Healthcare System of Canada - Coursework Example

Healthcare System of Canada Introduction Canada is the second largest nation in the world by area. It is an economically stable country with an established industrial economy. The country’s economic performance has been steady since 2006 in spite the economic depression that was experienced in the world from 2008. In addition to the strong economic growth experienced in the country, the federal government and some provincial governments in the country have reduced tax rates (Marchildon & European Observatory on Health Systems and Policies, 2013). However, the cost of healthcare services has continued to escalate at rates that go beyond the economic growth and government revenue. This has raised concerns on whether the financing of the health expenditure through the public will be sustained. Canada is a monarchy, which is based on the type of parliamentary system found in Britain. It has two orders of government, which are the federal or central government and the provincial government. The provincial governments are responsible for a variety of social programs and services, which include health services that are largely financed through public means. Life expectancy in the country has been increasing since 1980 as compared to other European countries. This trend has been evident especially among the males. However, infant and maternal mortality rates are worse than those found in other countries such as Sweden, France, and Australia. Death in this country is caused mainly by cancer and heart diseases. Various factors influence the health status of Canadians. They include cigarette smoking, alcohol consumption and unhealthy eating. These factors have led to a decline in the health status of Canadians and most of them have succumbed to diseases caused by these unhealthy habits. In this paper, the healthcare system of Canada will be analyzed to determine its effectiveness in delivering the required services to the citizens of Canada. Organization and governance of the health system in Canada The health system in Canada is predominantly publicly financed with about 70 percent of the health expenditures settled through tax revenues from the territorial, provincial, and federal governments. Governance of the health system in the country in terms of organization and health services delivery is highly decentralized. For instance, there are multiple organizations, which include privately governed hospitals, which operate independently from the provincial governments (Pryke & Soderlund, 2003). Most of the planning in the health system is carried out at the territorial and provincial levels although the regional health authorities sometimes engage in the planning about service provision for their respective populations. The ministries of health in some provinces and regions are helped to plan on provision of health services by health technology assessment agencies and provincial quality councils. However, in recent years, there have been efforts to reduce or eliminate regional health authorities in order to centralize the provision of health services. Most of the health professions in the country self-regulate using the legal frameworks instituted by the territorial and provincial governments. The federal government’s role in the health system in Canada includes funding and facilitating research and data gathering, regulating public health and prescription drugs, and supporting the national dimensions of medical care through transferring funds to the territories and provinces (Adams, 2001). The federal, provincial, and territorial governments cooperate with each other in the provision of health services through councils, conferences, and working groups made up of ministers of health. Recently, intergovernmental bodies that carry out data collection and dissemination, ensure patient safety, and manage blood products have supplemented these efforts (Pryke & Soderlund, 2003). Nongovernmental organizations in the country at both the federal and provincial take part in policy formulation and management of the public health system in the country. The provinces have the responsibility of administering and funding the health care in Canada. Health care in the provinces is organized and delivered mostly through regional health authorities. However, some provinces have limited the number of health care activities carried out by the regional health authorities. In most provinces, ministers of health in the provinces have mandated the regional health authorities to administer the provision of health care in certain geographical areas (Adams, 2001). This they do through providing services directly to the people or through contracting other health organizations for the services. However, the regional health authorities do not take in physician remuneration or pharmaceutical coverage. Health ministries in the provinces carry out this work. The provincial health ministry’s run drug plans, which reduce the cost of drugs for the citizens, especially the poor and retired ones who cannot afford private health insurance covers (Pryke & Soderlund, 2003). Physicians in Canada are mostly privately engaged although they provide services to the public, which are funded by the provincial health ministries. Physicians are remunerated based on the services provided. Organization of the Canadian health care system (Adams, 2001) Transfer of payments Financing Health care in Canada is financed by the public sector. The public sector finances about 70 percent of the health expenditure in the country. The government expenditure on health has grown rapidly from mid 1990s after it a restraint period in spending. The rate of growth in government expenditure in the country is only surpassed by the expenditure in private health sector. The growth has gone beyond the revenue received by the government and this has raised concern on whether the health system will be sustained (Marchildon, McIntosh, Forest & Commission sur l'avenir des soins de santé au Canada, 2004). The rapid growth in the government expenditure on health has been due to prescription drugs. Over the last two decades, prescription drugs have been the main factor behind the rising cost of health care in Canada. This is contrary to common belief and perception that ageing is the major cost driver in the health system in the country (Boychuk, 2008). However, the health expenditure has been rising due to huge hospital and physician expenditure in addition to increased prices of prescription drugs. The hospital