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British North America Act of 1867 - correct answer ✔✔led to the creation of Canada as a
nation, the provincial and federal governments divided responsibilities for maintaining the
health of Canadians; the provinces and territories would oversee public health (including
hospitals), while the federal government would manage public policy aspects of health (such as
pharmaceutical safety, data collection, and health research) as well as health services for
Indigenous peoples
1947 - Tommy Douglas - correct answer ✔✔Premier of Saskatchewan Tommy Douglas
introduced the first mandatory universal hospital insurance plan in North America, with general
revenues (and later a provincial sales tax) as the funding source; the rest of Canada would
receive universal health coverage two decades later
Canadian Federal and Provincial/Territorial Jurisdictional Differences - correct answer
✔✔Federal Jurisdiction
Financing through transfer payment arrangements
Enforcing relevant Acts and legislative documents, especially the Canada Health Act
Co-delivery or delivery of health services to target groups
Establishing and enacting national agendas in core areas such as consumer health and safety,
pharmaceuticals, public health, and health research
Provincial/Territorial Jurisdiction
Financing and managing health services as specified in the Canada Health Act
Arranging for payments or co-payments for services as specified in the Canada Health Act or
relevant legislation
Developing and implementing the health care insurance plan for their jurisdiction
,Canada Health Act - correct answer ✔✔rooted in five guiding principles: Portability
- Mobility between provinces or territories (as well as outside of Canada in the short term) is
not to be a deterrent to receiving insured health service benefits (some conditions apply)
Universality
- All insured residents (regardless of age, gender, ethnicity, income) receive the same health
service benefits
Accessibility
- Reasonable access to insured health services by all insured residents
Comprehensiveness
- No out-of-pocket charges (i.e., copayment or deductible) for all insured benefits (medically
necessary) provided in hospital and through physician services, health services, and dental
services in hospital
Public
Administration
- Administration on a nonprofit basis by a public authority (such as a regional health authority)
Under the Canada Health Act, the federal government is obligated to "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"
Kirby Report and Romanow (2002) - correct answer ✔✔Both national reports contained
recommendations to increase funding to stabilize and sustain the system, as well to increase the
accountability of the federal government to honour the Act while preserving Medicare.
Conversely, the authors of the Alberta report were highly critical of the status quo, suggesting
that a private-public model (two-tiered) was essential to meeting the needs of all Canadians.
Although contradictory in approach, the synergy in the messages was clear: the health care
system needed to be reimagined and restructured if it was to meet the needs of Canadians.
,Major Commissions and Reports on the Canadian Health System - correct answer ✔✔Royal
Commission on Health Services (Hall Commission), 1964
Comprehensive health coverage for all Canadians
Strengthened national policy on health care and health financing
Health Services Review, 1980
Reviewed post-1964 commission changes
Determine status of extra-billing and user fee compliance
Royal Commission on Aboriginal Peoples, 1996Representative training of health care providers
Standing Senate Committee on Social Affairs, Science, and Technology Study on the State of the
Health Care System in Canada (Kirby Committee), 2002
Increased federal government oversight of all dimensions of health care
Advanced need for equity in human resources and health service across geographies
Commission on the Future of Health Care in Canada (Romanow Commission), 2002Renewal of
commitment to philosophical values of equity and a single-payer health care system
Truth and Reconciliation Commission of Canada, 2015Establish a comprehensive response to
abuses experienced by Indigenous peoples throughout the era of residential schools (see
additional discussion later in this chapter)
Advisory Panel on Healthcare Innovation, 2015Imperative for a health care system that uses
modern technologies and leads on innovations to improve patient outcomes
Canada's health care system is highly decentralized - correct answer ✔✔each province and
territory retains significant latitude in the provision and allocation of selected services but
ascribes to a common set of financing principles. This decentralization has, in part, enabled
, physicians to act as independent contractors who remain somewhat at arm's length from the
system
Canadians are inherently resistant to privatization - correct answer ✔✔which is frequently
mentioned in times of recession or shortfalls (such as waitlists for surgeries). Private clinics exist
and are growing for the provision of some services, especially fertility, surgical, and diagnostic
services. The argument around private clinics has many dimensions, including whether these
private clinics save time, money, or both; whether they create a two-tiered system; whether
competition actually leads to quality and efficiency; and whether there is a risk of prioritizing
profit over people (Government of British Columbia, 2007). Recently, there has also been much
discussion regarding the cost of universal health coverage and its long-term sustainability
(Kondro, 2010).
health care expenditures - correct answer ✔✔involve costs for both the funder (i.e., through
taxes) and the user (e.g., prescription drugs or dental care). In Canada, these combined
expenditures have long neared or exceeded double-digit percentages of Canada's gross
domestic product (GDP; the total value of goods and services produced in a country in a year).
Canada's health care expenditures were estimated to be 11.6% of the GDP in 2019, up from
10.4% in 2018, with over $264 billion being invested by governments and citizens directly
(through personal payments and private insurance)
health care expenditures considerations - correct answer ✔✔The first layer contains the
Medicare "bundle," which includes publicly financed hospital care and physician services.
Although this layer is available to most Canadians, some individuals fall outside the legal
mandate (see previous discussion); other individuals who cannot access these services are
subgroups of refugees and temporary residents with expired permits. The second layer contains
a range of packages of health services, such as ambulance services, extended care, and
pharmacare; these services are often co-paid or cost shared through public and private funding
(CIHI, 2019). In 2017, the amount Canadians spent on pharmaceuticals alone was $860 US
dollars per capita at the household level (OECD, 2019b). Finally, the third layer consists of
services that are predominantly or entirely privately funded, such as physiotherapy, chiropody,
private duty nursing, and vision care (Marchildon, 2013).
This three-tiered model is highly reliant on individuals having access to sufficient financial
resources or adequate private insurance to offset the real costs in layers two and three. Yet,
nearly one-third of Canadians lack a private insurance plan (similar to the proportion of