Executive Summary
The healthcare system in Canada (also known as Medicare) is a publically-structured and funded arrangement. Canada’s healthcare system allows for Canadian residents to have equal access to care and physician services across the entire country. Essentially, the system is a made up of groups of “socialized” health insurance plans that provide coverage for all Canadian citizens. These plans are administered on a provincial or territorial basis within standards that the Federal Government has outlined.
Canada as a country is among some of the highest spenders when it comes to Universal Healthcare; We are ranked third on an economic percentage and 11th on a per-person basis to be exact (National Post.) There seems to be a lot of controversy over the efficiency and effectiveness of the system as a whole. Over many years, patients have had to bear with lengthy wait times trying to see a doctor or even in the emergency room, the number of physician available country-wide is on the lower end of the spectrum and we fall short in some areas such as Acute Care. This is hurting people more than doing them any good, Canada should have to upper-hand when it comes to healthcare worldwide because everyone has access, but for some reason the country falls short. Aside from this, Canada’s overall health is on a high-rise, “[we] keep our people healthy and out of the hospital.” Canada also shines in breast cancer research and patients who get sent to the hospital from a heart attack have a higher survival rate.
This essay analyzes and sheds light on the current system in place today and some of the current issues, challenges, strategies and even touches on Mixed Systems as well as the popular topic of Privatization. We as Canadians care deeply about healthcare and there is a general consensus that pumping more money into the system will not solve the problems we have at hand.
Introduction
In Canada, we have a publically funded health care system called Medicare. Within the system, there are thirteen Provincial and Territorial health care insurance plans spread across the country. These healthcare insurance plans are funded by taxpayers through the Federal Government. The government is responsible for both setting and administering national standards for the healthcare system in Canada through the Canadian Health Act. The Act was adopted in 1984 and it focuses on five main areas; Public Administration, Comprehensiveness, Universality, Portability, Accessibility.
The purpose of the Act is “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 and other barriers.” This premise of the Act is to ensure that all Canadians have access to medically necessary hospital and physician services without having to pay large amounts of money out of pocket.
Past Development Trends
Prior to the Health Care Act of 1984, there were a series of national grants that were designed to create funding structures for hospital construction and professional training. But after that, it was the responsibility of the provinces to manage and fund their own systems. According to Boychuk, the development of the current structure was “highly tenuous and contingent.” It was developed during a time when “powerful political currents…provided a central dynamic in favour of the development of a national system of medical insurance,” (Boychuk.) The system was brought in to replace a failing system that was strife with debt.
Where Healthcare in Canada is Today
Current Issues and Challenges
For quite some time Canada has been among the most expensive universal-access healthcare systems in the world. Surprisingly, for so much money being put toward our system, performance is said to be “modest to poor,” (Barusa, Hasan and Timmermans, iii.) A recent study conducted in July 2017 showed that Canada ranked ninth among eleven of the world’s most “affluent” countries in healthcare. The study was grouped into five distinct categories; Care Process, Access, Administrative, Efficiency and Equity, and Health Care Outcomes. The country-specific scores revealed and recognized the prevalence of chronic conditions, emphasized long wait times in emergency rooms and to see a specialist, poor availability for after-hour care and a lack of reliable coverage for things such as dental work and many prescription drugs (Scotti.) Generally speaking, the arrangement of healthcare can be looked at amid four broad categories, those being; the availability of resources, the use of resources, the access of resources and overall clinical performance and quality (Barusa, Hasan and Timmermans, 1.)
The availability of medical resources is obviously considered to be the most basic requirement for healthcare. Without medical resources, not much can be done. When it comes to “inputs” in the healthcare system, human and capital resources play the most important roles. These human capitals include physicians and different health personnel such as nurses who are directly involved with patient care. In addition to this, standards are not met unless capital resources are present as well. Capital resources meaning the hospitals or care centers themselves, patient beds and equipment. It is also proposed that medical technology and diagnostic imaging plays a compelling role for improving the effectiveness and efficiency of Canadian healthcare (Barusa, Hasan and Timmermans, 15.) Medical technologies are said to “…have reduced disease risk factors, long-term complications of related chronic diseases and the need for drugs. They also improve mobility and day-to-day functions and reduced hospital admissions length of stay and indirect costs of caring for patients,” (Esmail and Wrona, 5.) From an international standpoint, Canada ranked among the bottom third of OECD countries in the availability of medical technologies despite being one of the highest spenders (Esmail and Wrona, 14.)
