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The Canadian Healthcare System. Lecture 4 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems. Where are we?. Canada: Updated info. 2 nd largest country in the world—10 provinces, 2 territories Population: 31.5 million (2005)

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The canadian healthcare system l.jpg

The Canadian Healthcare System

Lecture 4

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 609 Comparative International Health Systems

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Canada: Updated info.

  • 2nd largest country in the world—10 provinces, 2 territories

  • Population: 31.5 million (2005)

  • Life Expectancy: 78 m/ 82 f (2005)

  • Population over 60: >17%

  • All cause mortality: #1 Cancer, #2 CHD

  • Healthcare 10.4% GDP (2005)

  • $142 billion (Canadian) (2005)

  • $2,931 (US) per capita health exp.

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Health System Overview

  • Medicare (started in 1968)

  • Single-payer, universal coverage

  • 12 separate provincial programs

  • Funding: personal, sales, corporate taxes and federal transfer payments (<25%)

  • Federal gov’t: only provides to special populations (military, native Canadians, federal prisoners), <2% pop.

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Birth of a system

  • 1966 National Medical Care Insurance Act

  • Medicare went into effect 1968

  • Widely supported legislation

  • Eliminated financial barriers to care

  • Patient choice of physician

  • Physician choice of practice location/style

  • Health care is a right, not a privilege

  • Capitalism w/ social responsibility (collectivism)

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Organization of Healthcare

  • Health Canada department: Federal responsibility for national health programs:

    • Occupational and Environmental Health

    • Health Promotion

    • Indian Health Services

    • Health Protection

  • Medicare: decentralized, provinces determine the management, delivery and financing of health services

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Private Market

  • Private insurance exists to cover services NOT covered under Medicare (vision, dental, pharmaceuticals for non-elderly)

  • Private insurance is most often employment based 15% of total health expenditures

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  • Total: $142 Billion (Canadian) in 2005

  • Public spending covers 69.9%

  • Private Insurance: 15%

  • Out of Pocket 15%

  • Funding: >25% federal transfer funds

  • Provinces raise money through taxes: corporations, personal income, fuel, lottery

  • Two provinces require a low, monthly flat-rate premium paid by employers

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Where does the money go?

  • $2,931 (US) per capita health exp.

  • 34% Hospital payments (global)

  • 14% Physician payments (FFS)

    • Salary Caps

    • Negotiated rates between province and providers

  • 14% Pharmaceuticals

  • 10% Other institutions (LTC, Mental)

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  • Provincial level planning

    • Prevents duplication of technology or services

  • National oversight of pharmaceuticals, emphasis on health protection & promotion, R&D

  • National and provincial controls on physician production and practice

  • Strong nation-wide reliance on health administrators: powerful, make policy, emphasis on leadership, cost efficiency, social responsibility

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Health Services Workforce

  • ~54,000 physicians (1.8 per 1,000)

  • >50% generalists, FP’s

  • 99% reimbursed by provincial health plans

  • Most fee-for-service, some capitation, some salary (community health centers)

  • Out-migration of MD’s to USA (salary caps)

  • All Canadian medical schools are US accredited, easy transfer, much recruiting

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More Health Services Workforce

  • Nurses: <300,000

  • Low salaries, low job satisfaction

  • Little autonomy, little professional development (MD’s discourage use of mid-level practitioners)

  • Much out-migration to the USA

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  • 95% not-for-profit (community boards)

  • Global Budget negotiated annually with province.

  • Capital expenditures are separate from Operating expenditures, gives province control of facilities and renovation.

  • Hospitals developed based on provincial planning

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  • Advanced technology is hospital based

  • Waiting time for non-emergency procedures

  • Hospital beds declining due to shift to ambulatory setting for procedures.

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Delivery of Services

  • Most patient care takes place in the office of the private physician.

  • Increased emphasis on prevention/promotion

  • Close monitoring to not duplicate secondary and tertiary services within a region

  • Rationing via review process and wait lists of expensive services (MRI, CTscan)

  • Cost containment shift from inpatient to ambulatory setting (like USA)

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Long Term Care

  • Each province has a different program

  • 23% of hospital beds are used for LTC: low intensity, low service needs (cost efficient versus acute care services)

  • Hospital based LTC causes waiting lists

  • Especially for the elderly: no cost pharmaceuticals, special poverty preventing programs

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Current Concerns

  • Inequity in care across provinces and territories (next slide)

  • Increasing number of elderly citizens

  • System-wide rising costs

  • Citizen dissatisfaction with long waits for some services and procedures

  • Cost-containment efforts and global budgeting will interfere with adoption of new technologies.

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Illustration of Problems with Rurality

Infant Mortality Rates by Province, 1995

Source: Statistics Canada, Births and Deaths, 1995.

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Compared to US

  • Canada has similar health outcomes—OECD ranked 30th v. US at 37th.

  • Considerably lower portion of GDP spent on healthcare system

  • 300% per capita less in Canada on administrative fees

  • A true single payer system

  • All inclusive access

  • Waitlists are bad, but exclusion for 44 million Americans is bad, too.

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  • Canadian Healthcare System: Medicare

  • Single-payer insurance based in each province

  • Physicians in private practice

  • Global Budgeting for hospitals

  • Healthcare is a right, not a privledge