Expanding health care coverage in Canada: a dramatic shift in the debate (original) (raw)
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The Challenge of Defining Medicare Coverage in Canada
SSRN Electronic Journal, 2013
There is a widespread impression among Canadians that their health-care system is universal, comprehensive and equitable. Given this impression, Canadians may be surprised to discover that, for instance, while annual physicals and receiving advice on dealing with cold symptoms are covered by the public plan, the costs of rehabilitation from a brain injury or stroke are not fully covered. While universal, the public plan is not comprehensive nor, arguably, is it equitable. The Canada Health Act (CHA) uses the term "medically necessary" to define medical procedures and treatments to be paid for by the publicly-funded medicare system. In Canada's health-care system, the term has come to refer almost exclusively to those services provided by a physician, or provided within a hospital setting, by a physician or other staff. Services that a reasonable person might consider "necessary," but are provided outside those settings, are typically not covered. In many ways the federally-legislated Canada Health Act has been culturally enshrined as a consecrated icon of national identity. But the legislation fails to clearly identify the line between necessary and unnecessary medical services. This has put provincial governments-who are responsible for medical-funding decisions-in the difficult position of having to make this decision, and they have resorted to drawing that line in sometimes surprising places. The line drawn between "necessary" and "unnecessary" medical treatments has been determined by the financial self-interest of medical stakeholders, by hospitals rationing global budgets, and by financially-constrained provincial governments. The result is a relatively narrow definition of medical necessity that undermines the equality goals the CHA is often claimed to uphold. Health care is arguably the most important public-expenditure program in Canada. It is important for Canadians to understand clearly what services and levels of care this program provides so that they can prepare for, and possibly insure against, outcomes that are not covered. We do not argue it is easy to make this demarcation between what is and what is not covered by medicare. We do argue, however, that it is necessary to establish this line and to draw attention to its position. † The authors wish to acknowledge the helpful comments of the anonymous referees.
The Three Dimensions of Universal Medicare in Canada
Canadian Public Administration, Vol. 57, no.3, pp. 362-382, 2014
The history of Canadian Medicare is reviewed to demonstrate the extent to which non-universal alternatives almost became the norm in Canada. While this historical survey focuses on the most critical dimension of universal coverage – the drive to have all Canadians insured on the same terms and conditions – it also addresses the second and third dimensions of universality, the extent of user fees and the breadth of coverage, respectively. However, that there is no single national narrative on health coverage, in part because of the highly decentralized nature of the Canadian health system. Ultimately, public-sector health system coverage is a policy decision taken at the sub-national level by the provincial rather than the federal government.
Canadian Medical Association Journal, 2020
A s the coronavirus disease 2019 (COVID-19) epidemic continues in Canada and financial pressures mount on all levels of government, the federal-provincial/territorial cost-sharing framework for universal publicly financed coverage of physician and hospital services-commonly referred to as Medicare-has once again become a point of contention. In September 2020, just days before a federal Speech from the Throne, Canada's provincial and territorial premiers called for the federal government to become "a full funding partner" in health care spending, raising its contribution to provincial and territorial health spending from 22% to 35%, an increase of $28 billion per annum. 1 Yet, to the expressed disappointment of the premiers, 2 the Throne Speech offered no increases in federal funding for health. Instead it reiterated the Government of Canada's previous commitment to "a national, universal pharmacare program" and set out some steps toward that goal. Although Medicare remains one of the social programs that Canadians value most highly, its stability, and any potential expansion of Medicare services, such as pharmacare, depends on a robust federal-provincial/territorial cost-sharing framework. Yet, the conflicting perspectives of different levels of government pose major challenges to any expansion of public coverage or pursuit of national health care reforms. We review the history of federal-provincial/territorial bargaining that led to the current Medicare system and consider what constitutes a fair deal in the current climate, drawing on a variety of print and online sources (Appendix 1, available at www.cmaj.ca/lookup/ doi/10.1503/cmaj.200143/tab-related-content) as well as the firsthand observations of 2 of the authors starting in the 1980s. What is the history of Medicare bargaining in Canada? Nothing in the 1867 Canadian constitution anticipated national health insurance programs. The constitution instead assigns authority for oversight and delivery of health care services to provinces and territories. Hence, provinces moved at different speeds to implement public coverage of health care, with Saskatchewan pioneering universal hospital insurance in 1947 and universal medical services insurance in 1962. This constitutional reality means that Canada has 13 somewhat distinctive provincial or territorial health care systems. Those systems have much in common, however, given shared fiscal and legislative DNA arising from a series of agreements that, since the late 1950s, have set out terms and conditions for sharing of specified costs between the Government of Canada and provinces and territories.
