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    Health CarePublic health care in Canada -Medicare

    Sociology 210

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    Canadian Health Care - How did we get here?

    Universal government health insurance widely regardedas triumph of postwar Canadian state

    Estimated 47 million Americans have no health-carecoverage (1/5 population)

    many more have inadequate coverage In U.S., health-care costs = leading cause of personal

    bankruptcy most with health insurance, get through job

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    Canadian Doctors for Medicare

    Co-founder: Dr. Robert Woolard

    As a doctor, I know the value of our public healthcare system. Everyday, I see patients getting the

    care they need regardless of their ability to pay.

    And I know that without Medicare, Canadians wouldhave to worry about whether they could afford to

    get care when theyre sick or injured. http://www.canadiandoctorsformedicare.ca/ -

    www.canadiandoctorsformedicare.ca/

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    Canadian Health Care - How did we get here?

    Post World War II: Conditions in Canada popular demand for public health care

    good economic timespositive experiences of governmentintervention during & after the war political will on part of individuals &governments

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    Political Will

    One of most famous individuals = Tommy Douglas, Premierof Saskatchewan, 1944 As child, infection in leg. Would have lost leg if caredepended on familys ability to pay.

    Doctor offers services, using young Tommy to illustrate anew technique.

    Douglas decides health care must not be dependent oncharity or accident (i.e. doctor offering aid without pay)http://www.cbc.ca/archives/categories/arts-entertainment/media/media-general/and-the-

    greatest-canadian-of-all-time-is.html - http://www.cbc.ca/archives/categories/arts-entertainment/media/media-general/and-the-greatest-canadian-of-all-time-is.html

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    1947: his social-democratic government introduces1st public hospital insurance plan in Canada

    Becomes model for public-health care system Opponents: fear government intervention + loss of

    private controlHospitals: mainly owned/operated by non-profit/charitable or religious organizations.

    Often financially troubled patients unable topay for hospital services

    Across Canada, see growing demands fromindividuals, organizations & regional governmentsto follow Saskatchewan

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    Resistance from certain provinces - fear federalgovernment interference

    Health care primarily a provincial responsibility(first under British North America Act, thenCanada Act, 1982) 1950s: Despite opposition from wealthier provinces(Ontario, Quebec, Alberta, B.C.), federalgovernment proceeds

    1957: introduces national hospital insurance planOffers to pay 1/2 hospital operating costs ifprovinces agree to certain basic principles

    Provinces agree

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    Late 1950s: Douglas proposes doctors get a paidsalary from the governmentMany doctors not amused - some strike, some

    continue to work long tradition of private,independent practice1962: Saskatchewan legislation - Doctors continuein private practice, with fees paid by governmentDoctors: public payment for private practice, witheveryone covered for doctor care

    Next step = Doctors

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    At Federal level: Progressive Conservative PrimeMinister, John DiefenbakerGives in to doctors pressures

    Calls for Royal Commission to search foralternatives to universal public health care

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    1964-5: Report of the Royal Commission on

    Health Services

    Recommend single payment system argue: everyone covered for doctor care +

    full range of health services

    Cover allservices - from hospitals tolong-term care & home care, drugs,doctors, nurses, dentists + preventativeprograms

    Argued would increase efficiency &effectiveness

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    Federal proposal:provide universal insurance to cover physician

    care

    1966: Liberal Prime Minister Lester Pearson - only

    adopts recommendation on doctors - assumed willmove on to other services later Medical Care Act becomes law - many doctorsprotest - over next few years provinces decide

    whether to support 1972: All provinces pass legislation

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    5 Principles of Canada Health Act (1983)

    Universality

    Accessability Comprehensiveness Portability Public Administration

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    Universality

    Everyone in province (except tourists, visitors,transients) must be covered for public healthinsurance under same terms & conditions.

    Care defined as a right

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    Accessibility

    Services must be similar for everyone. Must be reasonable access to health care

    Must be unimpeded by financial or otherbarriers

    Doctors cannot extra-bill, hospitals cannotimpose user-fees or charge patients foressential services

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    Comprehensiveness

    All medically necessary services guaranteed Means: those associated with medical practitioners,

    dentists performing required services in hospitals,and hospitals - not all health services

    For hospital care: Everything needed for care inhospital must be provided without charge (even

    private rooms if medically necessary) Doctors decide what medically necessary.

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    Portability

    Can take health insurance from province toprovince - also from job to job

    If visiting another province, get sick, homeinsurance must pay for care, and pay at ratein other provinceWhen move, take health insurance with youfor 3 months, until other provincial healthcoverage in place

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    Public Administration

    Health insurance plan of each province/

    territory be publicly administered

    Administered by non-profit agency -responsible to government

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    The Present:

    The profitizationof Canadas Health Care System

    Must position the politics of medicareinperiod where mounting pressures to

    dismantle post-war Canadian statePublic health care being undermined

    erosion of 5 principles of Canada HealthActmassive hemorrhaging of programs/services outsideof public coverage

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    Massive health-care reforms:Medicare remains, but gets hollowed outNeo-liberal governments in Canada shifting locusof care outside hospitals & doctors offices

    Therefore, outside the rules and universalentitlements of medicareImportant - doing reforms this way, avoids intensepolitical debates that would follow direct assaultson medicareConcern about potential conflict between privateprofits & public interest

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    Privatization is not a cure Pat Armstrong

    Chapter focusses on women as health careusersand providers

    Argues: Fundamental transformations inCanadas public health care systemundermining:

    Womens access to health care

    Womens work in health care sector

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    Privatization of Health Care

    Refers to different policy initiatives: Limit role of public sector Define health as private responsibility

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    From the Welfare State to the Managerial State:Building for Sale

    Privatizing Costs Privatization through Deinstitutionalization Privatization through For-profit delivery Privatization through Management Privatization through Home Care

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    Privatizing Costs

    Services cut back Increased various forms of private payment Delist certain services (eg: eye exams) Redefine hospital care (short term stays)

    acute care Move people from hospitals -> long term care

    facilities & home care (where fees can becharged

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    Privatization through Deinstitutionalization

    1990s key part of health care reform: Shift from institutional -> home &

    community-based care

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    Privatization through For-profit delivery

    Canada now has for-profit laboratories, for-profit cataract surgery, for-profit dialysis,

    for-profit cancer care, for-profit home care

    All justified as compensating for inadequaciesin the system

    Inadequacies created by governmentcutbacks

    Consequences for womens access to healthcare & wages in sector


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