Health care in a highly decentralized federation the case of canada
Download
1 / 16

Health Care in a Highly Decentralized Federation: The Case of Canada - PowerPoint PPT Presentation


  • 80 Views
  • Uploaded on
  • Presentation posted in: General

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha

Download Presentation

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

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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

  • 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


Decentralization and Role of Private Sector in Canada


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

  • 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


Family Medicine-Specialist and Nurse-Physician Ratios, 2006


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


Average Length of Hospital Stay


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


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

  • 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


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


ad
  • Login