Canada’s health care system “can be described as a publicly-funded, privately-provided, universal, comprehensive, affordable, single-payer, provincially administered national health care system” (Bernard, 1992, p. 103). Health care in Canada is provincial responsibility, with the Canada Health act being a federal legislation (Bernard, 1992, p. 102). Federal budget cuts, has caused various problems within Medicare such as increased waiting times and lack of new technology.
Another problem with Medicare is that The Canada Heath Act does not cover expenditures for prescriptions drugs. All these issue has caused individuals to suggest making Medicare privatized. Although, Canada’s health care system consists of shortcomings, our universal comprehensive health care system is not crisis. The following paper will discuss how the federal-provincial relations and media have aided to these problems. Lastly, throughout the paper intergovernmental solutions to these issues will be presented.
The 1867 Constitution Act did not assign responsibility for health care to either provincial or federal governments, but it did assign the responsibility of hospitals towards provinces, thus health care in Canada has become under provincial jurisdiction (Stamler, ; Yiu, 2005 p. 17). In addition, “the Canadian Constitution has an equalization clause requiring provinces to provide “reasonable comparable levels of public service for reasonably comparable levels of taxation” (Stamler, ; Yiu , 2005 p. 17).
Despite it being under provincial jurisdiction, the federal government has been involved in funding and making sure the services are available. Since territorial and provincial wealth differs, the federal government’s role is to equalize services across provinces. The federal government does this two ways: “first by contributing money (in effect, transferring money from wealthier to poorer provinces), and second, by stipulating specific conditions that provinces must meet in order to receive that money” (Stamler, ; Yiu , 2005 p. 17).
Roy Romanow, the premier of Saskatchewan argues that Canada does not have a universal health care system but “14 public health care systems – one for each province and territory and one for the federal government to provide funding, regulation, and administration” (Romanow, 2005, p. 3). The fourteen systems are tied together by Canada Health Act, 1984. The Canadian Heath Act states that “all citizens are entitled to a core of medically necessary services, delivered by physicians and hospitals” and paid through progressive taxation measures (Romanow, 2005, p.3).
In addition, the Act outlines five principles: “it must be universally accessible, comprehensive in nature, portable between provinces, delivered without direct charge to patients, and publicly administered” (Romanow, 2005, p. 3). Therefore, each province decides on how to administer funds,“ subsidize, and deliver additional public health care services such as prescription drug plans, home care, mental health care, long-term care, and community care services” (Romanow,2005, p. 3).
The federal government used to provide approximately a third of the money to provinces on health care costs, but during the 1990s due to budget deficits the federal government cut heath care funds towards the provinces (CBC News Online, 2006). The federal government cash contribution between 1997- 1999 was $12. 5 billion (Stamler, ; Yiu , 2005, p. 19). In addition, “yearly increases in health spending averaged 11. 1% from 1975 to 1991, but dropped to increases of 2. 5% annually in the late 1980s and early 1990s” (Canadian Doctors of Medicare, 2009). In 2003, Roy Romanow released a report on fixing Medicare.
At the same time, Ottawa cut 16 percent of its share and in order to increase Ottawa’s share to 25% Romanow recommended an infusion of federal dollars (CBC News Online, 2006). This led to the first Ministers gathering in 2003. This gathering was “described as the most important session on health care since Canada adopted Medicare” (CBC News Online, 2006). The outcome of the meeting led to “ $16-billion, five-year Health Reform Fund for primary care, home care and catastrophic drug coverage, $13. 5 billion in new federal funding to the provinces over three years, $2.
5 billion cash infusion for 2003 , $600 million for information technology and $500 million for research” (CBC News Online, 2006). At the end this plan did not carry out because the Premiers received half of what was suggested and the territorial leaders did not sign the agreement. The territorial leaders felt that Ottawa was being inflexible and that “the north would be receiving the same amount of money per capita as the rest of the country, despite the much higher costs of delivering health care in Canada’s most remote regions” (CBC News Online, 2006).
