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HLTC43H3 (51)
Scott Sams (15)
Lecture 6

HLTC43 Lecture 6.pdf

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Health Studies
Scott Sams

HLTC43 Lecture 6 Wednesday, June 12, 2013 10:00 AM Cue Column: Note-Taking Area: Admin stuff: • No class next week (reading week) ○ Work on assignment • Do the midterm course evaluation ○ BONUS POINT IF YOU DO THIS!! ○ Do this by next week (earlier the better) Canadian Medicare Purpose: To outline the development and realities of publicly funded universal health insurance in Canada. Lessons from today’s class: 1. Financial and political arrangements influence how and how well the system works. • How HC is delivered 2. The Canadian health care “system” is more like a collection of independent provincial systems. • Really not a system; collection of 12 provincial systems 3. Health care expenditures don’t seem to be correlated with outcomes. • Not always the case of if the more you spend, the better the result ○ More spend, more waste Policy shaped by: • Governance ○ Configuration of governance and other actors ○ Cdn system is federal system  Fed gov't & series of prov gov't & municipalities □ Municipalities are created by provincial gov't • Finance ○ No $ for HC, can't get outcome ○ Who has the $?  If prov gov't has all responsibilities but feds get all of the money? □ Allocation is huge problem  Certain gov'ts have easier time raising money Medicare today underpinned by: • Canada Health Act (CHA) ○ Legislation passed by fed gov't (HofC & senate)  HofC sends idea to senate HofC = House of Commons  s.91 and s.92 □ s.91 = fed gov't power s.# = section # □ s.92 = prov gov't power  Residual power □ If something not written, it automatically fed gov't responsibility  Health is shared between provincial and feds • 2004 First Ministers’ Accord on Health Care Renewal ○ 10 year agreement btwn feds & prov responsibility  Health is shared between provincial and feds • 2004 First Ministers’ Accord on Health Care Renewal ○ 10 year agreement btwn feds & prov  How allocate $ for HCS  Overall objectives & priorities  Feds have lots of $ □ Can use $ to get what they want  Called - federal spending power • Provincial decisions on coverage and funding ○ Certain areas each prov gets to decide on  Due to what services covered Canada Health Act • Idea of universal HC was early idea; Mackenzie King (PM) showed interest but did nothing ○ So Tommy Douglas actually brought it  Came thru b/c of depression □ DRs charged patients  T.Douglas said, we'll guarantee DR payment □ DRs accepted • Roots of health insurance ○ Paul Martin Sr. intro'd health insurance plan  Business, med insurance companies, med professions opposed system □ Thought they'd get less paid  Gov't appointed royal commission □ They said it's working very well & expand to  MH, optical for children, dental CMA = Cdn Med Association □ Extra billing: charging extra for what prov sets as rate  As a result, increased barrier to HC MH = mental health ◊ Though didn't pay much, still had to pay something  Eliminated in 1984 with CHA • Primary objective of health care policy
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