Is Canadian Health Care a Model for the United States Gerard W. Boychuk, Ph.D. Author of National Health Insurance in - PowerPoint PPT Presentation

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Is Canadian Health Care a Model for the United States Gerard W. Boychuk, Ph.D. Author of National Health Insurance in

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    2. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    3. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    4. What is the Canadian model? Canada Health Act, 1984 (CHA) health care as predominantly provincial jurisdiction federal principles governing financial reimbursement for eligible health services by provincial health plans does not apply to means of provision of services (which may be provided by for-profit providers) physicians -- primarily private, for-profit practice on a fee-for-service basis hospitals -- primarily private not-for-profits (e.g. not publicly-owned) on a global-funding basis increasingly, private for-profit facilities offering surgical and diagnostic services on a fee-for-service basis arguably a single-payer system not a single-provider system

    5. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services

    6. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services

    7. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services single-public-payer (not exclusive-public payer system)

    8. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services single-public-payer public plan may charge premiums (various provinces)

    9. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services single-public-payer public plan may charge premiums (various provinces) on uniform terms and conditions

    10. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services single-public-payer public plan may charge premiums (various provinces) on uniform terms and conditions mandatory community-rating -- cannot be experience-rated

    11. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services

    12. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services no mandate that individuals carry public insurance coverage

    13. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services no mandate that individuals carry public insurance coverage individuals allowed to opt out of public coverage (various provinces)

    14. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services no mandate that individuals carry public insurance coverage individuals allowed to opt out of public coverage (various provinces) cannot subsidize private coverage

    15. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services no mandate that individuals carry public insurance coverage individuals allowed to opt out of public coverage (various provinces) cannot directly subsidize private coverage eligibility for coverage cannot be categorical or income-tested

    16. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services

    17. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services financial barriers at point of access must not impede or precludereasonable access to insured services places limits on allowable extent of user fees (co-payments) and extra-billing (balance billing)

    18. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services financial barriers at point of access must not impede or precludereasonable access to insured services limited required coverage of services within province

    19. What is the Canadian model? universal availability of publicly-administered health insurance (on uniform terms and conditions) for access to all medically necessary hospital and physician services financial barriers at point of access must not impede or precludereasonable access to insured services limited required coverage of services within province narrow but deep -- e.g. not comprehensive not covered: pharmaceuticals home care long-term care dental care

    20. What is the Canadian model? regulation of private purchase of health services and private health insurance? limits on how public payment can be combined with private payment for privately-purchased health services payment from public plan must be accepted by provider as payment in full if services are to be billed directly to the public plan (or province faces federal penalties) physicians can opt-out of public plan e.g. forfeit ability to bill public plan directly bill patients at rates above provincial fee schedule patient reimbursed from public plan up to provincial rate schedule patient allowed to carry third-party, private insurance for the difference

    21. What is the Canadian model? does not preclude competition between publicly and privately funded services or competition between public and private insurance

    22. What is the Canadian model? does not preclude competition between publicly and privately funded services or competition between public and private insurance does not mandate a single-payer system allows for a single-payer dominant system

    23. What is the Canadian model? does not preclude competition between publicly and privately funded services or competition between public and private insurance does not mandate a single-payer system allows for a single-payer dominant system sets the terms of competition different degrees of tax-funded subsidization of public insurance versus private payment/private insurance

    24. What is the Canadian model? does not preclude competition between publicly and privately funded services or competition between public and private insurance does not mandate a single-payer system allows for a single-payer dominant system sets the terms of competition different degrees of tax-funded subsidization of public insurance versus private payment/private insurance public insurance insulated from adverse selection individuals may opt out of provincial insurance premiums/coverage cannot opt out of provincial taxes!

    25. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    26. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    27. Should Canadian Healthcare be a Model for the US? performance objective criteria optimizing among competing goals quality (e.g. physician perceptions) access (e.g. unmet health care needs) effectiveness (e.g. survival rates, avoidable events) cost and cost control (over time)

    28. Total Health Expenditures, % of GDP, Canada, 1992-2008

    29. Should Canadian Healthcare be a Model for the US? performance objective criteria optimizing among competing goals quality (e.g. physician perceptions) access (e.g. unmet health care needs) effectiveness (e.g. survival rates, avoidable events) cost and cost control (over time)

    30. Should Canadian Healthcare be a Model for the US? performance objective criteria subjective (public) perceptions quality and general satisfaction caveats insurance status sicker adults indirect evidence of public perceptions fundamental reform of the Canadian health funding system is not on the political agenda

    31. Should Canadian Healthcare be a Model for the US? performance objective criteria subjective (public) perceptions

    32. Should Canadian Healthcare be a Model for the US? performance objective criteria subjective (public) perceptions similar problems

    33. Should Canadian Healthcare be a Model for the US? performance objective criteria subjective (public) perceptions similar problems esp. fee for service vs. capitation cost-shifting

    34. Should Canadian Healthcare be a Model for the US? performance normative implications of different models

    35. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    36. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model?

    37. Nowtell me something interesting, David. Hillary Rodham Clinton to David Himmelstein, 1993

    38. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? could Canadian health care be a model? feasibility of reforms that would move the US system closer toward the Canadian model in the long-term

    39. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits which paved the way for public benefits

    40. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic

    41. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favorable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic public predisposition toward/against public insurance is not immutable

    42. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favorable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic public predisposition toward/against public insurance is not immutable impressive resilience of the public insurance element of the Canadian system

    43. Public Expenditures as Proportion of Total Health Expenditures, Canada, 1996-2008

    44. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favorable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic public predisposition toward/against public insurance is not immutable impressive resilience of the public insurance element of the Canadian system

    45. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic length of time for system implementation

    46. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic length of time for system implementation comprehensive universal public health insurance proposed in 1942 national hospital insurance 1958 national physician care insurance 1968-1971 CHA 1984 (effective 1987) system remains incomplete by standards of 1945 blueprint

    47. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic length of time for system implementation

    49. Health Care and Hockey proposing universal public health insurance in US is tantamount to selling the US a product that is about as American as hockey. (Birch, 1993) National Hockey League new NHL franchises since 1993 US +6 Canada -2 US (2008) 24/30 NHL franchises Stanley Cup winning franchises 1978-1992 Canadian 9/15 US 6/15 1993-2008 Canadian 0/14 US 14/14

    52. Political Feasibility of the Canadian Model politics of health care in the US gaining perspective on resistance reform period 1945-1965

    54. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? health care performance in Canada and the US could Canadian health care be a model? feasibility of the Canadian model

    55. Is Canadian Health Care a Model for the US? the Canadian model? should Canadian health care be a model? health care performance in Canada and the US could Canadian health care be a model? feasibility of the Canadian model

    56. What is the Canadian model? regulation of private purchase/provision of health services and private health insurance? private purchase of health services by individuals allowed (various provinces) physicians allowed to opt out of public plan and provide services privately except Ontario since 2004 private third-party insurance for health services allowed even for services that are otherwise publicly-insured (various provinces)

    58. Political Feasibility of the Canadian Model inception of health care in Canada occurred in political culture and institutional context no more favourable to public insurance than US displaced existing private benefits positive feedback -- created its own self-sustaining dynamic length of time for system implementation driven by powerful dynamics related to the politics of territorial integration