In addition, the deal had no accountability strings attached (Doctors of Medicare, 2009). Furthermore, during the 2004 election, the Liberals indicted the Conservatives of wanting to turn Medicare into a two-tiered system (CBC News Online, 2006). After the election, Prime Minister Martin assembled the first minister’s conference on health care. The federal government and provinces` `agreed to a $41-billion infusion into the system over 10 years” (CBC News Online, 2006).
The agreement included “ $3.5 billion over two years in additional transfers to the provinces and territories, an “escalator clause” that automatically boosts transfers by six per cent a year to keep up with rising health costs, $4. 5 billion over six years for a special fund to reduce waiting times for treatment. In addition, a National Wait Times Strategy was developed for five priority areas: cancer care, cardiac treatment, diagnostic tests such as MRIs, joint replacements and cataract surgeries” (CBC News Online, 2006). Yet despite these conferences, the promises were not fulfilled.
The 2003 and 2004 agreements did not specify if the money was to be targeted toward particular needs (eg. training health personnel), innovations (eg. chronic disease management) or provided accountability to ensure that money was allocated towards these areas (Doctors of Medicare, 2009). Financial cuts by the federal government have resulted in many problems in the health care system such as long waiting lists and lack of new technology. In addition, the problem with The Health Canada Act is its failure to include prescription drugs.
Lastly, the media gives the public the false notion that Medicare is in a “crisis“ by exaggerating these issues. In addition, all these problems have caused individuals to suggest having Medicare privatized. The next section of this paper will look at these subjects in more detail. Long waiting lists One of the criticisms of Medicare is the “long waits to see a specialist, get diagnostic tests and undergo elective surgery” (CBC News Online, 2006). Patients have to wait several months for elective surgery and diagnostic procedures (Bernard, 1992, p. 105).
One common explanation in justifying increased wait times is a growth in aging population increases demand for surgery (Priest, Rachlis, ; Cohen, 2007, p. 8). In fact this is not true. The increase for more surgeries is due to more advanced technology (Priest, Rachlis, ; Cohen, 2007, p. 8). Modern technology has allowed one to receive services which were not available fifteen years ago. Thus, “the health care system is asked to perform more surgeries simply because it is more capable than ever of relieving patients’ pain and suffering and increasing their quality of life” (Priest, Rachlis, ; Cohen, 2007, p.8). ”
Another key contributor to waitlists is that most surgeons do not work as a team with nurses and other health professionals (Priest, Rachlis, ; Cohen, 2007, p. 9). For instance, there is not a designated person who makes sure that patients are socially, psychologically, and physically, prepared for surgery (Priest, Rachlis, ; Cohen, 2007, p. 9). By health care officials working together to make sure that patients can cope at home after the surgery, it will decrease the chances of re-admission. Another alternative is having health care personnel conducting work on the telephone.
A Dartmouth University study found that health care costs were reduced 30% when health personnel called their patients for follow up visits (Rachlis, Evans, Lewis, ; Barer, 2001, p. 35). One last problem aiding to long waiting times is the shortage of family doctors. Statistics show that between 2001 and 2004, family doctors decreased the number of patients they were taking and by the end of 2004; more than 4 million Canadians did not have access to a family doctor (Zitner, 2007). The shortage of doctors is because “provincial governments have reduced medical school enrolments and post-graduate training programs since 1993” (CBC News, 2006).
“Between 1991 and 2000, the number of medical-school admissions was reduced by 14% and foreign-trained doctors found it increasingly difficult to earn Canadian licences” (McParland, 2008). One obvious solution to the lack of doctors would be increasing medical school and post-graduate enrolments (Rachlis, Evans, Lewis, ; Barer, 2001 p. 33). Graduate students outside of Canada have suggested “approving extraordinary licensing procedures and increasing post-graduate training opportunities to facilitate the entry to practice of foreign-trained doctors” (Rachlis, Evans, Lewis, ; Barer, 2001 p. 33).
