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Scott Sams (15)
Lecture 7

HLTC43 Lecture 7.pdf

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Health Studies
Scott Sams

HLTC43 Lecture 7 Wednesday, June 26, 2013 10:00 AM Cue Column: Note-Taking Area: August 12th (Monday) 9-11AM MW170 final exam!!! Federalism and Intergovernmental Relations Purpose: To review the roles and responsibilities of governments in health care and the character of intergovernmental relationships. Lessons from today’s class: 1. Federalism and power sharing leads to blame avoidance and inhibits change. 2. Canada moving toward “open” federalism with implications for unity of the system. Federalism • Supports & also impediment to HC policy • Gives way for feds to give money/funding • Sharing of power btwn more than 1 level of gov't • Prov gov't demands more $ ○ Takes for granted; ○ Start to expect for more money ○ 1980s there were cutbacks(financial crisis)  Feds starting to take back the money □ i.e. giving less $ to prov ○ Gov'ts elected on policies • Constitutional framework / division of powers ○ HC was private matter ○ Provinces had power for HC (s.92)  Constitutionsays hospitalsand asylums  Provinces have power to manage  However feds play a big role - 5 ways: □ Financing  Fed $ allowed for establishment of health programs; & upgrade prov systems □ Research & evaluation  Health institutions; Cdn Institute of Health Research ◊ Is HC adequate □ Health Human Resources & Health Technologies  Cda Health Info Way ◊ Lead development of electronic health records □ Populationhealth  Disease surveillance and prevention ◊ Deal w/ pandemics □ Service delivery  Provide certain care to groups ◊ Ex. Aboriginals, military  BUT, prov makes decisions; Feds have spending power □ Feds can raise a lot more $ thanprov  Residual powers: leftover powers to feds □ Regulate bloodsupply • What about municipalities? ○ Who cares! (haha) ○ s.92 prov and also says municipalsas 'creatures'  Think of them as fancy delivery service of prov gov't □ Mandated by prov ○ Who cares! (haha) ○ s.92 prov and also says municipalsas 'creatures'  Think of them as fancy delivery service of prov gov't □ Mandated by prov ○ [email protected] the bottom  Ambulance □ Prov said they won't pay □ Thus they hand responsibility to municipal ○ But they are responsible for SDoH  Social/publichousingfor ppl less well off  Urban planning  Sustainabletransportation □ TTC  Recreational □ Parks, swimming poolsetc. • Joint decision trap and the evolution of health care ○ "health = hospitals" (prov)  Reality, all 3 levels of gov't play role □ Sometimes play role in same area ○ Joint decision trap  Situation in policymaking, any 1 gov't has ability to veto policy □ Cost shared programs (feds and prov can decide not to fund)==> program can't happenthen  Diff gov't, diff ideologies, diff priorities  Blame avoidance □ Everyone is responsible for something but no one is responsible
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