spending has grown to the same level as the cost of prescription drugs while physician expenditure has surpassed the cost of prescription drugs. Almost all the funds used for public health expenditure come from tax revenues of the federal, provincial, and territorial governments. A considerable portion of these funds is utilized for the universal medicare. Universal medicare is hospital and physician services provided freely to residents in all territories and provinces (Rankin & Campbell, 2006). The remaining part of the money is used in reducing the cost of other health care commodities and services, which include prescription drugs and long-term care. Although the provinces raise a larger portion of the funds used for funding health expenditure through their own sources of revenue, they also receive some portion from the federal government through the Canada Health Transfer. Canada Health Transfer is an annual cash transfer given to the regional governments by the central government. Provincial and territorial governments have the responsibility of administering their own Medicare and universal hospital plans. Diagnostic, hospital, and physician services that are medically necessary are provided freely in all the provinces and territories. The introduction of these plans was mainly the work of the federal government. It did this by discouraging user fees and tying this condition to the contributory transfers to the provinces and territories. Provincial and territorial governments also subsidize health goods and services just like prescription drugs as well as long-term care (Olson, 2006). Most of the programs found at the provinces target small populations found mainly in the provinces. For the private sector, the funds used to take care of the health expenditure come mainly from the out-of-pocket payments, which are payments made by patients when they receive health services and the funds derived from the purchases of the private health insurance. Most of the private insurance covers come from employment-based insurance, which cover such things as Medicare goods and services, vision care, dental care and prescription drugs. Physical and human resources The other inputs injected into the health system in Canada, which are non-financial, include equipment, buildings, health workforce, and information technology. For any health system to be able to provide quality health care services, it needs not only to have sufficient physical and human resources, there must also exist a balance among the resources. The central, provincial, and regional administrations need to continually adjust the sufficiency and balance of the resources in order to be keep up with the evolving health care practices, technology and health needs of the people of Canada. From mid 1970s to 2000, the investment in hospitals in terms of equipment and buildings declined (Adams, 2001). This led to many small hospitals to be closed in many regions of the country. This forced many acute care services to be consolidated. In spite reinvestments in the recent past in hospitals by provincial and territories especially in imaging technologies, ICT, and medical equipment, the quantity of acute care beds has continued to decline. This has partly been due to increase in the number of surgeries carried out per day (Rankin & Campbell, 2006). Although the country’s supply of sophisticated diagnostic technologies is good and is on the same level as other advanced countries, its use of ICT in the provision of health services is poor as compared to other countries. However, the recent years have seen an improvement in this area. In 1990s, Canada experienced a reduced supply of health care workers, physicians, and nurses for a long time because of government cutbacks however, since 2000; the country has experienced a growth in the health workforce (Doern & Stoney, 2009). The private sector has also experienced a growth in the health professionals, which has been more substantial than the one experienced in the public sector. Medical and nursing training institutions and faculties have grown in number and size so that more graduates can be produced. However, there has also been an increase in the migration of doctors and nurses, especially those that are foreign educated, to other countries like the United States. These reduced the overall workforce in the medical field and are responsible for the constant shortages in medical workers in Canada. Provision of services Although it is hard to give a general overview of the way services are provided in the Canadian health system because of the way it is decentralized in terms of administration and provision and delivery of health services, the usual patient pathway begins with a patient’s visit to a family physician. The family physician then determines the way treatment will take place, if any. Family physicians, in most provinces, act as gatekeepers. They decide if their patients are supposed to obtain diagnostic tests, whether the patients should be referred to a medical specialist, or whether they should be given prescription drugs. However, there have been efforts by the provincial ministries of health to reform primary health care (Fierlbeck, 2011). Many of the targeted reforms aim at moving from the physician-only kind of practice to an inter-professional primary care, which involves a team of professional, that provide a wide range of health care services around the clock. In situations where a patient lacks a family physician, the health care process begins with a walk-in to medical clinic or any healthcare facility. Illness prevention services, which include disease screening, are provided by a public health office, a dedicated screening program, or a family physician. The governments in the provinces and territories in the country have health promotion and public health initiatives. The governments also carry out health surveillance and epidemic response, and although the public health agency in the country develops and manages initiatives that support public health throughout the country, the daily public health activities and infrastructure remain the responsibility of the territorial and provincial governments. Acute care in the country is provided by public hospitals or non-profit private hospitals (Fierlbeck, 2011). However, some advanced diagnostic and specialized ambulatory services can be provided by some private clinics that are profit making. Most hospitals in the country have an emergency department, which has emergency medical service units that are provide first