Another suggestion is for provincial governments to exempt tuitions and allow medical schools to determine their own admission levels (CBC News, 2006). Furthermore, provinces and regional provinces have also implemented community programs. For example, Edmonton’s Choice program offers out of hospital services care for patients who have chronic illness and frailty (Rachlis, Evans, Lewis, ; Barer, 2001, p. 3). Another example is Hamilton’s Let Me Decide program which allows patients and their families decide the appropriate level of intervention at the end of life (Rachlis, Evans, Lewis, ; Barer, 2001, p.3).
In addition, “the overall health care costs were 33 percent lower for the Let Me Decide participants who also used 61 percent fewer acute hospital days” (Rachlis, Evans, Lewis, ; Barer, 2001, p. 23). Thus, if a similar program could be put in effect across the country it would free up 1,700 to 1,800 acute care beds (Rachlis, Evans, Lewis, ; Barer, 2001, p. 23). By implementing services like Edmonton’s Choice and Hamilton’s Let Me Decide programs it will lessen the burden of hospitals, allowing patients to receive better care (Rachlis, Evans, Lewis, ; Barer, 2001, p. 3).
Furthermore, such programs save the government money which could be allocated towards other areas of Medicare such as updated technology. Lack of New Technology Another criticism is that there is limited access to expensive, high-technology medical equipment in Canada. When compared to the United States, Canada technology is not as abundant (Bernard, 1992, p. 105). “This is because the provincial governments seek to control rising health costs by allocating the use of technology among hospitals in any given region. In the U. S., such decisions about the purchase of new technology are made by individual hospitals seeking a competitive advantage in the marketplace.
“This often leads to a proliferation of high-cost technology which is, arguably, unnecessary” (Bernard, 1992, p. 106). In addition, inadequate financial support for preventive and chronic care makes it harder for doctors to provide high-quality care (Health Management Technology, 2009). The 2009 Commonwealth Fund International Health Policy Survey found that when compared against other countries Canada falls behind in using electronic medical records (EMRs).
Approximately, 46 percent of Canadian doctors use EMRs, compared to 99 percent in Netherlands, 97 percent in New Zealand and 96 percent in the United Kingdom (Health Management Technology, 2009). In addition according to the Organization of Economic Cooperation and Development (OECD), “the number of MRI units in Canada (6. 2 per million people in 2006) lags the OECD average (10. 2 per million), and the number of CT scanners (12 per million people in 2006) also lags the OECD average (19. 2 per million)” (Esmail, 2008).
Using outdated technology causes a slower recovery rate and patients have to visit the doctor often (Esmail, 2008), which in turn can increase the number of medications prescribed. Increase Costs of Medications Another problem with Medicare is Canadians may not be able to afford the medications they need. The Canada Health Act “covers medically necessary hospital, physician and surgical-dental as well as limited long-term care services, but not prescription medication” (Dewa, Hoch and Steele, 2005, p.496).
Studies show that prescription drugs are increasing at a fast rate and “between 1984 and 2001, total expenditures on drugs increased an average of 12 percent” (Dewa, Hoch and Steele, 2005, p. 497). In addition, studies show that most of the increased costs are due to prescribing of newer, more expensive, drugs that are as effective as older drugs (Rachlis, Evans, Lewis, ; Barer, 2001, p. 37). Many individuals receive coverage through private insurance companies such as employment-related packages.
Statistics show that “about 65 percent of working-age Canadians has some form of private drug insurance, 10 to 20 percent have incomplete coverage, particularly for drugs with exceptionally high costs, and 10 to 20 percent of Canadians have no drug coverage of any kind” (Hanley, 2009). Studies show that those who are most likely to be insured are individuals from lowest income groups (Dewa, Hoch and Steele, 2005, pg 508).
