Week 2: A primer on Canadas health care 'system'

Question 1

What is the constitution act, 1867? (who was the law passed by?, what does it specify?)

Answer 1

Law passed by the british parliament that created Canada (on indigenous lands)
As a union, the law specifies the responsibilities of the national (federal) government and the provinces and territories

Question 2

What exclusive powers does the law set out of provinces (Sections)

Answer 2

Section 92 (a): “the establishment, maintenance, and management of hospitals, asylums, charities, and eleemosynary institutions in and for the province, other than marine hospitals”

92 (16): “generally all matters of a merely local or private nature in the province.”

Subsequent court decisions have interpreted these clauses as placing most of health care under provincial jurisdiction

Question 3

Federalism

Answer 3

divides authority among different levels of government, and intentionally restricts the powers of the central government.”

Question 4

What type of government does Canada fall under

Answer 4

Federal

Question 5

True or False: Canada does not give a lot of power to the provinces and territories?

Answer 5

False…it DOES

Question 6

Why does Canada not and cannot have a national health care system?

Answer 6

because constitutional responsibility for health care largely rests at the provincial/ territorial level

Question 7

Implication

Answer 7

who can and cannot make health policy in Canada

Question 8

What can we think of policy as?

Answer 8

Decisions taken by those with responsibility for a given policy area

Question 9

Briefly explain the examples of assisted reproductive technology, safe injection sites and medical assistance in dying

Answer 9

???

Question 10

Canada Health Act

Answer 10

• Sets out the primary objective of canadian health care policy: “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”
• overarching policy that covers everyone
  -Establishes criteria and conditions related to insure health services and extended healthcare services that the provinces and territories must fulfill to receive the full federal cash contribution under the canada health transfer.

Question 11

True or False the Canada health act is a direct consequence pf federalism

Answer 11

True

Question 12

What are the 5 conditions the provincial health insurance plans must meet when delivering healthcare to receive Canada health transfer. Explain each of them

Answer 12

• Comprehensiveness: provincial insurance plans must insure (ex. ohip) (ie., financially cover) all “insured health services” provided by physicians or within hospitals (must be deemed medically necessary to be covered) (medically necessary not in canada health act so it’s up to provinces/ insurance)

Universality: provincial insurance plans must cover 100% of insured health services for all insured persons under uniform terms and conditions

Accessibility: provincial insurance plans must provide insured health services in a manner that is “reasonably accessible” to all insured persons (e.g., no user charges or extra billing/fees)
Must also provide reasonable compensation to its health professionals

Portability: requires certain coverage for insured residents when temporarily out of province, and specifies the waiting period before a resident moving to a new province/ territory is eligible for insured healths services (can’t exceed 3 months) (also applies to US, can bill ohip for what ohip would bill u for if those medical services were done in ontario)
If not available in ontario you can apply to ohip and go do it in the us or whatever where its available because “its medically necessary)

Public Administration: provincial insurance plans must be administered and operated on a non-profit basis by a public authority (e.g., OHIP- Ontario Health Insurance Plan)

Question 13

If taken together what do the conditions in the canada health act ensure

Answer 13

Universal health coverage or health care

Question 14

What is Ontario health insurance plan (OHIP)

Answer 14

-Government-run health insurance plan for Ontario
-Pays for a wide range of health services by funding hospitals, by reimbursing physicians for their services, etc.

Question 15

What is OHIP funded from

Answer 15

taxes paid by Ontario residents and businesses, as well as from ‘transfer payments’ by the government of Canada

Question 16

Canada Health transfer

Answer 16

The transfer of cash from the federal government to provincial/ territorial governments

Question 17

How much was transferred in 202-2021

Answer 17

42$ billion

Question 18

What basis is the transfer made on

Answer 18

equal per capita basis

Question 20

True or false: funds have been withheld for violations of the canada health act

Answer 20

True

Question 21

Where can the witholds be found

Answer 21

in canada health act annual reports

Question 22

Patient charge

Answer 22

if an enrolled physician or dentist charges an insured resident for an insured service