aid services and care to patients while they are being transported to hospitals. Every territorial and provincial government has a plan for prescription drugs that covers outpatients in selected populations. On the other hand, the federal provides drug coverage for eligible Inuit and First Nations users. Long-term care and rehabilitation services and policies vary among the various provinces and territories. Up to 1960s, mental health care services were provided in provincially run psychiatric hospitals (Olson, 2006). However, since the deinstitutionalization of the psychiatric hospitals, mental health care services are provided on an outpatient basis although patients may spend some period in the psychiatric wards in hospitals. Most of the mental health care services are provided by family physicians. Unlike mental health and long-term care services, dental care is privately funded in the country. Since access to these services is largely based on income, it is highly inequitable. Alternative and complementary medicine is also funded and delivered privately. Because of differences in the health outcomes for the minority groups in the country such as the aboriginal people, coupled with challenges of providing health services to the remote regions the three governments in Canada, that is, the federal, provincial and territorial governments, have come up with various programs and services that ensure these remote communities receive adequate health services (Boychuk, 2008). Despite the governments’ efforts, the health status of the aboriginal population, although it has improved, still lags behind. A large gap still exists between the health status of the aboriginal people and that of the mainstream communities. Patient empowerment Patients in Canada rely mostly on health care providers for information concerning their health. This information is normally supplemented with information given by health organizations such as hospitals (Doern & Stoney, 2009). In addition, there are programs that are intended to provide information on cancer. This information addresses the issues of diagnosis, prevention, and treatment of cancer. There are also patient navigation programs, which help them to avoid cancer cases. In recent years, health organizations, quality councils, and provincial ministries have been providing information on many health issues to the public. On patient choice, patients have the freedom to choose any hospital or physician within their province of residence. However, patients cannot receive medicare services insurance cover from another province. Recently, patients’ choice of care providers such as physicians in some places has been limited due to the limited supply of these health care providers. On patients’ rights, there is no charter of rights for patients in Canada. In addition, there is no territory or province, which has enacted laws that spell out patient rights. Patients’ rights movements in Canada are not fully developed as compared to other countries such as the United States and France (Fierlbeck, 2011). Although there are a few organizations that fight for patients’ rights in the country, they tend to do in only specific diseases or conditions and the general health of patients. The few patients’ rights groups present in the country are very weak and this makes them to be largely ineffective. This has reduced the ability of patients to lay claims incase they receive poor medical services from medical practitioners or healthcare facilities. They are also unable to lay claims if they are injured in a health facility while undergoing medication. Strengths The Canadian health system has a number of strengths that makes it superior to other health systems in the world. One of its strengths is that no one in the country is denied access to health services. Since the provision of health care services is publicly funded, no Canadian can fail to access the services because of lack of money (Ostry, 2006). Another strength is that the standard of care in the Canadian health system is excellent. For instance, health outcomes in areas such as cardiovascular disease and cancer are better than in other countries indicating that the provision of health services in the system is excellent. Most of the funds set aside for the health system go to healthcare and not administration (Gratzer, 2002). In Canada, much money is spent on healthcare provision and less on administration. This makes sure services offered are of high quality. This is contrary to other countries like the US where the larger portion of the healthcare funds are spent on administration. Weaknesses Despite its strengths, the Canadian health system has also a number of weaknesses. One of the weaknesses is that the health care system is costly. The Canadian health care system is among the most expensive in the world. The single payer model used in the country has not delivered the desired results considering the amount of money spent on it. Another weakness is that healthcare decision making in the country is political (Ostry, 2006). Health care decisions in the country are made basing on what is acceptable to the public and not on what makes sense in terms of financial sustainability. In addition, decision-making process on health matters is normally slow and complicated making it hard to realize real change. Access to care is problematic. Restrictions on government funding make it hard for people to access healthcare in the country. Wait-lists are normal and the citizens in this country are finding it hard to access the services of physicians (Boychuk, 2008). The Canadian healthcare system is also not nimble. The system is focused on chronic and acute care instead of prevention and health promotion. The system has also not being keeping up with changes in technology and patient needs. Although the health system is universal, not all Canadians are accessible to the same treatment and quality of services. Funding of the health care in the country is not consistent (Marchildon, McIntosh, Forest & Commission sur l'avenir des soins de santé au Canada, 2004). Resource-rich provinces like Saskatchewan and Alberta invest more in healthcare meaning that the citizens of such provinces are accessible to better health care services. Since access to care is determined by one’s province of residence, this means that not all citizens can access same quality healthcare services in the country. Major health reforms Since 2005, there has not been any major health reform initiative in Canada. However, ministries of health