This may also be because of the difference between provinces. For example, studies by Dewa, Hoch and Steel (2005 p.508) show that residents of Alberta are more likely to report being insured compared to British Columbia and the reason is because British Columbia has deductible attached to its plan.
The Report by Romanow, offers a wide range of solutions such as modernizing The Canada Health Act by expanding coverage and renewing its principles. Therefore, it makes sense to include prescription drugs in The Canada Health Act (Dewa, Hoch and Steele, 2005, p. 506). In addition, prescription drugs should be geared towards a national system where all provinces agree on one structure (Dewa, Hoch and Steele, 2005, p.507).
It is important to remember that Canada’s universal Medicare is “built on the belief that universal access to healthcare is a right of all its citizens” (Dewa, Hoch and Steele, 2005, pg 510). Yet, majority of Canadians depend on employment benefits to cover prescription drugs while publicly funded drugs are available to the aged, and poor (Dewa, Hoch and Steele, 2005, pg 510). Lack of new technology, long waiting lists, and not having prescription drugs covered are solvable problems Canada’s heath care system faces.
These problems are blown out of proportion by media stories, making the public believe that Canada’s Medicare is in a “crisis. ” The next section discusses the role media plays in misleading the public. Media Exaggeration Many academics argue that the Medicare system has done what it has promised and the media exaggerates Medicare problems. Many other countries such has Europe and America have had these problems “yet the Canadian “crisis” was widely reported in the North American media as indicating the impending collapse of Medicare” (Rachlis, Evans, Lewis, ; Barer, 2001, p. 2).
Furthermore, the media focuses more on the “crisis” of Medicare than the initiatives which have been suggested. For instance, during 1999/2000 Canada experienced influenza season in which the media exaggerated the overcrowding in hospitals. During this incidence, Saskatoon, Calgary and Edmonton found solutions to this problem by “implementing timely and comprehensive immunization and flu control initiatives within long-term care institutions” (Rachlis, Evans, Lewis, ; Barer, 2001 p. 2).
The media did not focus on the initiatives developed by these provinces but instead diverted the public`s attention on the issue of overcrowding. In addition, media also exaggerates the increased wait times. It is true that waiting times have increased but to what extent is unknown because in Canada data on wait lists is not regularly updated (Rachlis, Evans, Lewis, ; Barer, 2001 p. 2).
The data that is available shows that waiting times have increased but they are not as severe as stated by critics. In addition, according to studies, there are shortage of doctors in certain areas in Canada, but overall there has been had an increase in doctors (Rachlis, Evans, Lewis, ; Barer, 2001).
Despite Media claims Canada has had implemented a number of programs to decrease waiting times. Some programs include are, The Ontario Cardiac Care Network, The Western Canada Waiting List Project, and Ontario’s Joint Replacement Network (Rachlis, Evans, Lewis, ; Barer, 2001). Furthermore, the Canadian Nurses Association (CNA) outlines some services which should be available to Canadians beyond physicians and hospital care. These services include: “a national pharmacare program that addresses prescribing practices, drug pricing and equity in coverage across the continuum of care and between jurisdictions” (CNA, 2008, p.
1). The CNA argues that privatization will not solve the problem and our current health system is “sustainable through better financial management” (CNA, 2008, p. 1). Governments should work with stakeholders and the public when making decisions about policies regarding finances of health services (CNA, 2008, p. 2). In addition, another solution for the long-term care shortage “would be to foster a range of publicly-subsidized supportive housing and long-term care options in partnership with Regional Health Authorities and non-profit societies” (Vogel, and Cohen, 2000).