Question 23

Extra billing

Answer 23

An amount in addition to the amount paid by the provincial or territorial health insurance plan

Question 24

User chargers

Answer 24

Other charges (e.g., for supplies) related to the provision of insured health services

Question 25

What are the key features of Canada health act, 198

Answer 25

-Free at the point of care
-Provision of healthcare based on need, not ability to pay
-Provinces are able to fund health care beyond the requirements of the Canada Health Act if they choose

Question 26

Health Policy implications

Answer 26

-Variation in coverage exists between provinces/territories
-Canadians can be charged for things like dental care in dentists’ offices, nursing homes, ambulances, etc., but provinces/territories could choose to insure these
-If non-physician care shifts from hospitals to clinics or the community, these services are no longer required to be insured even if they are considered medically necessary (e.g., outpatient pharmaceuticals, rehab, home care, optometry, etc. )
-These uncovered services are paid for via private insurance (e.g., through an employer) or out of pocket

Question 27

Health care financing can be

Answer 27

public
private
out of pocket

Question 28

Roughly how much of canada’s expenditures (e.g., paying for hospitals and physician services, etc.) are paid from public sources (e.g., taxes?)

Answer 28

70.9 % of total health expenditures are publicly sourced (2018)

Question 29

True or False: Ontario physicians cannot simultaneously practice in both the public and private sectors

Answer 29

True

Question 30

True or False: Ontario allows private insurance to cover services that are publicly funded

Answer 30

False; they prohibit

Question 31

True or false: Ontario physicians may opt-out of the public plan (i.e., OHIP), but if they do, they are prohibited from charging fees greater than the amounts payable under the public plan

Answer 31

True

Question 32

True or False: Health care delivery can be public, private, not-for profit and private for-profit

Answer 32

True

Question 33

True or False: Canada has a “public-contract model”

Answer 33

True

Question 34

Single-payer healthcare system

Answer 34

-health care costs of essential healthcare covered by a single public system
-not government run healthcare
-delivered privately the government is only involved in financing

Question 35

Federal responsibilities for health care

Answer 35

-First nations populations living on reserves

-Inuit populations

-Serving members of the canadian forces

-Eligible veterans

-Inmates in federal penitentiaries

-Some groups of refugee claimants

-Health protection and regulation (e.g., regulation of pharmaceuticals, food and medical devices), consumer safety, and disease surveillance and prevention

Question 36

What are the branches of canadian government and explain them

Answer 36

Legislative-made up of elected officials who make up the house of commons, and appointed senators who make up the senate
-make laws

Judiciary- made up of judges (appointed), interprets laws

Executive- sets policy directions and implements laws and programs, leader:prime minister, broken down into ministries (ministry of health/ health canada), each ministry has a political leader (elected) and a ‘civil service’ leader, ministers (among others) form a group called the ‘cabinet’, cabinets change when governments change; civil service does not

Question 37

What is a civil service person

Answer 37

bureaucrat

Question 38

Ontario health

Answer 38

A ‘super agency’ established in 2019 whose mandate is “to implement the health system strategies developed by the ministry of health” and manage health service needs across ontario…” (among other things)

Question 39

What is absorbed in Ontario Health

Answer 39

-Cancer care ontario
-Ehealth ontario
-Trillium gift of life network
-Health quality ontario
-Healthforceontario
-Ontario telemedicine network
-Health shared services ontario
1-4 local health integration networks (LHINs) / home and community care support services

Question 40

Ontario health teams

Answer 40

voluntary collaborations between health service providers, intended to integrate services of a regional population
(n=57)

Question 41

How many Ontario health regions

Answer 41

6

Question 42

how many public health units and are they changing

Answer 42

34 and yes

Question 43

public health units

Answer 43

Provide disease prevention and health promotion programs to all members of their community, e.g., sexual health clinics, vaccinations, addictions, etc.
-federal government, provincial governments

Question 44

Ontario health regions was formerly ____

Answer 44

local Health integration networks (n=14)

Question 45

What are Ontario health teams and regions responsible for

Answer 45

-regional “infrastructure” for the majority of ontario’s health care system
-responsible for the local planning of health services