Second, the use of the available resources. Canada may have access to these capabilities but it does not provide information about the use of them. An observation was made by Figueras, Saltman, Busse and Duboise who noted that “the number of units provides no information about the efficiency with which they are operated,” (Barusa, Hasan and Timmermans, 20.) Canada ranks 8th out of 27 for doctor consultation per 100 population, 29th out of 29th for hospital discharge rates per 100,000 population and 11th out of 25 for MRI exams per thousand population (Barusa, Hasan and Timmermans, 20.) With so much money being circulated in the system and the country ranking higher than the “average high-income OECD country,” these resources should be utilized more effectively and efficiently causing our rankings to go up rather than slip down.
Along with seeing the resources available to us and being able to observe how they are being used, it is useful to measure the accessibility of them directly. Out of ten countries, it was shown that Canada was dead last for the percentage of patients able to make a same-day appointment when sick. It was also found that cost in general was a barrier to access as a whole (Barusa, Hasan and Timmermans, 26.) Accessibility should the number one advantage for Canadian healthcare but the question still lies of why it is not when we rank high in spending.
Lastly, Canada’s clinical performance and quality. When speaking in terms of overall performance and quality, it is broken up into Primary Care, Acute Care, Mental Health Care, Cancer Care and Patient Safety. Despite areas that need improvement and challenges Canada faces in their system, most areas of the performance and quality exceed average scores such as cancer care, where Canada ranks third out of 22 on measuring the rate of 5-year survival after treatment of breast cancer and 9th out of 29 for 30-day mortality after admission in the hospital for AMI in acute care (Barusa, Hasan and Timmermans, 30.)
Stakeholders
The most important stakeholders in Canadian healthcare would be us, the patients. When the system is not performing at its absolute best, patients are the ones who suffer the greatest consequences. Patients are said to be “the subject of much debate concerning healthcare legislation and policies,” (“Stakeholders”, 2009.) As Canadian citizens, we are fortunate enough to have a right to access healthcare and possess a wide-range of knowledge based on personal experiences. That being said, patients possess a lot of knowledge but are still provided with very few opportunities for contributing to policy-making and decision-making of the system for which they pay for (“Stakeholders”, 2009.) As outlined above, wait times in emergency rooms and to see a specialist is a huge problem in Canada’s healthcare system. The wait times themselves are said to be recorded as the longest in history. The Fraser Institute came to a conclusion that, “patients in Canada are waiting longer than ever, and physicians consider such wait times longer than medically reasonable.” A statistic derived from the Fraser Institute Checkup, showed that 30% of Canadians stated they have waited two months or more for an appointment with a specialist and 18% have waited four or more months for an elective surgery. An elective surgery meaning something scheduled in advance such as an Angioplasty. It is possible that with these outrageous wait times and delays, medical conditions could worsen over time putting the patient at risk. People experience this first-hand, but cannot do anything about it because they have such little input on ways to make it better.
Another stakeholder within the system is the government. The government has the power to implement policies and maintain them as time goes on. Each province and territory in the country is responsible for their own health agencies. These agencies create legislation, policies and programs for administering health insurance plans and effectively delivering services to all Canadians and ensure they have full access to them (“Stakeholders”, 2009.)
Strategies
At the present time, there are no strategies that Canada intends to implement in the near future to “fix” our system or make it any better, or worse for that matter. According to the Government of Canada, current keys areas of concern include; “promoting good health, strengthening healthcare and providing relevant health information.” Health Canada aims to, “develop and implement policies intended to maintain and improve the health of Canadians.” Listed on the website, there are different topics that Canada has currently been working on, improving or has created a permanent policy and/or strategies. Some examples outlined were, Family Violence, First Nations and Inuit Health and HIV/AIDS.
Specific Laws and Regulations
Canada Health Act
According to section 7 in the Canada Health Act; “In order that a province may qualify for a full cash contribution referred to in Section 5, the healthcare insurance plan of the province must, throughout the year satisfy the following… Public Administration, Comprehensiveness, Universality, Portability and Access.” If a province fails to meet any of these criteria, that matter can be forwarded to the Governor in Council and can ultimately result in having their cash contributions from the Federal Government withheld. Sections 8 through 12 of the Act clearly define all of these criteria. The one that was found to be most interesting was the portability criteria. While each province maintains their own provincial health care system, individuals with valid provincial health cards can use those cards to access limited services in other provinces. There are some restrictions to these services, one example of this is if you are using your OHIP card in Alberta, you would be covered for emergency medical care if you went into a hospital, but, not any costs to get you to the hospital, such as ambulatory services.
