The document provides an overview of Canada's healthcare system, outlining that responsibilities are divided between the federal, provincial, and territorial governments, with the provinces administering plans and delivering services while the federal government sets national standards and provides funding. Key aspects of the system include universal public coverage for essential services, private delivery of care, and both public and private sources of financing.

1. Who Does What in
Canada’s Healthcare
System
Thursday, February 18, 2021
1:00 PM to 2:00 PM
Presented by Ryan Clarke, LL.B.
founder of Advocacy Solutions
ryan@advocacysolutions.ca

2. Agenda
• Welcome & introductions
• Webinar outcomes
• Five common myths about Canada’s healthcare systems
• Key healthcare statistics
• Government overview
• Structure – governance and coverage
• Federal (CHA)/provincial/territorial/national roles
• Delivery vs. financing
• Q&A
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3. Webinar Outcomes
3
Attendees will be provided with an overview of the
structure of our healthcare systems
People will be taken through a review of the Canada
Health Act
Everyone will have a better understanding of the
intersection between delivery vs. financing in
healthcare

4. Five Common Myths About Canada’s
Healthcare Systems
• Myth #1: People often refer to the
“Canadian healthcare system” in
the singular.
• Reality: Instead of having a single
national plan, we have 13 provincial
and territorial healthcare insurance
plans. In addition, the federal
government has responsibility for
delivering healthcare services to
some defined groups i.e. First
Nations and Veterans.
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5. Five Common Myths About Canada’s
Healthcare Systems
• Myth #2: The Canadian healthcare system is a
“single payer” system.
• Reality: Canada does not have a true “single
payer” system; rather a significant portion of
Canadian healthcare comes from both public
(Medicare) and private financing. For example,
most Canadians have to pay for eye and dental
care out-of-pocket, or through private insurance.
The Canada Health Act also does not cover
prescription drugs; it is estimated that more
than 60% of prescription medications are paid
for privately in Canada.
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6. Five Common Myths About Canada’s
Healthcare Systems
• Myth #3: Healthcare services are provided
equally across the country.
• Reality: The Canada Health Act mandates
healthcare to be universal and accessible for
essential physician and hospital health
services across the country. However, the
details of how each system operates,
including what is covered by public
insurance and how, is determined
provincially/territorially.
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7. Five Common Myths About Canada’s
Healthcare Systems
• Myth #4: The Canadian healthcare system is
“socialized medicine” where physicians are
government employees.
• Reality: Canada has a publicly funded healthcare
system, but physicians are self-employed, not
government employees. Physicians earn money by
billing their provincial/territorial governments for the
services they provide to patients. Physicians can
determine their own hours and work location, and
they are responsible for paying their employees, for
office space and other overhead expenses.
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8. Five Common Myths About Canada’s
Healthcare Systems
• Myth #5: There are long waits for care, which
compromise access to care.
• Reality: There are no waits for urgent or
primary care in Canada. There are usually
reasonable waits for most specialists’ care and
much longer waits for elective surgery. It is
also important to note that wait times can vary
across the country.
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9. 9

10. Source: Canadian Institute for Health
Information.

11. 11
Notes
^ 2019 revised preliminary estimate.
OHS: Other Health Spending includes a new broader definition of home and community care spending. Publicly
funded home and community care expenditures by provincial and territorial governments in Canada are
estimated at about $10 billion for 2018–2019.
Source
National Health Expenditure Database, Canadian Institute for Health Information.

12. 12

13. 13
Source: National Health Expenditure Database, Canadian Institute for Health Information.

14. Governments in Canada
• Canada is a federal state, parliamentary
democracy and constitutional monarchy
• A federal state brings together a number of
different political communities with a central
government (federal) for national matters and
separate local governments
(provincial/territorial) for local affairs
• As a parliamentary democracy, we elect
members to our parliament and legislatures
across the country
• As a constitutional monarchy, Canada’s head
of state is a hereditary sovereign (queen or
king), who reigns in accordance with the
constitution

15. Three Levels of Government
• Canadian governments function within a three-level
system: federal, provincial/territorial and municipal/local
• Each level has its own arrangement of elected and
appointed officials, as well as a unique set of
responsibilities
• Only the federal and provincial levels are enshrined in the
Constitution Act, 1982 – municipal/local governments are a
creation of the provinces

16. Three Branches of Government - Federal
• Monarch: Includes the Queen’s representative (the Governor General) and
sits atop the three branches
• Legislative Branch: Creates statutes under federal jurisdiction. The
legislative branch is made up of:
– elected representatives called Members of Parliament (MPs) who sit in the
House of Commons
– appointed regional representatives who sit in the Senate
• Executive Branch: Responsible for government operations, and
implementing and enforcing laws. Includes the prime minister and cabinet
ministers (appointed by the prime minister).
• Judicial Branch: Interprets the law and determines the penalty for those
who violate established laws, rules and regulations. Includes the federal
court system, which is headed by the Supreme Court and nine appointed
judges.

