Health system change and reform in canada
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Health System Change and Reform in Canada. Monitoring Health System Change/Health Reforms PAHO/WHO Seminar, Belize, 30 May 2006 Gregory P. Marchildon Canada Research Chair in Public Policy and Economic History Graduate School of Public Policy, University of Regina. Outline of Presentation.

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Health System Change and Reform in Canada

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Health system change and reform in canada

Health System Change and Reform in Canada

Monitoring Health System Change/Health Reforms

PAHO/WHO Seminar, Belize, 30 May 2006

Gregory P. Marchildon

Canada Research Chair in Public Policy and Economic History

Graduate School of Public Policy, University of Regina


Outline of presentation

Outline of Presentation

  • Organization

  • Fiscal Resources

  • Physical and Human Resources

  • Health Services

  • Health Reforms: Phase I

  • Health Reforms: Phase II

  • Performance Indicators

G.P. Marchildon

Graduate School of Public Policy


Public mixed and private systems of health care

Public, Mixed and Private Systems of Health Care


Organization of the public health care system

Canadian Constitution

Statistics Canada

Transfer payments

Provincial and Territorial Governments

Federal Government

Canadian Institutes for HealthResearch

Federal-Provincial-Territorial Advisory Committees and Councils

Minister of Health

Regional Health Authorities

Ministries of Health

Canada Health Act, 1984

Health Canada

Public Health Agency of Canada

Patent Medicine Prices Review Board

Mental Health and Public Health

Home Care and Long-Term Care

Single Payer Hospital, primary care and physician Services

Provincial and Territorial Prescription Drug Subsidy Programs

Canadian Institute for Health Information

Health Council of Canada

Canadian Coordinating Office of Health Technology

Canada Health Infoway

Canadian Blood Services

Organization of the Public Health Care System


Revenue sources for all health expenditures 2003

Revenue Sources for all Health Expenditures, 2003

G.P. Marchildon

Graduate School of Public Policy


Overview of canadian health system expenditure perspective

Total Health Expenditures 2005

$142 Billion

Private Sector

30.4%

Public Sector

69.6%

Dental and vision care, drugs, complementary and alternative medicine, and some long term care and home care

Other Public

Sector

6.3%

Provincial Government

Sector

63.3%

Physician Remuneration

Regional HealthAuthorities

Federal Direct

4.2%

Private Health Insurance

Out-of-Pocket Expenditures

Other

Provincial Drug Plans

Municipal

(Public Health)

0.7%

Commercial Insurance Firms

Hospitals

Not-for-Profit Insurance Firms

Long-term Care

Social Security Funds

1.4%

Community Care

Worker’s Compensation

Quebec Drug Insurance Fund

Home Care

Overview of Canadian Health System: Expenditure Perspective


Trends in health expenditures 1976 2005

Trends in Health Expenditures, 1976-2005


Health system change and reform in canada

Canada Health Act Expenditures as a Share of Total Health Care, 2005

CHA

$55.7B

39.2%

G.P. Marchildon

Graduate School of Public Policy


Health system change and reform in canada

Annual Growth Rates of Prescription Drug (Rx) Plans, other Components of Health Expenditures and Canadian GDP, 1998-2004 (Current Prices)

G.P. Marchildon

Graduate School of Public Policy


Health system change and reform in canada

Total Health care expenditures as a share of GDP in Canada and selected countries, 1960 to 2002


Health system change and reform in canada

Public Health Care Expenditures as a share of GDP in Canada and selected countries, 1960 to 2002


Comparison of selected imaging technologies per million

Comparison of Selected Imaging Technologies (per million)


Health care personnel in canada per 1 000 people 1991 2003

Health Care Personnel in Canada (per 1,000 people), 1991-2003


Health system change and reform in canada

Decline in the number of recorded hospital admissions for Canada and provinces, 1995-2001

Note: The % decline is calculated on age-standardized hospitalization rates for all conditions, per 100 000 population


Health system change and reform in canada

Comparison of Active Physicians (per 1,000), 1980 to latest year


Health system change and reform in canada

Comparison of Active Nurses (per 1,000), 1980 to latest year


Health services i

Health Services I

  • Public health

  • Primary care

  • Secondary/inpatient care

  • Rehabilitation/intermediate care

  • Long-term care, home care and other community care

  • Prescription drugs …

G.P. Marchildon

Graduate School of Public Policy


Health services ii

Health Services II

  • Palliative care

  • Mental health care

  • Dental health care

  • CAM products and services

  • Maternal and child health care

  • Services for informal caregivers

  • Aboriginal Canadians

G.P. Marchildon

Graduate School of Public Policy


Health reforms i 1988 1996

Health Reforms I, 1988-1996

  • Public fiscal restraint due to

    • Rapidly growing health care costs

    • High public debt

  • Cost-cutting and disinvestment and patient dissatisfaction but also…

  • Profound Organizational and Managerial change: integration and coordination

  • The regionalization revolution

G.P. Marchildon

Graduate School of Public Policy


Health reforms ii 1997 to now

Health Reforms II, 1997 to now

  • Public reinvestment and growing costs

  • Rival hypotheses as to cause and effect

    • Public-private debate: delivery and financing

  • Major Consensus

    • Primary Care Reform

    • Managing system: regionalization and integration

  • Post-Chaoulli

    • Move from delivery to heart of medicare

    • Single-payer administration and finance

G.P. Marchildon

Graduate School of Public Policy


Performance indicators

Performance Indicators


Life expectancy and mortality indicators 1970 2001

Life Expectancy and Mortality Indicators, 1970-2001


Factors influencing health status 1981 2002

Factors Influencing Health Status, 1981-2002


Health system change and reform in canada

Province and Ranking

Weighted Count

Number of Indicators Reported

Weighted Count per Reported Indicator

1. British Columbia

153

117

1.31

2. Alberta

133

119

1.12

3. Saskatchewan

125

111

1.13

4. Ontario

122

113

1.08

5. Quebec

121

99

1.22

6. New Brunswick

113

113

1.00

7. Prince Edward Island

104

104

1.00

8. Newfoundland and Labrador

98

103

0.95

9. Nova Scotia

98

114

0.86

10. Manitoba

92

114

0.81

Table 2.3A: Overall Provincial Performance Based on Conference Board of Canada’s Weighted Count of Health Indicators

Source: Derived from Conference Board of Canada (2006), tables 1-2, p. 4.


Health system change and reform in canada

Comparative Disease Indicator Rankings (OECD rankings in brackets), 2000


Health system change and reform in canada

Satisfaction with Health Care and/or Health System

G.P. Marchildon

Graduate School of Public Policy


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