in individual provinces and territories have struggled to bring about reforms to their health systems. The reforms have been focused on two items. The first one is reorganizing of the health systems and the second item is improving quality of services and care provided to patients (Gratzer, 2002). Assessment of the Canadian health system The Medicare system in Canada has been efficient in financially protecting citizens of the country against the high cost of health care services. However, the narrow range universal services provided in the system under Medicare have resulted to occurrence of gaps in coverage. For dental care and prescription drugs, these gaps are taken care of by private health insurance and, for drug therapies, provincial plans (Ostry, 2006). In situations where the public coverage does not fill the gaps left by the private health insurance, equal access to Medicare becomes a challenge. Since the funding of healthcare is through tax revenues, there is a high level of equity in financing. However, if it financing is extended to the out-of-pocket method and the employment-based insurance benefits, financing of healthcare becomes less equitable. There are differences in accessing the healthcare services in the system. However, this occurs in a few areas of health care provision such as mental health care and dental care, which are privately funded. However, the overall gap is not large. There is also an economic gradient among the provinces with provinces found to the east of Canada being less wealthy than those found to the west are. This disparity has been taken care by the federal government through equalization payments. The central government offers equal payments to the poor provinces to enable them provide equal public services to the people like the rich provinces without having to heavily tax the citizens. Conclusion Generally, the health care system in Canada is efficient in terms of financial protection of citizens in accessing health services. However, it is less efficient with the access to health services themselves. There is dissatisfaction among citizens in terms of accessing physicians, waiting times accessing emergency departments in hospitals. Despite the shortcomings, quality indicators show that there have been improvements in the health system in the country. In addition, efforts, especially at provincial and territorial levels, are being put in place to ensure improvement in the provision of the services. This will further improvement the system and make it more efficient in terms of financial protection as well as provision of services. References Marchildon, G. P., & European Observatory on Health Systems and Policies. (2013). Health systems in transition: Canada. Toronto, ON: University of Toronto Press. http://books.google.co.ke/books?id=ZenLRRI682cC&printsec=frontcover&dq=health+sy stem+in+canada&hl=sw&sa=X&ei=CpUjU9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Fierlbeck, K. (2011). Health care in Canada: A citizen's guide to policy and politics. Toronto: University of Toronto Press. http://books.google.co.ke/books?id=K- cvzH07VCUC&printsec=frontcover&dq=health+system+in+canada&hl=sw&sa=X&ei= CpUjU9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Olson, R. P. (2006). Mental health systems compared: Great Britain, Norway, Canada, and the United States. Springfield, Ill: Thomas. http://books.google.co.ke/books?id=Qg9o6G- EDwsC&printsec=frontcover&dq=health+system+in+canada&hl=sw&sa=X&ei=CpUjU 9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Gratzer, D. (2002). Better medicine: Reforming Canadian health care. Toronto: ECW Press. http://books.google.co.ke/books?id=j_gRkX6JgTkC&printsec=frontcover&dq=health+sy stem+in+canada&hl=sw&sa=X&ei=CpUjU9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Marchildon, G. P., McIntosh, T. A., Forest, P.-G., & Commission sur l'avenir des soins de santé au Canada. (2004). The Romanow papers. Toronto: University of Toronto Press. http://books.google.co.ke/books?id=4TRqeiLLAc4C&printsec=frontcover&dq=health+s ystem+in+canada&hl=sw&sa=X&ei=CpUjU9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Boychuk, G. W. (2008). National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference. Washington: Georgetown University Press. http://books.google.co.ke/books?id=McL2UV9_QGUC&printsec=frontcover&dq=health +system+in+canada&hl=sw&sa=X&ei=CpUjU9SuB8nH0QX- 8ICIBw&redir_esc=y#v=onepage&q=health%20system%20in%20canada&f=false Ostry, A. S. (2006). Change and continuity in Canada's health care system. Ottawa: CHA Press. http://books.google.co.ke/books?id=9xpGAAAAYAAJ&q=strenghts+of+the+canadian+health+system&dq=strenghts+of+the+canadian+health+system&hl=sw&sa=X&ei=ApgjU-L3BoWe0QXy7IHgBQ&redir_esc=y Doern, G. B., & Stoney, C. (2009). Research and innovation policy: Changing federal government-university relations. Toronto: University of Toronto Press. http://books.google.co.ke/books?id=Zi09vwJkm1IC&pg=PA259&dq=strenghts+of+the+ canadian+health+system&hl=sw&sa=X&ei=ApgjU- L3BoWe0QXy7IHgBQ&redir_esc=y#v=onepage&q=strenghts%20of%20the%20canadi an%20health%20system&f=false Adams, D. (2001). Federalism, democracy and health policy in Canada. Montreal [u.a.: McGill- Queen's Univ. Press. http://books.google.co.ke/books?id=MUOblLEAB0wC&pg=PA83&dq=weaknesses+of+ the+health+system+in+canada&hl=sw&sa=X&ei=65gjU4LWL4yX0AXZnoHgBw&redi r_esc=y#v=onepage&q=weaknesses%20of%20the%20health%20system%20in%20canad a&f=false Pryke, K. G., & Soderlund, W. C. (2003). Profiles of Canada. Toronto, Ont: Canadian Scholars' Press. http://books.google.co.ke/books?id=44Kwg7sZmzEC&pg=PA308&dq=weaknesses+of+t he+health+system+in+canada&hl=sw&sa=X&ei=65gjU4LWL4yX0AXZnoHgBw&redir _esc=y#v=onepage&q=weaknesses%20of%20the%20health%20system%20in%20canad a&f=false Marchildon, G. P., McIntosh, T. A., Forest, P.-G., & Commission sur l'avenir des soins de santé au Canada. (2004). The Romanow papers. Toronto: University of Toronto Press. http://books.google.co.ke/books?id=INIVCKI0shQC&pg=PA257&dq=reforms+of+the+ health+system+in+canada&hl=sw&sa=X&ei=spkjU9eMJYaT0QXViIGoDQ&redir_esc= y#v=onepage&q=reforms%20of%20the%20health%20system%20in%20canada&f=false Rankin, J. M., & Campbell, M. L. (2006). Managing to nurse: Inside Canada's health care reform. Toronto ; Buffalo: University of Toronto Press. http://books.google.co.ke/books?id=Wq42CyNXmOIC&printsec=frontcover&dq=reform s+of+the+health+system+in+canada&hl=sw&sa=X&ei=spkjU9eMJYaT0QXViIGoDQ& redir_esc=y#v=onepage&q=reforms%20of%20the%20health%20system%20in%20canad a&f=false Read More

