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HLTA02H3 (135)
Chapter 2

Chapter 2 - HLTB03

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University of Toronto Scarborough
Health Studies
Michelle Silver

Health, Illness, and Health Care in Canada CHAPTER 2: HEALTH CARE AND HEALTH REFORMS – TRENDS AND ISSUES Introduction: - Medicare: system of universal, accessible, comprehensive and portable medical and hospital care insurance, publicly administered on a non-profit basis o Most popular government program o Source of great pride because it is seen as central element of our national identity (more caring and compassionate) o Source of perpetual public concern because we worry as taxpayers, about the cost of medicare and whether it is financially sustainable and if it is draining away from other public resources (post-secondary, social services) - ‘cost- containment’ and ‘cost transfer’ have been implemented for possible solutions but are seen as a part of the problem rather than a solution o Cost transfer initiative are 2 main types: first involves directly transferring costs from public sector in a private sector – marketization o Second, indirect cost transfer strategy, involves having family, friends, and community organizations provide uncompensated care to individuals in need – downloading - Other main dimension of perpetual crisis is whether medicare has the capacity to satisfy existing and emerging health care need of Canadian o Epidemiological shift taking place (aging of population, changing lifestyles, and climate) - Also lack of transparency and accountability of health care policy makers, system managers, and service providers Medicare: Origins and Contradictions - By the 1940’s, failure of market to ensure adequate access to necessary medical and hospital care generated renewed interest in a system of public insurance and was important because wartime military recruitment efforts revealed that an alarmingly high number of people were too sick for military/industrial service which resulted in the establishment of the health insurance after the second world war o In 1945, federal government introduced draft legislation for a universal, comprehensive, publicly financed and administered hospital and doctor services plan  Key features: establishment of health regions, patient registration with physicians, a capitation mode of payment, financial incentives for physicians to adopt preventative approaches - this proposed legislation was not enacted - In 1962, Saskatchewan government introduced the country’s first publicly financed and administered medical insurance system o First step occurred in 1948 with the introduction of Hospital Construction Grants Program o By 1972, all provinces had signed on and medicare was a reality o 1984 Canada Health Act: there are 13 provincial and territorial medical care and hospitalization insurance systems all of which receive federal government resources and all of which are loosely structured by the framework of medicare principles - Main contradictions of medicare were related to the cost sharing formula under the terms of the 1966 arrangement and the federal government had no control over its health care expenditures o It also discouraged experimentation with alternative forms of non-physician and non- hospital community based health care (because they were ineligible for federal funds) - The 1977 Federal –Provincial Arrangements and Established Programs Financing Act (EPF) was the first substantial revision of health insurance cost sharing arrangements and had a number of effects: o Reduced federal government’s share of the cost of medicare from 50 to 25% o Uncoupled federal costs from provincial expenditures o Limited growth in direct federal government increases to the rate of growth of the gross national product (GNP) o Provided $20/capita incentive for provinces to put
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