Canada's universal health-care system: achieving its potential
Lancet (London, England), 2018
Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants...
Funding of Universal Health Care Coverage: Is it still possible in next Future: Canada Example
DergiPark (Istanbul University), 2022
After the coronavirus disease 2019 (COVID-19) outbreak takes its course in World, financial pressure mounts on all levels of government across the country, cost-sharing of medical and hospital care covered by the public plan health insurance has once again become a very big conflict. Following the Canadian constitution in 1867, the door is opened to a national health insurance plan. Succeeding document indicates that the monitoring and delivery of health services is a provincial and territorial responsibility. The provinces have therefore, at different rates, implemented their own public health insurance plans. Government of Saskatchewan got the ball rolling, establishing a provincial universal public hospital insurance plan in 1947 and a provincial universal health insurance plan in 1962. Due to its constitutional reality, the country has 13 relatively distinct health care systems, one for each province and territory. However, these systems have much in common, as they draw their fiscal and legislative origins from the same series of agreements which, since the late 1950s, have defined the terms of cost sharing between the Government of Canada and the provincial governments. and territorial. This article analyze historical federal government cost shares shows a difference of about 20billionincurrentfundingdependingonwhethertaxpointstransferredin1977areconsidered,andresultsrangingfromasurplusofsome20 billion in current funding depending on whether tax points transferred in 1977 are considered, and results ranging from a surplus of some 20billionincurrentfundingdependingonwhethertaxpointstransferredin1977areconsidered,andresultsrangingfromasurplusofsome15 billion to a deficit of some $23 billion if only the transfer payment is observed.
Health Systems in Transition, Vol. 15, no. 1, pp. 1-179, 2013
Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.
Canadian medicare: historical reflections, future directions
Health Economics, Policy and Law, 2018
This special volume is a reflection by scholars from across Canada and around the world on Canadian medicare. Our goal was to marry history (and historical scholars) with policy (and policy scholars) to reflect on how history can help us better understand present policy problems in Canadian medicare. Many readers will be familiar with Winston Churchill's adage that 'those who fail to learn from history are doomed to repeat it'. Philosophers, writers, thinkers and academics have opined for centuries on the need for a fulsome understanding of history. Churchill also feared that erasing the past would lead to 'the most thoughtless of ages. Every day headlines and short views'(National Churchill Museum, 2012). In other words, blindness to the past hinders innovation and progress and propagates, at best, an inadequate status quo. This special edition of the Journal of Health Economics Policy & Law has been supported by Associated Medical Services (AMS), which, for more than 40 years, has advanced the assessment and use of knowledge, especially historical knowledge, to understand and improve health care in Canada. AMS' (2017) first priority upon becoming a charity in 1976 was to support scholarly work in the history of medicine. AMS (2017) created five History of Medicine Chairs in the 1970s and, in 2015, introduced the History of Medicine and Healthcare Post-Doctoral Fellowship and the Hannah Chair in the History of Aboriginal Health at the Northern Ontario School of Medicine. In celebration of its 80th anniversary, AMS hosted a conference in Toronto in May 2017 that focused on