The chapter begins with describing Canada’s health-care system as a jumble of confusion that sometimes contains conflict elements and practice. For example doctors work on a fee-for service base and are similar to business persons however business owners differ as they are not paid directly by those whom they provide service nor can they can determine what they can charge. Doctors get the benefit from the provincial government as they are reimbursed for the bills they submit. Health- care system is embraced in Canada and is part of the public system, as critics refer the public health-care system as “socialized medicine”. Only one-third of the total health-care expenditure falls outside the public sector. Those expenditures that are not covered by the public sector are most prescription drugs, dental services, vision correction and most physiotherapy.

Those with insurance health-care plan either have it with private plan such as their employers and those who do not have the plan pay on their own. Health care is a provincial jurisdiction and indeed Ottawa the federal Government plays a significant role in providing expenditure and setting some of the rules, delivering some services to groups for example, such as aboriginal community living on reserves and those in the military. One of the losses that Canada suffers from is the loss of doctors , nurses to the U.S however to substitute the losses Canada welcomed trained physicians from other countries. The Canadian population often complain about the health-care system yet the majority claim to be satisfied with their personal experiences with the treatment they received. Health spending is the single most spending of the provincial government expenditure. In the 1970’s the expenditure spending was one-quarter now its 40 percent today. Some of the issues raised in Canadian politics are the long waiting periods for elective surgery procedures ,overcrowded emergency rooms, lack of general practitioners and specialists in many communities as doctors and nurses leave Canada and move to U.S, hospital closing and restructuring has been a routine.

In addition Canadians believe there is a problem with their health-care system and some the dilemmas examine that confront policy makers in the health-care field are: 1.Is lack of money the main problem facing the health-care system 2.How does Canada health care system compare to those other countries in terms of performance and citizen satisfaction 3. In what way does the health-care system reflect the values of Canadian? The chapter provides where in the constitution is assigned as provincial jurisdiction in making laws in health-care, which is section 92 subjection 7 that states that the establishment, maintenance, and management of hospitals, asylum, charities and Eleemosynary institutions in and for the province, other than marine hospitals. Historically, at the time of confederation 1867 Canadian government spent very little on health-care. The position of minister of health did not become common at the provincial level until the 1880s and the provincial boards were created as well with the federal having the existence of such board in 1919 with the dominion department of health establishment. In the 1960s all Canadian provinces had hospital insurance plans in place. Public insurance for doctors services and diagnostic and therapeutic procedures began in Saskatchewan in 1962 and extended across Canada in 1972. Medicare is defined as Ottawa’s willingness even eagerness to help finance nation-wide public health-care system. The certification of doctors, nurses, therapists and other health-care workers has always combined a combination of provincial regulation and self-regulation by practitioner s themselves for example provincial medical associations determines the licensing that doctors must meet in order to practice in a particular province. Most doctors income are not set by the Government the exception is the minority that work for salary for public health board r public-sector agency however doctors are influenced by the fact the provincial regulations determine the fees that doctor may charge in addition doctors may charge patients more than the billable amount without penalty. With nurses excluding those who work for private organization such as the Victorian Order of Nurses and the Red cross the conditions of employment are established under collective agreement with provincial government.

Mid wives are long recognized and regulated by the state in many European countries , midwives are now licensed in many Canadian provinces. Ottawa has legislation that indirectly affect the conditions of health-care professions , the Canada health act 1984 penalizes provinces that allow doctors to bill their patients above what the provinces schedule of billable services permits. Ottawa’s authority in welcoming immigrants that are of health-care professions in regions that have short supplies of employees. The federal statues affects Canada health-care system are the medical act 1966, Canada health act 1984. The Medicare act states 4 principles: 1. Provincial health insurance plans must be administered and operated on a non profit basis by a public authority 2. They must provide universal and equal access to health services for all insurable residents of the province 3. Provincial health insurance plans must be comprehensive, covering all necessary procedures and services 4. Coverage must be portable , so that the people do not lose their health-care benefits when temporarily absent from their home province The chapter states that the meaning of these principles are not self-evident for example the term extra- billing was the ambiguity associated with these principles and became a problem in the late 1970s where a number of physicians began to charge their patients a fee on top of the amount paid by provincial health insurance plans five principles of the Canadian act are: 1.Public administration 2.Comprehensiveness

3.Universality
4.Portability
5.Accessibility
Ottawa has played a major role in financing of health-care services since the 1960s,paying as much as 41 percent of provincial health-care cost. Years of milestone development of Medicare: 1947-Public hospitalization introduced in Saskatchewan 1957-Ottawa commits to 50/50 cost-sharing for provincial hospitalization insurance 1962-Sasketchewan government extends universal 1964-Royal commission on health care recommends publicly funded 1966-Ottawa introduces the Medicare act 1968-72- All ten provinces and two territories sign on to Medicare agreeing to provide universal public coverage for hospitals and physician care with federal providing cost of services 1977-Ottawa charges its funding agreement , replacement cost-sharing with block funding :establishment programs financing 1984-Ottawa passes the Canada Health Act 1995-EPF transfers are replaced with Canada Health and Social Transfer which provinces are free to determine what portion of the CHST transfer devote to health The charter of rights and freedom within health care; former deputy minister of finance Stanley Hartt and a law professor Patrick Monahan argue that the charter provides a constitutional challenge towards the public-sector monopoly on the provision of health care related services and procedures where delays in treatment have become such that they violate the charter (s.7) guarantee of the individuals life, liberty and security of the persons and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

