Health care in a highly decentralized federation the case of canada
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Health Care in a Highly Decentralized Federation: The Case of Canada. Gregory P. Marchildon, Ph.D. Johnson-Shoyama Graduate School of Public Policy, University of Regina, Canada Symposium on Decentralization of Health Care: Reform of Belgian Health Care

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Health Care in a Highly Decentralized Federation: The Case of Canada

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Health care in a highly decentralized federation the case of canada

Health Care in a Highly Decentralized Federation: The Case of Canada

Gregory P. Marchildon, Ph.D.

Johnson-Shoyama Graduate School of Public Policy, University of Regina, Canada

Symposium on Decentralization of Health Care: Reform of Belgian Health Care

Sponsored by Flemish Physicians Association: Vlaams Gennesheren Verbond

Brussels, Belgium, 18 October 2008


Overview of presentation

Overview of Presentation

  • Nature and origins of political and health system decentralization

  • Some health service differences among provinces

  • Decentralization and language of health care delivery

  • SWOT analysis of decentralization


Political decentralization

Political Decentralization


Decentralization and role of private sector in canada

Decentralization and Role of Private Sector in Canada


Public universal system

Public Universal System

  • Medicare: universal hospital + medical care services

    • Narrow (40% of THE) but Deep (no user fees or co-payments)

  • Defined as medically necessary or medically required services

  • Funded by both orders of government

    • 75% by provincial taxation – general revenue funds

    • 25% by federal government – cash transfers to provinces

  • Provincial single-payer administrations

  • National framework of Canada Health Act

    • Five funding conditions/principles: universal, portable, public administered, comprehensive, and accessible


Decentralization of health services

Decentralization of Health Services

  • Do differences in health services increase over time within a decentralized system?

  • Are differences encouraged by particular forms of decentralized governance, administration or delivery?

  • Snapshot of differences in physician and hospital services in 6 more western provinces


Number of physicians and nurses per 100 000 people 2006

Number of Physicians and Nurses(per 100,000 people), 2006


Family medicine specialist and nurse physician ratios 2006

Family Medicine-Specialist and Nurse-Physician Ratios, 2006


Inpatient hospitalization rates per 100 000 people age standardized

Inpatient Hospitalization Rates (per 100,000 people, age-standardized)


Average length of hospital stay

Average Length of Hospital Stay


Language of health care delivery

Language of Health Care Delivery

  • Important factor in access to, and quality of, health care

  • Mainly determined by provincial governments

    • English-speaking (8) – majority with 4.2% or less with French as mother tongue (and 2.5% using French as primary language at home)

    • French-speaking (1) – Quebec with 80% having French as mother tongue and 82% using French as primary language at home

    • Officially bilingual (1) – New Brunswick – 65% with English and 33% with French as mother tongue

  • But federal government underwrites cost of providing services to linguistic minorities due to policy (and law) of official bilinguilism


Status of two official languages 2006

Status of Two Official Languages, 2006


Quebec

Quebec

  • Motivation behind attaining greater autonomy

  • Control over culture and language

  • Control over public health care: CLSCs and regionalization

  • Montreal and “bilingual” hospitals and institutions

    • McGill University: Montreal General; Royal Victoria; Montreal Children’s Hospital; Montreal Neurological Institute; and Montreal Chest Institute

    • Jewish General Hospital

    • Saint Mary’s Hospital

    • Lakeshore General Hospital

  • Alliance Quebec and subsequent action by federal Minister of Health: $30 m investment


Ontario

Ontario

  • Health Services Restructuring Commission

  • Order to close Montford Hospital, Ottawa

  • Pressure on Ontario government from civil society as well as other governments

  • Court action

  • Reversal of decision and re-investment


Conclusion swot analysis of decentralization

ConclusionSWOT Analysis of Decentralization

  • Strengths

    • Freedom and capacity of provinces to innovate and experiment

    • Intergovernmental collaboration, federal spending power and balance

  • Weaknesses

    • Non-cooperative strategies of blaming and cost-shifting

    • Difficulty of setting “national” direction

  • Opportunities

    • Replace old system of cost-sharing with more effective federal-provincial approach

  • Threats

    • Increased non-cooperation and, possibly, secession


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