Most of the planning in the health system is carried out at the territorial and provincial levels although the regional health authorities sometimes engage in the planning about service provision for their respective populations. The ministries of health in some provinces and regions are helped to plan on provision of health services by health technology assessment agencies and provincial quality councils. However, in recent years, there have been efforts to reduce or eliminate regional health authorities in order to centralize the provision of health services.

Most of the health professions in the country self-regulate using the legal frameworks instituted by the territorial and provincial governments. The federal government’s role in the health system in Canada includes funding and facilitating research and data gathering, regulating public health and prescription drugs, and supporting the national dimensions of medical care through transferring funds to the territories and provinces (Adams, 2001). The federal, provincial, and territorial governments cooperate with each other in the provision of health services through councils, conferences, and working groups made up of ministers of health.

Recently, intergovernmental bodies that carry out data collection and dissemination, ensure patient safety, and manage blood products have supplemented these efforts (Pryke & Soderlund, 2003). Nongovernmental organizations in the country at both the federal and provincial take part in policy formulation and management of the public health system in the country. The provinces have the responsibility of administering and funding the health care in Canada. Health care in the provinces is organized and delivered mostly through regional health authorities.

However, some provinces have limited the number of health care activities carried out by the regional health authorities. In most provinces, ministers of health in the provinces have mandated the regional health authorities to administer the provision of health care in certain geographical areas (Adams, 2001). This they do through providing services directly to the people or through contracting other health organizations for the services. However, the regional health authorities do not take in physician remuneration or pharmaceutical coverage.

Health ministries in the provinces carry out this work. The provincial health ministry’s run drug plans, which reduce the cost of drugs for the citizens, especially the poor and retired ones who cannot afford private health insurance covers (Pryke & Soderlund, 2003). Physicians in Canada are mostly privately engaged although they provide services to the public, which are funded by the provincial health ministries. Physicians are remunerated based on the services provided. Organization of the Canadian health care system (Adams, 2001) Transfer of payments Financing Health care in Canada is financed by the public sector.

The public sector finances about 70 percent of the health expenditure in the country. The government expenditure on health has grown rapidly from mid 1990s after it a restraint period in spending. The rate of growth in government expenditure in the country is only surpassed by the expenditure in private health sector. The growth has gone beyond the revenue received by the government and this has raised concern on whether the health system will be sustained (Marchildon, McIntosh, Forest & Commission sur l'avenir des soins de santé au Canada, 2004).

The rapid growth in the government expenditure on health has been due to prescription drugs. Over the last two decades, prescription drugs have been the main factor behind the rising cost of health care in Canada. This is contrary to common belief and perception that ageing is the major cost driver in the health system in the country (Boychuk, 2008). However, the health expenditure has been rising due to huge hospital and physician expenditure in addition to increased prices of prescription drugs.

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