17. Three Branches of Government - Provincial
• Monarch: Includes the Queen’s representative (the Lieutenant Governor)
and sits atop the three branches
• Legislative Branch: Creates statutes under provincial jurisdiction. The
legislative branch is made up of provincial elected representatives called
Members of Provincial Parliament (MPPs) in Ontario.
• Executive Branch: Responsible for government operations, and
implementing and enforcing laws. Includes the Queen’s representative
(the Lieutenant Governor), cabinet ministers (headed up by the Premier)
and the body of professional civil servants.
• Judicial Branch: Interprets the law and determines the penalty for those
who violate established laws, rules and regulations. Includes the provincial
court system.

18. Our Constitution
• There are three main parts to the written
component of our constitution
– The Constitution Act, 1982. This describes the
authority, parts, and functions of parliament.
– The Charter of Rights and Freedoms. This
describes the basic rights and freedoms all
Canadians have.
– The Amending Formula. This sets out ways
that the constitution can be changed.
• When they chose a federal form of government,
the Canadian Fathers of Confederation assigned
particular responsibilities to the federal and
provincial governments (outlined in sections 91–
95, Constitution Act, 1867)

19. Sections 91-95
• When they chose a federal form of
government, the Canadian Fathers of
Confederation assigned particular
responsibilities to the federal and provincial
governments (outlined in sections 91–95,
Constitution Act, 1867)
• This division of powers is based on the idea of
subsidiarity, meaning that the government
level closest to the issue governs it

20. Section 91 – Federal Powers
• The Public Debt and Property.
• The Regulation of Trade and Commerce.
• Unemployment insurance.
• The raising of Money by any Mode or System of
Taxation.
• The borrowing of Money on the Public Credit.
• Postal Service.
• The Census and Statistics.
• Militia, Military and Naval Service, and Defence.
• The fixing of and providing for the Salaries and
Allowances of Civil and other Officers of the
Government of Canada.
• Beacons, Buoys, Lighthouses, and Sable Island.
• Navigation and Shipping.
• s. 91.11 - Quarantine and the Establishment and
Maintenance of Marine Hospitals.
• Sea Coast and Inland Fisheries.
• Ferries between a Province and any British or
Foreign Country or between Two Provinces.
• Currency and Coinage.
• Banking, Incorporation of Banks, and the Issue
of Paper Money.
• Savings Banks.
• Weights and Measures.
• Bills of Exchange and Promissory Notes.
• Interest.
• Legal Tender.
• Bankruptcy and Insolvency.
• Patents of Invention and Discovery.
• Copyrights.
• Indians, and Lands reserved for the Indians.
• Naturalization and Aliens.
• Marriage and Divorce.
• The Criminal Law, except the Constitution of
Courts of Criminal Jurisdiction, but including the
Procedure in Criminal Matters.
• The Establishment, Maintenance, and
Management of Penitentiaries.

21. Section 92 – Provincial Powers
• Education
• Direct Taxation within the Province in order
to the raising of a Revenue for Provincial
Purposes.
• The borrowing of Money on the sole Credit
of the Province.
• The Establishment and Tenure of Provincial
Offices and the Appointment and Payment of
Provincial Officers.
• The Management and Sale of the Public
Lands belonging to the Province and of the
Timber and Wood thereon.
• The Establishment, Maintenance, and
Management of Public and Reformatory
Prisons in and for the Province.
• s. 92.7 - The Establishment, Maintenance,
and Management of Hospitals, Asylums,
Charities, and Eleemosynary Institutions in
and for the Province, other than Marine
Hospitals.
• Municipal Institutions in the Province.
• Shop, Saloon, Tavern, Auctioneer, and other
Licences in order to the raising of a Revenue
for Provincial, Local, or Municipal Purposes.
• Local Works and Undertakings…
• The Incorporation of Companies with
Provincial Objects.
• The Solemnization of Marriage in the
Province.
• Property and Civil Rights in the Province.
• The Administration of Justice in the Province,
including the Constitution, Maintenance, and
Organization of Provincial Courts, both of
Civil and of Criminal Jurisdiction, and
including Procedure in Civil Matters in those
Courts.
• The Imposition of Punishment by Fine,
Penalty, or Imprisonment for enforcing any
Law of the Province made in relation to any
Matter coming within any of the Classes of
Subjects enumerated in this Section.
• Generally all Matters of a merely local or
private Nature in the Province.

