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By: Ileana BotezMaria FosterMila Ivanova

1PME 160 Presentation

Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate.

These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis.


19th century

-In 1834, William Kelly, a surgeon with the Royal Navy, introduced the idea of preventing the spread of disease via sanitation measures following epidemics of cholera.

Around 1892, a movement began that called for the improved health care for the poor, focusing mainly on sanitation and hygiene. This period saw important advancesincluding the provision of safe drinking water to most of thepopulation, public baths and beaches, and municipalgarbage services to remove waste from the city.


20th century

The early 20th century saw the first widespread construction of government run hospitals, mainly asylums for the mentally ill and Sanatoriums for those suffering from tuberculosis. The idea of a national health insurance system had considerable popularity.

During the Great Depression calls for a public health system were widespread.


The beginning of coverage

It was not until 1946 that the first Canadian provinceintroduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government.


In 1946, government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population.

In 1950, Alberta created a program similar to Saskatchewan's. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services.

The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act.


By 1961, all ten provinces had agreed to start HIDS Act programs. Premier Woodrow Lloyd introduced the law in 1962. The federal government, introduced the Medical Care

Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan. It also set up the Medicare system.

In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed that they are committed to health care that has"comprehensiveness, universality, portability, public administration and accessibility."


Canada's publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health insurance plans. Known to Canadians as "medicare", the system provides access to universal, comprehensive coverage for medically necessary hospital and physician services.

At the provincial level, there are also several much smaller health programs alongside Medicare.

The largest group the federal government is directly responsible for is First Nations.

The largest of these is the health care costs paid by the worker's compensation system.

The various levels of government pay for about 70% of Canadians' health care;

Despite being a provincial responsibility, the large health costs have long been partially funded by the federal government.

~ 30% of Canadians' health care paid through private sector. Services not covered: prescription drugs, dentistry and optometry;

~ 65% of Canadians - private health insurance (via employers)

The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises.

Doctors receive a fee per visit/service; The Canada Health Act of 1984 "does not

directly bar private delivery or private insurance for publicly insured services”.

Canada, like its North American neighbour the United States, has a level of practising physicians that is well below the OECD average;

Level of practicing nurses is higher than either the U.S. or the OECD average;

Family physicians in Canada make an average of $202,000 a year (gross, 2006). AB has the highest average salary of around $230,000, while Que has the lowest average annual salary at $165,000;

Interprovincial competition for doctors and local shortages;

In 1991, the Ontario Medical Association (OMA) agreed to become a province-wide closed shop, making the OMA union a monopoly;

In September 2008, the OMA and the ON government agreed to a new four-year contract that will see doctors receive a 12.25% pay raise. The new agreement is expected to cost Ontarians an extra 1 billion;

December 2008, the Society of Obstetricians and Gynaecologists of Canada reported a critical shortage of obstetricians and gynaecologists.

Each province regulates its medical profession through a self-governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members;

The national doctors association is called the Canadian Medical Association (CMA); Mission: "To serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care”;

StatisticsHealth expenditures

are expected to be 10.7% of the Gross domestic product. Hospitals account for the largest segment in spending at

$48.1 billion, however, this amount is declining.

Doctors against new system:1962-most of the province’s doctors responded by going on strike to protest against “creeping socialism”. It was not supported by public

Fraser institute: 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks

5% of Canadian citizens have not been able to find a regular doctor, with a further 9% having never looked for one


Health Minister Tony Clement said in August 2006 that patients should expect to receive treatment for procedures within an acceptable time. If this does not happen, he said, the patient would be able to seek "recourse."

Medical tourism-one of the reasons- long waiting time

Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand, Belgium, Poland and Singapore are now entering the field

South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.


CBC news: a woman from Alberta with a back problem was supposed to wait three years for corrective surgery, she went to India and later received reimbursement from the Government

Federal government supported health care providing one third of the money on Health Care

In 1990 increased budget deficit forced the government to cut the money transferred to provinces what, in turn, caused wait time increase

Criticisms during the administration of H1N1 shots in 2009 including Hamilton and Toronto.


Since 2002, the Canadian government has invested $5.5 billion to decrease wait times

On ministers conference on Health Care in 2004 was decided to infuse into the system 41 billion over 10 years

In April 2007, Stephen Harper announced that all ten

provinces and three territories would establish patient wait times guarantees by 2010

National wait time strategy was developed


Radiation therapy to treat cancer within four weeks of patients being ready to treat.

Hip fracture treatment within 48 hours. Hip replacements within 26 weeks. Knee replacements within 26 weeks. Surgery to remove cataracts within 16 weeks for patients who are at

high risk. Breast cancer screening for women ages 50 to 69 every two years. Cervical cancer screening for women 18 to 69 every three years

after two normal tests. Cardiac bypass patients will get treatment within two weeks to 26

weeks, depending on the severity of the case.


Canada is anticipating various experiments combining

public and private care. Such efforts aim to reduce patients' waiting times

A lot of doctors believe that significant reform is needed and that part of that reform should be looking at alternative systems

Canada Health Act of 1984 does not directly bar private delivery or private insurance for publicly insured services

Although there are laws prohibiting private health care in some provinces, they can be changed


If the system goes private people with money will no longer want to pay the taxes required to provide quality health care for everybody

They will want to shift the cost from government to patients, employers, and third-party payers. Once that is done, the competitive advantage of Canada's single-payer public health care system will be lost


Brian Day, orthopaedic surgeon from Vancouver, predicts that in five years Canada will still have universal health care, but with a small private component — perhaps 5 to 10% of core services, as compared with about 1% now.

Jack Layton (NDP) in his speech to defence Canadian healthcare said:

“If you face a medical emergency -- you get the help you need. An admitting nurse doesn't check your credit card -- she checks your pulse”


Sixty years ago Canadians families shouldered their own medical bills. Those with the money got the care they needed, but those without struggled -- they sold their farms, mortgaged their homes, or went without care, suffered, and even died

Our system does have flaws. We need better prescription drug coverage, better remote access to care and better practices in hospitals and clinics. No honest advocate for our health care system would dismiss these things. But Canadian health care works -- and works well


Canadians strongly support the health system's public rather than for-profit private basis

A 2009 poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada.


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PME 160 Presentation 25

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