HEALTH CARE SYSTEM

IN CANADA

Canada is the second largest country in the world, with a land area of about 10 million km2.

It is a confederation of 10 provinces and 2 territories.

The estimated total population of the country

is about 29.6 million people

OVERVIEW

Publicly funded, privately delivered health care system

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.

The services are administered and delivered by the provincial and territorial (i.e., state or regional) governments, and are provided free of charge

HEALTHCARE SYSTEM

Also assistance from the federal (i.e., national) government in funding

To receive their full allocation of federal funding for health care, the provincial and territorial health insurance plans must meet five criteria:

1. Comprehensiveness, 2. Universality, 3. Portability, 4. Accessibility 5. Public Administration

The provincial and territorial plans must insure all medically necessary services provided by hospitals, medical practitioners and dentists working within a hospital setting.

All insured health services provided by hospitals and medical practitioners be covered by the plan

COMPREHENSIVENESS

The provincial and territorial plans must entitle all insured persons to health insurance coverage on uniform terms and conditions

It should cover 100% of the total insured population

UNIVERSALITY

The provincial and territorial plans must cover all insured persons when they move to another province or territory within Canada and when they travel abroad.

The provinces and territories have some limits on coverage for services provided outside Canada, and may require prior approval for non-emergency services delivered outside their jurisdiction.

PORTIBILITY

The provincial and territorial plans must provide all insured persons reasonable access to medically necessary hospital and physician services without financial or other barriers.

ACESSIBILITY

The provincial and territorial plans must be administered and operated on a non profit basis by a public authority accountable to the provincial or territorial government.

PUBLIC ADMINISTRATION

ORGANIZATIONAL STRUCTURE

OF THE HEALTH CARE SYSTEM

Individuals

Providers:Hospital

sOther

Institutions

Physicians

Other health

professionals

TaxesMunicip

al Governments

Health Services

Provincial

Governments

Taxes

Premiums

Federal Government

TaxesTransfers

Transfers

Employers

Workers’Compensation BoardPrivat

e Insurers

Insured Health Services

Federal Direct Health Expenditures

Taxes Premiums

Premiums Premiums

Health Services

Non Insured Health ServicesPremiums

Non Insured Health Services

Financed primarily through taxation, both provincial and federal, personal and corporate income taxes

Federal funding is transferred to the provinces as a combination of cash contributions and tax points (taxing power).

Public sector funding represents about 72% of total health expenditure. The remaining 28% is financed privately through supplementary insurance, employer-sponsored benefits or directly out-of-pocket.

HEALTH CARE FINANCE AND EXPENDITURE

Most public sector funding comes from central revenue streams.

Some provinces use ancillary funding methods which are nominally targeted for health care, such as sales taxes, payroll levies and lottery proceeds.

BENEFITS:A minimum, medically necessary hospitalMedicare care as provided for under the

Canada Health Act

Approximately 1.6 million people work in health care and social services in Canada, and include a mix of professionals in addition to nurses and physicians.

The health industry is the 3rd largest employer after manufacturing and the retail trade.

HEALTH HUMAN RESOURCE

HEALTH CARE DELIVERY SYSTEM

By general practitioners (GPs) and family physicians

Usually the initial contact with the formal health care system

Control access to most specialists, many allied providers, admissions to hospitals at which they have admitting privileges, diagnostic testing and prescription drug therapy.

Most GPs are private practitioners who work in independent or group practices and enjoy a high degree of autonomy.

PRIMARY HEALTH CARE

Private practitioners are generally paid on a fee-for-service basis and submit their service claims directly to the provincial insurance plan for payment.

Patients are free to choose their own physicians

Use of the emergency room is also their primary access point for health care. This practice is generally discouraged by provincial governments due to the cost of emergency care.

Other healthcare personnel includes:DentistsNursesPharmacists

Primary health care services often includes: Prevention and treatment of common

diseases and injuries; basic emergency services;

Referrals to and coordination with other levels of care , such as hospital and specialist care;

Primary mental health care; palliative and end-of-life care;

Health promotion; Healthy child development; Primary maternity care; Rehabilitation services.

Funded and provided separately from the main components of health care

Administered through local or regional health units

Services range from broad immunization programmes, such as the current programme of providing second-dose measles immunizations, to health programmes that educate identified at risk groups

Perform a role of coordinating or directly providing personal and home care services such as meals-on-wheels programmes, homemaker services, or home nursing care

They are an integral part of community health care.

PUBLIC HEALTH SERVICES

Specialized ambulatory physician care is provided

Specialists control access to other specialists and allied providers, and admissions to hospitals, and prescribe necessary diagnostic testing, treatment and prescription drug therapy.

Specialists are trained and must be certified too

Many specialists maintain private practices and are more likely to have a staff appointment in a hospital or an affiliation with a hospital out-patient clinic.

SECONDARY AND TERTIARY CARE

Institution-based CareLargely focused on

the provision of long-term care and chronic care

Range from residential care facilities to intensive chronic care facilities

Majority of patients are elderly

Services provided outside institutions

Ranges from physician visits, specialized nursing care and homemaker services to meals-on wheels programmes and adult day care.

SOCIAL CARE

Home-based care

Evolutionary change in the health care system during the 1980s and 1990s

Focuses on quality assurance and the role of provinces in reviewing their lists of services provided, ensuring that they are financing high quality services directed towards health gain

There is freedom of choice of primary care providers, while on the level of secondary care there are some limitations as access to specialists and hospitals requires a referral by the primary care provider.

CONCLUSION

Canadian health care system will continue its development through an evolutionary process and that it will be renewed to reflect the new vision of health care

It is increasingly being recognized as one of a broader range of services, providers and delivery sites