Future Directions
Privatization
As described above, Canada has had a publically-funded healthcare system for a long time. Publically-funded meaning that, most of the medical situations and hospital visits are dealt with, with little to no cost for patients. Each province is required to have their own health care system meaning that they are all in charge of their own administrative processes and healthcare policies. Privatization is defined as the “transfer of a business, industry or service from public to private ownership and control.” Essentially, it is healthcare and medicine that are provided by entities other than the Government. Privatization has been integrated in healthcare conversation for quite some time as it does bring a lot of benefits to the table, particularly the access to ASAP (as soon as possible) treatment (Formosa Post.) Patients get prioritized by their doctors when they get sick and are able to receive treatments efficiently with high-end technology and effective service. Wait times would not be an issue and the idea of it relieves the overstressed public system without decreasing quality of care for everyone. Along with benefits for privatization, naturally, there are some drawbacks that have an effect on Canadians and their view on their health and well-being. Private insurance policy involves higher costs overall and even the most thoroughly selected private health insurance does not cover all benefits. The person needs to select what is the bigger priority and be almost willing to sacrifice the other (“Top Advantages of Private Canadian Health Care.”) In a recent article on Ontario’s healthcare system, Marc Montgomery outlines that approximately 77% of Ontarians are concerned about Canada’s healthcare system sustainability and that 80% feel as though our country will need to undergo a “broad reform” in order to meet the challenges of changing demographics. He also states that the often-promoted idea of privatization of some services is less costly, is actually false and also believes that increasing private clinics and operations will create a two-tier system; one for the rich and another for the less wealthy. In the end, that will be true. The only people actually receiving effective treatment and being cared for are the ones who are willing to pay for it and the people who cannot afford it will end up suffering. Privatization will be better for those who can pay but not much else.
Mixed Systems
Countries that have public healthcare systems often have long wait times. This can lead to people traveling abroad to have procedures done that they don’t want to wait for. Referred to as Healthcare tourism it is becoming a booming business. There are websites dedicated to matching potential patients with locations that offer the services they are looking for. The sole purpose of these sites is to locate facilities with the procedures you are interested in and providing the cost information to have the work done. Any reviews that are available and package deals. For example, if I use it to search for Botox in Spain, I find out that I can have this done at Todo en Belleza by Dr. Manchon for a cost of $590. That is a completely cosmetic surgery that can also be done in Canada at cost. However, on these sites you can also request info for procedures such as Bone Marrow transplants, cardiac surgery, cancer treatments and other procedures that can take months to get done in Canada. If this is such a popular thing, why doesn’t Canada implement a mixed health care system?
A mixed system is exactly what it sounds like, access to both public healthcare and private healthcare. If you want to jump the queue and avoid wait times you would have the access to pay for the procedure you need to have. Six of Canada's ten provinces have banned private insurance for publicly insured services to inhibit queue jumping and so preserve fairness in the healthcare system. In 2005, the Supreme Court of Canada ruled on The Chaoulli Decision, “The 4 judges merely concluded that the Quebec Charter guarantees a right to private insurance where the public system is inadequate. Thus, the Court’s decision was explicitly based on the failure of Quebec’s public health care system to provide reasonably timely access to health care in the mid-1990s, before government reinvestments into the public healthcare system. It did not rule that a parallel private insurance system is constitutionally guaranteed, nor did it hold that a single-tier publicly insured system is unlawful. It merely stated that under the Quebec Charter, if the public system fails to deliver care within a reasonable time (including through publicly funded wait time guarantees), individuals have the legal right to purchase private insurance,” (Chaoulli 2005.)
However, this ruling only applies within the Province of Quebec. A second court challenge is currently underway to determine whether the prohibition of private parallel health care violates the patient's' right to life, liberty, and security under Section 7 of the Canadian Charter of Rights and Freedoms.
Conclusion
Drawing from the information in this paper, it is evident that the system needs an overhaul. What’s worked in the past is failing our current social system. Canada could learn from other countries, in particular France, which according the the World Health Organization ranks number 1 in the world.