial Health Quality Councils
– report directly to on the quality, safety and performance of
health services and the health system in given provinces

15. Other Key Players
• Regional/Local Health Authorities
– provide the delivery of operational public health care
services by geographic region
• Patient/Advocacy Groups
• Patients/Caregivers
• The Public

16. Current Challenges
• On September 16, 2004, the Canadian government
announced $41 billion over the next 10 years of new
federal funding in support of the action plan on health
• That Health Accord expires in 2014 and the current
federal government has indicated they will not negotiate
funding leading up to next year, just measurement,
accountability and best practices
• The funding is set – an increase of six percent in the first
three years, and a minimum of three percent in the
remaining seven years
• In 2011, health care accounted for about 38% of
provincial/territorial government spending: PQ 30.1%,
SK 35.8%, MB 44.3%, ON 46.0%, NS 47.8%

17. Federal/Provincial
Government Structure
Minister: Deputy Minister:
– Political staffers – Hierarchical structure
below
– Serve at the pleasure
of the Crown – People under DM do
not serve at the
– Sole purpose is to
pleasure of the
serve their Minister Crown
and their political
interests – Sole purpose is to
serve the public in an
– Transitory positions
impartial manner
– Permanent positions

18. Advocating to Politicians
• Ensure that your key messages are clear, compelling concise
and consistent – with one ‘ask’
• Assume they know nothing about your issue
• Find out everything you can about that person and their
potential link to your issue
• Where possible, link your issue to their stated political
objectives or public policies i.e. Families First
• Bring your issue down to the riding/personal level
• Position your issue within the context of the election cycle
• Position your issue as a political ‘win’
• Selectively engage the opposition to leverage the gov’t
• Keep them informed of your engagement with the bureaucrats
• Be prepared to be assertive/aggressive if necessary

19. Advocating to Bureaucrats
• Ensure that your key messages are clear, compelling concise
and consistent – with one ‘ask’
• Find out everything you can about that person, including past
roles, career track, etc.
• Where possible, link your issue to gov’t programs and
initiatives i.e. disease strategy
• Have people who can speak to the technical or clinical aspects
of your issue
• Know where you are in the election cycle
• Keep them informed of your engagement with the politicians
• NEVER blindside a bureaucrat

20. Advocacy Solutions®
Contact Information:
Ryan Clarke, LL.B.
t. 905.891.0311
f. 905.891.0366
ryan@advocacysolutions.ca
www.advocacysolutions.ca