Furthermore, recently the federal/provincial/territorial agreement on primary health care resulted in the federal government supplying $200 million. Hopefully the money given “will improve access to all health care services, enhance the satisfaction of providers and reduce pressures on various parts of the system, such as emergency departments and hospitals ” (Rachlis, Evans, Lewis, ; Barer, 2001, p. 44). One must keep in mind that though the federal and provincial governments have implemented programs and funds towards health care “the task of reforming primary health care is not an easy one” (Rachlis, Evans, Lewis, ; Barer, 2001, p.44).
Despite, having federal budget cuts in Medicare, there are options available such as increasing student enrolments in medical schools or promoting services such as Edmonton`s Choice program. Despite having these options many individuals believe that privatization is the best option to restoring Medicare. Privatization of Medicare The lack of public funds is leading long term care facilities towards privatization. In British Columbia, the government has not spent any money on buildings and equipment.
For instance, in 2000 about 7,000 seniors were waiting for one of BC’s care beds (Vogel,, and Cohen, 2000). Despite having government budget cuts, privatization is not an effective solution due to many reasons. For one, privatization costs more and this can be seen by comparing the health care costs between Canada and the United States. “While Canadians spend 8. 7% of their Gross National Product on health care, or the equivalent of $ 1,483 (U. S. ) per person, the U. S. spends 11. 8% of the GNP, or $ 2,051 per person for a health care system that doesn’t provide health care for all” (Bernard, 1992, p.102).
The high costs in the States is due to “higher administrative costs in a system comprised of numerous competitive insurance firms, hospitals, clinics“ (Vogel, and Cohen, 2000). Another reason not to have Medicare privatized is because it does not cause efficiency. For instance, cataracts surgeries in Calgary which are purchased from private companies are more expensive and have longer waiting lines (Stamler, ; Yiu , 2005, p. 29). In addition, in the public health system officials are accountable to their patients and public employers (Vogel, and Cohen, 2000).
Lastly, privatization would not shorten waiting times but increase them. This is because if practitioners are working in the private sector, they will not be available in the public one, thus increasing waiting time (Stamler, ; Yiu , 2005, p. 29). Therefore, a public health care system should be in place because it is more effective and efficient. Conclusion The federal government is responsible for the Canada Health Act and the provinces have discretion over the health services provided.
Canada’s universal Medicare has allowed Canadians to have access to health care and at a lower price compared to private health care in the United States. Federal budget cuts have increased waiting lists, and have caused individuals to suggest privatization. In addition, using old technology aids to the problem of “long waiting times, less efficient use of medical resources, and less timely and sophisticated diagnosis and treatment” (Esmail, 2008). In addition, there is a need for a national strategy for prescription drugs.
Furthermore, some individuals have suggested that the media focuses on the problems of Medicare but not on the initiatives the government has implemented. Although, there are problems in Medicare, they are not severe and are solvable. The solution is that federal, provincial, and local jurisdictions should work together in making sure all Canadians receive health care services (CNA, 2008, p. 1). New policy initiatives need to be discussed and “proper evaluation is best accomplished in organizations controlled by communities, such as health care co-operatives” (Zitner, 2007).
Other solutions include, having home or community alternatives which are cheaper compared to having individuals stay in a hospital when they are dying or adding more care beds. Another solution would be to having “more comprehensive range of health care professionals, including community pharmacists, integrated in a primary health care organization” (Rachlis, Evans, Lewis, ; Barer, 2001, p. 43). If funding can be available to such organizations, the wait lists would decrease and patient care would be more efficient (Rachlis, Evans, Lewis, ; Barer, 2001 p. 43).
In sum, with time every policy needs to be updated and reformed and the same holds true for Canada’s Medicare. With modern times comes a demand for more effective and efficient health care. In addition, government providing money does not solve problems within Medicare (Rachlis, Evans, Lewis, ; Barer, 2001, p. 6). Governments should decide where the money is needed and Canadians should have a voice in notifying governments where to allocate the money (Rachlis, Evans, Lewis, ; Barer, 2001, p. 6). Canada’s universal comprehensive health care is not in “crisis”, it just needs reforming.
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