Financial picture health care is expensive it is estimated that total public and private spending on health care in Canada in 2006 was approximately $148 billion. The access to health care services report from January to June are that the waiting times remain the number one barrier for Canadians. The data shows from 2003 and 2005 most individuals reported they received care within three months and the median waiting time was about for weeks for visits to specialists, four weeks for nonemergency surgery and three weeks for diagnostic tests. There has been an inflation over the past years as per capital public-sector spending on health care has increased 12-fold over the last generation from about $401 per person in 1976 to about 3,200 per person in 2006. The fastest growing component s of health care spending are increasing cost of drugs, drug therapies, and diagnostic and other medical technology. figure 7.1 demonstrates that total public spending has increased throughout the years, Figure 7.2 demonstrates how federal direct transfers increased throughout the years however total public spending of the federal has declined over the years while the provinces share has increased.

The chapter than follows on telling us our political leaders state that our health care system is the envy of the world and in addition the truth is the rest of the world knows little to nothing about health care in Canada. Canada spending on health care is measured whether per capita or as a percentage of the gross domestic product it ranks near the top internationally. United states is the highest spender on health followed a few western Europe countries and Canada in seventh place. Spending on health care consists for example coverage for dental services is universal in Germany but limited to a small minority in Canada, drug prices, how services are delivered, the pay levels of doctors and other health care practitioners and the age of distribution of the population. In addition the author states that spending on health care does not mean a healthier population as United states and Germany would have the longest expectancies and lower infant rates mortality that they do not have. United states has the most private spending than public spending on health care. Canada has fewer physician per capita than many countries as about two per 1,000 compared to three in France and Germany and about six in Italy. In addition drug prices are lower in Canada than many countries. The public satisfaction with health care in Canada believe that 56 percent said that fundamental changes were need but the system has some good things in 1988 however in 2005 it dropped to 22 percent. Reasons for the problem of health-care system is Canada is lack of money in 2000 Jean Chrétien was targeted by other political party leaders for having starved the underfunded Medicare. Two of the health care economist Robert Evans and Greg Stoddart had been funded but the system needs to be restructured in order to perform more efficiently. Measuring performance and determining accountability can be seen for example when people diagnosed with breast or prostate cancer must wait two months before receiving radiation treatment allowing time for their cancer to spread, we know that things are not working as we would wish on the other hand when an organ transplant saves someone’s life we are likely to think this is how we expect our health system to perform. The problem of measuring health care in Canada was acknowledge by the commission on the future health of Canada.

Canada lagged behind both with respect to systematic performance measurement partly because some in the system resisted this sort of evaluation and partly because political will was lacking to require hospitals to collect and make publicly available information that could be interpreted as an indication of substandard performance. One change was in 2003 when first ministries agreed on action plan to improve access to timely care across Canada and one of the steps was to measure and address waiting times. Posting wait times on internet sites is a positive step towards giving citizens they information they need and ensuring accountability on the system and those who pay for it. The author than defines outcome-oriented performance indicators as relatively few cases in which high volumes of reasonably similar procedures are performed in a variety of centers. Input oriented performance indicators is defined as those in the system such as number of practitioners with specific qualifications in a given area, the rate of diagnostic tests and similar measures from which probable health outcomes may be inferred. Lastly the author discusses on prevention versus curative care as for decades studies have confirmed that the key drivers of health quality are related to life style, the quality of the environment including public sanitation, access immunization against contagious diseases and the availability of antibiotics. As disease prevention and the improvement of conditions that may lead to illness have been goals of public policy since the nineteenth century. For example when ships carrying immigrants to Canada were required to land in Sable Island so that new arrivals could be checked for tuberculosis and cholera and if necessary treated as this was a public health measure. With these public health measures the Canadian society made improvements in diet and a stronger immune system for increasing share of the population. Affluence has also meant less crowded housing, reducing stress and violence as communicable disease. With the definition of curative care practitioners, hospitals, sophisticated medical technology, the latest drugs the amount of money spent on prevention is small yet health care experts agree that health care return on each dollar invested preventative measures is comparatively high. This raises a question why the health system or public policy is not oriented to the prevention of illness there is two parts of the answer , the life style built around personal automobile, high energy consumption, waste, and stress can’t be eliminated as the societies have values and interest.

Second , transfer of resources from existing procedures will have to change for example, government spending of $80billion annually on health care an addition of $1 billion for public education may not be significant. However more coercive measures such as automatic licence suspensions for persons exceeding legal blood-alcohol limits and bans on smoking in public places are more likely to deliver health results. The author last statement has a broader agenda to improve health as a positive action the greatest threats to life expectancy is unemployment, substance abuse, native poverty and disintegration ,obesity hunger, poor eating habits , adolescent suicides, AIDS. Solving these issues can be focus as investing our health as a nation and if we direct our spending and follow it up with the right legislation, we can improve health where it is really decided in order to shift the goal from cure to prevention. Questions 1.Do you think the health-care system in Canada is genuine in terms of services provided by doctors , yes or no and why? 2. As discuss in the chapter the major barrier in the health-care system in Canada is waiting times in emergency rooms, what other barriers can you identify through your own personal experiences and why would you claim it as a barrier?

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