About the case summary

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About the case summary

• 12 Font size Times New Roman
• Average 2-3 pages
• Name and student number
• First case summary due on September 26

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Canadian health care systems the past and the
future

• Objectives
• Understand principles of Canadian health care
  system
• Understand its evolution and how the system works
• Understand the current problems in the system

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QuizTesting your knowledge about the Canadian
Health Care System

• The health insurance plan of a province must be
  administrated and operated on a non-profit basis
  by a public authority accountable to the
  provincial government.
• True False

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• Medically services provided by hospitals and
  physicians are covered by Medicare.
• True False

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• All people living in Canada are entitled for the
  insured health services on uniform terms and
  conditions.
• True False

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• Additional charges to insured patients for
  insured services are not allowed.
• True False

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• Canadian residents are entitled to coverage when
  they move to another province within Canada, but
  not covered when they travel aboard.
• True False

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Principles of Medicare

• Public administration
• Comprehensiveness
• Universality
• Accessibility
• portability

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Canadian health care system

• Publicly financed, privately delivered
• The responsibility of provincial government -
• Management and delivery of health care services
• The responsibility of federal government
• Setting and administering of national principles
• or standards for the health care system
• assisting in the financing of provincial health
• care services through fiscal transfers,
  fulfilling
• functions for which it is constitutionally
• Responsible, and responsible for health
• protection, disease prevention, and health
• promotion.

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• Rely extensively on primary care physicians
• Account for 51 of all active physicians in
  Canada
• Paid on fee-for-services basis
• Act as gatekeeper of the Canadian health care
  system

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• 95 hospitals are non-profit entities
• Run by community boards of trustees, voluntary
  organizations or municipalities.
• Accountable to the communities they serve, not to
  the provincial bureaucracy

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Evolution of universal health insurance

• Prior to 1940s, private medicine dominated
  health care in Canada resulting in access to care
  being based on ability to pay.

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Evolution (contd.)

• 1947 the province of Saskatchewan introduced a
  public insurance plan for hospital services
• 1956 federal government, seeking to encourage the
  development of hospital insurance programs in all
  provinces, offered to cost-share hospital and
  diagnostic services on a roughly fifty-fifty
  basis.

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Evolution (contd.)

• By 1961, all ten provinces and the two
  territories had signed agreements establishing
  public insurance plans that provided universal
  coverage for at least in-patient hospital care
  that qualified for federal cost-sharing.

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Evolution (contd.)

• Public medical care insurance began in the
  province of Saskatchewan, providing coverage for
  services provided by physicians outside
  hospitals.
• By 1972, all of the provincial and territorial
  plans had been extended to include physicians
  services. The objective to have a national health
  insurance plan for hospital and medical care in
  Canada had been realized.

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How does the system work?

• Payers
• Provincial government Ministry of Health (MOH)
• Covers insured hospital and physician services
• Covers costs of certain non-insured services for
  certain specific population groups
• Controls the rate of adopting and diffusing
  expensive medical technology

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• Insurance companies
• Cover a range of health services that remain
  outside the national health insurance framework
• Workplace safety and insurance board
• Provide insured benefits to workers with
  work-related injuries or illness

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• Providers
• Hospitals teaching hospitals, general/community
  hospitals, small hospitals and mental health
  hospitals
• Physicians general physicians and specialists
• nurses

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• Other health care providers
• Include dentists, chiropractors, opticians,
  occupational therapists, etc.
• Voluntary organizations
• Ontario Gerontology Association (is an
  incorporated voluntary organization concerned
  with aging, thereby promoting quality of life for
  older adults. Its membership provides an
  inter-disciplinary forum for those involved in
  the field of gerontology)

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Problems in the health care system

• Emergency overcrowding
• Doctor shortage
• One in four Ontario doctors will retire in four
  years
• By 2020, 30 of Ontarios population will be over
  the age of 55.
• Waiting time
• Access to health care providers, diagnostic
  tests, specialty treatment, hospital beds

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• Waiting time examples
• Six months to obtain a hip replacement
• Five months to get a CAT scan
• Some patients wait more than a year for cardiac
  surgery
• Some cancer patients go to the States for
  treatment
• 2/3 Canadian physicians are finding it difficult
  to get appropriate resources such as diagnostic
  tests, referrals or operating room time for their
  patients.