22. Apart from s. 91.11 and s. 92.7
• The structure of health and health care in Canada also rests
in part on more indirect sources of constitutional power.
• The provinces have exclusive jurisdiction for the direct
delivery of most medical services through:
– The powers over property and civil rights (s. 92.13)
– Matters of a merely local or private nature (s. 92.16)
• The federal government has jurisdiction over:
– Drugs and food through the criminal law power clause
(s. 91.27)
– Financial contributions to the national medicare system
through the public debt and property clause (s. 91.1A)
and its general taxing power (s. 91.3)
– National health emergency potentially through the
peace, order and good government power (s. 91)

23. Overall Structure
• In general, healthcare in Canada is publicly funded, but privately
delivered
• This means that while the vast majority of healthcare services are
“free” at the point of use, they are delivered by private providers i.e.
physicians
• Both administration and service delivery are highly decentralized
• Administration is a mix of public/private
• There are significant inequities within the systems, most notably
amongst Indigenous populations and some vulnerable groups

24. Overall Structure – Governance

25. Overall Structure – Coverage

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

27. Health Canada
• Health Canada is the department of the government of Canada with
responsibility for national public health, headed up by the Federal
Minister of Health.
• Health Canada is responsible for helping Canadians maintain and
improve their health. It ensures that high-quality health services are
accessible and works to reduce health risks.
• Health Canada is a federal institution that is part of the health
portfolio which also includes:
– The Canadian Food Inspection Agency – Prevents and mitigates risks to
food safety in collaboration and partnership with industry, consumers,
and federal, provincial and municipal organizations.
– Canadian Institutes of Health Research – Federal agency for health
research. Its objective is to create new knowledge that can be translated
into improved health for Canadians, more effective health services and
products and a strengthened health care system.
– Patented Medicine Prices Review Board – A quasi-judicial body that
protects consumers and contributes to health care by ensuring that the
manufacturers' prices of patented medicines are not excessive.
– Public Health Agency of Canada – In partnership with others, its activities
focus on preventing disease and injuries, promoting good physical and
mental health, and providing information to support informed decision
making.
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28. 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 healthcare 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.

29. Canada Health Act, 1984
• The Act states that "the primary objective of
Canadian healthcare 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.

30. Canada Health Act, 1984
Public administration
The health insurance plans must be "administered and operated on a non-profit basis by a public authority,
responsible to the provincial/territorial governments and subject to audits of their accounts and financial
transactions.”
Comprehensiveness
The health care insurance plans must cover "all insured health services provided by hospitals, medical
practitioners or dentists”. The provinces are allowed, but not required, to insure additional services.
Universality
All insured persons must be covered for insured health services "provided for by the plan on uniform terms and
conditions”.
Portability
“Residents moving from one province or territory to another must continue to be covered for insured health
care services by the "home" province during any minimum waiting period, not to exceed three months,
imposed by the new province of residence. After the waiting period, the new province or territory of residence
assumes health care coverage.”
Accessibility
Finally, the insurance plan must provide for "reasonable access" to insured services by insured persons, "on
uniform terms and conditions, unprecluded, unimpeded, either directly or indirectly, by charges (user charges
or extra-billing) or other means (age, health status or financial circumstances)”.

31. 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.
Ontario legislature
BC legislature

32. Delivery vs. Financing
• Healthcare delivery refers to the
manner in which medical services are
organized, managed and provided.
• In large measure, healthcare is
delivered through private providers
• The healthcare industry is the second
largest employer in Canada (over two
million people).
• They can be divided into three types
of services:
– Public
– Mixed
– Private

33. Key Players in Delivery
• Hospitals – representing 26.4% of total healthcare
expenditures. While independently operated, all
hospitals in Canada are regulated by the provinces
and territories (even the private ones).
• Physician services – representing 14.9% of total
healthcare expenditures.
• Prescription Drugs – representing 13% of total
healthcare expenditures. Includes brand and generic,
those delivered inside hospitals (publicly funded) and
outside hospitals (mixed funding).

34. Key Players in Delivery

35. Delivery vs. Financing
• Healthcare financing refers to how
medical services are paid for.
• In large measure, healthcare is
financed through public funds, but
that is evolving.
• Financing comes from three primary
sources:
– Public
– Private
– Out-of-pocket

36. National Roles
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 healthcare.
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 healthcare in Canada.
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.

37. Canadian Cancer Survivor Network
Contact Info
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Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
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