Health Care in Canada: Who Does What?

Ryan ClarkeThursday, April 16, 2015

Overview

• About Advocacy Solutions®

• Overall Structure

• Role of the Federal Government

• Role of the Provincial/Territorial Governments

• Delivery vs. Financing

• Key Players

• Current Challenges

• Advocating to Politicians vs. Bureaucrats

Advocacy Solutions®

• Business committed to providing a voice to organizations and individuals through the development and implementation of impactful advocacy strategies

• Three core services:

– Training and development

– Creation of strategic plans

– Implementation of strategies

In Canada?

Overall Structure

• In general, health care in Canada is publicly funded, but privately delivered

• This means that while the vast majority of health care services are “free” at the point of use, they are delivered by private providers i.e. physicians

• The provinces are constitutionally responsible for the administration and delivery of health care services under s. 92.7 of the Constitution Act, 1867:

– The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary (charitable) Institutions in and for the Province, other than Marine Hospitals

Federal Role

• The role of the federal government is to:

– Assist in financing provincial and territorial health care services through fiscal transfers

– Set standards and principles upon which transfers are contingent

– Deliver health care services to specific groups

– Provide and fund other health-related functions

House of Commons

Canada Health Act, 1984

• The Canada Health Act (1984) is Canada’s federal health insurance legislation

• It establishes the criteria and conditions related to insured health care services – the national standards – which the provinces and territories must meet in order to receive the full federal cash transfer contribution

• Historically, insured services are largely restricted to care delivered in hospitals or by physicians

Canada Health Act, 1984

• The Act states that "the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”

• To do so, the Act lists a set of criteria and conditions that the provinces and territories must follow to receive their federal transfer payments: public administration, comprehensiveness, universality, portability, and accessibility

• There is also a requirement that the provinces ensure recognition of the federal payments and provide information to the federal government

Provincial/Territorial Role

• Administration of their health insurance plans• Planning and funding of care in hospitals and other

health facilities• Services provided by physicians and other health

professionals• Planning and implementation of health promotion and

public health initiatives• Negotiation of fee schedules with health professionals

Ontario legislatureBC legislature

Delivery vs. Financing

• Health care delivery refers to the manner in which medical services are organized, managed and provided

• In large measure, health care is delivered through private providers

• The health care industry is the second largest employer in Canada (over two million people)

• They can be divided into three types of services:

– Primary care

– Secondary care

– Additional care

Delivery vs. Financing

• Health care financing refers to how medical services are paid for

• In large measure, health care is financed through public funds, but that is evolving

• Total health care spending in Canada was expected to reach $214.9 billion in 2014, averaging $6,045 per person

• Financing comes from three primary sources:

– Public

– Private

– Out-of-pocket

Timing is Everything…

Key Players in Delivery

• Hospitals – representing almost 30% of total health care expenditures

• While independently operated, all hospitals in Canada are regulated by the provinces and territories (even the private ones)

• Drugs – representing almost 16% of total health care expenditures

• Includes brand and generic, those delivered inside hospitals (publicly funded) and outside hospitals (mixed funding)

• Physician services – representing almost 15% of total health care expenditures

Other Key Players

• Canadian Institute of Health Information

– mandate is to lead the development and maintenance of comprehensive and integrated health information that enables sound policy and effective health system management that improve health and health care in Canada

• Canadian Institutes of Health Research

– mission is to create new scientific knowledge and to enable its translation into improved health, more effective health services and products, and a strengthened Canadian health care system

• Canadian Agency for Drugs and Technologies in Health

– provides decision-makers with the evidence, analysis, advice, and recommendations they require to make informed decisions in health care

Other Key Players

• Mental Health Commission of Canada

– a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues

• Canadian Partnership Against Cancer

– an independent organization funded by the federal government to accelerate action on cancer control for all Canadians

• Canada Health Infoway

– jointly invests with every province and territory to accelerate the development and adoption of health information and communications technology projects in Canada

Other Key Players

• Health Council of Canada

– The Health Council of Canada's role is to let Canadians and their governments know how progress towards the vision laid out in the health accords is coming along, to better enable decision-making at all levels

• Canadian Patient Safety Institute

– provides a coordinating and leadership role across health sectors and systems, promotes leading practices and raises awareness with stakeholders, patients and the general public about patient safety

• Provincial Health Quality Councils

– report directly to the public on the quality, safety and performance of health services and the health system in given provinces

Other Key Players

• Regional/Local Health Authorities

– provide the delivery of operational public health care services by geographic region

• Patient/Advocacy Groups

• Patients/Caregivers

• The Public

Current Challenges

• On September 16, 2004, the Canadian government announced $41 billion over the next 10 years of new federal funding in support of the action plan on health

• That Health Accord expired in 2014 and the federal government did not negotiate funding leading up to last year - just measurement, accountability and best practices

• The funding is set – an increase of six percent in the first three years, and a minimum of three percent in the remaining seven years

Current Challenges

• On September 16, 2004, the Canadian government announced $41 billion over the next 10 years of new federal funding in support of the action plan on health

• That Health Accord expired in 2014 and the federal government did not negotiate funding leading up to last year - just measurement, accountability and best practices

• The funding is set – an increase of six percent in the first three years, and a minimum of three percent in the remaining seven years

• In 2013, health care accounted for about 38% of provincial/territorial government spending: BC 43%, AB 38%, SK 37%, MB 44%, ON 41%, PQ 30%, NS 46%, NB 40%, PEI 38%, NL 37%

Federal/Provincial Government Structure

Minister:

– Political staffers

– Serve at the pleasure of the Crown

– Sole purpose is to serve their Minister and their political interests

– Transitory positions

Deputy Minister:

– Hierarchical structure below

– People under DM do not serve at the pleasure of the Crown

– Sole purpose is to serve the public in an impartial manner

– Permanent positions

Advocating to Politicians

• Ensure that your key messages are clear, compelling concise and consistent – with one ‘ask’

• Assume they know nothing about your issue

• Find out everything you can about that person and their potential link to your issue

• Where possible, link your issue to their stated political objectives or public policies i.e. Families First

• Bring your issue down to the riding/personal level

• Position your issue within the context of the election cycle

• Position your issue as a political ‘win’

• Selectively engage the opposition to leverage the gov’t

• Keep them informed of your engagement with the bureaucrats

• Be prepared to be assertive/aggressive if necessary

Advocating to Bureaucrats

• Ensure that your key messages are clear, compelling concise and consistent – with one ‘ask’

• Find out everything you can about that person, including past roles, career track, etc.

• Where possible, link your issue to gov’t programs and initiatives i.e. disease strategy

• Have people who can speak to the technical or clinical aspects of your issue

• Know where you are in the election cycle

• Keep them informed of your engagement with the politicians

• NEVER blindside a bureaucrat

Advocacy Solutions®

Contact Information:

Ryan Clarke, LL.B.t. 905.891.0311

f. 905.891.0366

ryan@advocacysolutions.ca

www.advocacysolutions.ca