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• Waiting time for the access to health care
  services
• Waiting time for unmet need and/or inadequate
  resources within the health care system

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Health care crisis or Really?
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Environmental factors

• Aging population (30 of Ontario population over
  55)
• Physicians leave outnumber those who have
  returned
• ¾ family physicians are unable to accept new
  patients
• Funding constraints
• People demands high quality services

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Long-term impact

• Personal life
• Work
• Economic development
• The Canadian health care system is one of the
  central determinants of our industrial
  competitiveness and our quality of life.
  (Conference Board of Canada, 1998)

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Causes

• The system
• Organized around acute care, rather than chronic
  care (reactive vs. proactive)
• Task-oriented rather than customer-oriented
• Lack of integration
• Lack of cost-saving incentives
• Hospitals
• Physicians
• patients
• Gatekeeper, is it necessary?

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• Ourselves
• Lack of medical knowledge
• Misuse
• Healthy life style

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Changing paradigm

• Old New
• acute care continuum of care
• treating illness maintaining and promoting
  wellness
• Individual patients defined population
• Provider similar differentiation
• Inpatient admission people health
• Fill beds provide timely care
• Separate org. Integrated system
• Run organization oversee a market
• Managers as depart.heads operate across
  organizations
• Coordinate services purse quality improvement

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Possible solutions
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Reforming the Canadian health care system

• Reforming primary health services (150
  physicians, 220,000 patients, 7 sites)
• Availability of a nurse practitioner to enhance
  access to primary care
• 24-hour access to care
• No change in the waiting time
• Quality of care is considered to be good or very
  good
• Patients were very satisfied

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• Hospital Services Restructuring Committee (HSRC)
• Horizontal integration within the hospital sector
• Result in extensive cost reduction and
  rationalization of services within the hospital
  sector
• But heavier load for hospital personnel

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• Physicians
• High level of satisfaction except those in
  Chatman
• No change in their practice patterns
• Some found unable to offset the extra costs of
  information technology
• Found difficult in providing on-all coverage
  (since they cant bill for the telephone advice)
• Unrealistic expectations from the government
• Information technology acquisition process
  (lengthy, resource-intensive, inefficient, and
  fragmented)

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The Western Canada Waiting List Project is a
consortium of medical associations, regional
health authorities, health research centres, and
ministries of health, which will develop valid
reliable, clinically transparent and useful tools
to assist the management of waiting lists in
cataract surgery, children's mental health,
general surgery, hip and knee replacement, and
MRI scanning
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Sources of information

• http//www.hc-sc.gc.ca/
• http//www.cihi.ca/

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Fully 82 agree with the idea that we need long
term, sustainable funding to improve the health
care system in Canada. Moreover, almost half
(49) think government spending on health care
should be increased even if it means higher
income taxes.
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• Health care misuse

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• Privatization
• Pay for some services
• Expanding the public health care system (cover
  all costs)

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What does the waiting time telling us?
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What do Canadians think their system?

• Generally speaking, Canadians assign the overall
  quality of the health care system a fairly
  positive rating.
• At least six in ten give the health care system a
  B grade or better in terms of overall quality,
  choice of
• health services, and their most recent
  interaction with the system.

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• They are most positive about access to their
  family doctor, to walk in clinics, and access
• for children and seniors (at least five in ten
  assign a B grade or better). Across the other
  accessibility
• dimensions tested (e.g., access to medical
  specialists, diagnostic equipment, and emergency
  room
• services) Canadians are less positive in their
  assessment of the health care system. The
  majority assign a
• C grade or worse in terms of accessibility to
  these health care services.

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• Only
• 5 give the federal government's performance in
  dealing with health care in Canada a very
  positive
• rating (i.e., an A) six times as many (30) give
  the federal governments performance in this area
  a
• failing grade. Similarly only 6 think the
  provincial government is doing a very good job in
  dealing with
• health care in their province (A rating), while
  fully 35 give their provincial government a
  failing grade.

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• Confidence in Various Players to Improve Health
  Care
• When asked how much confidence they have in each
  of a range of players to improve the health care
  system, health professionals such as doctors and
  nurses, and voluntary health organizations are
  given the highest confidence levels among the
  players tested. Two in three Canadians feel
  confident these groups can help to improve the
  health care system. Confidence levels drop
  sharply for both the federal and provincial
  governments. Only one in five Canadians express
  confidence in either federal or provincial
  government officials and politicians to help
  improve the health care system. Over twice as
  many express little confidence in the two senior
  levels of government to improve health care.

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Canadians express mixed views regarding the
health care system. The majority (61) believe
that manypeople misuse the health care system.
Fifty-three per cent think the Health care system
needs a completeoverhaul (only 14 disagree with
this idea). Moreover, only 17 believe there is
nothing wrong withCanadas health care system
(three times as many disagree).
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• Despite these pessimistic views of health care, a
  majority of Canadians (58) think Canadas health
  care system is one of the best in the world (only
  12 disagree with this notion), and a substantial
  minority (45) think the current health system
  provides the best possible health care for them
  and their family.