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Canadian Health Care Policy

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Emma van Vliet

on 27 January 2015

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Transcript of Canadian Health Care Policy

62
ECG
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Thank You!
Learning Objectives
1) Have a general understanding of the Canadian healthcare system and its funding policy

2) Recognize how privatization and a two-tiered health system affects and would affect Canadians

3.) Gain an understanding of the impacts of the Interim Federal Health Program cuts on the health care system and refugee care
History of Canada's medicare
Canada operates as a single-payer healthcare system. This means instead of a bunch of private funding for your healthcare (like your parents or your employers), the government pays for all necessary healthcare.

Here's an online exhibition at the Canadian Museum of History which outlines how healthcare in Canada has evolved over the years (Yay, Tommy Douglas!). Check it out before we go in-depth into one social policy affecting healthcare called the Canada Health Act (CHA).

Canadian Health Act
-Adopted in 1984
-piece of Canadian
federal
legislation
-outlines conditions and criteria of
provinces and territories
’ health insurance programs so they may receive federal transfer payments under the
Canadian Health Transfer (CHT)

-for example: Ontario's insurance program is OHIP = Ontario Health Insurance Plan
Two-tiered Health Care?
Although Canada is not officially a two-tiered health care state, it is evident that
health care is not universal
. Everyone does not have access to the same things, and this often disadvantages those with a lower socioeconomic status.

As in most cases, there are two sides to every story. This slide will explore some pros and cons of a two-tiered health care system.
Interim Federal Health Program
“Provides limited, temporary, taxpayer-funded coverage of health-care benefits to people in the following groups who are not eligible for provincial or territorial health insurance: protected persons,
- including resettled refugees;
- refugee claimants; and.
- certain other groups.” (Government of Canada)

This program provided refugee persons with health care coverage while in Canada. However, “On June 30, 2012, IFHP funding was cut for refugee claimant healthcare," leaving refugees with limited benefits
(Evans, Caudarella, Ratnapalan, & Chan, 2014).

How does our healthcare system work anyhow?
By: Nusaiba Al-Azem, Ashley Patterson, Emma van Vliet
Canadian Health Care Policy
Implications of IFHP Changes to Policy for Refugees
Canada's "Universal" Health Care
As we know, Canada's health care system only covers a
percentage
of health care services and materials needed by citizens.
What OHIP
Covers
http://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic00e.shtml
What OHIP
Doesn't Cover
physicians for medically necessary services
emergency dental surgery within hospital
annual eye exams for those under 20 and over 65
health services required in other provinces
MAY cover a set amount for services outside of Canada
Basically: The federal government dumps money onto the provinces & territories if they follow specific rules so that each one can pay for its residents' healthcare
Prescription drugs
regular dental visits
dental procedures
eye glasses
assisted devices
social work / counseling
Those "rules" or criteria for eligibility for the Canadian Health Transfer are that provinces (or territories) uphold these basic principles:
1)
Public Administration
-the insurance plans have to be operated by a public authority (so, the provincial government)
2)
Comprehensiveness

-this plan insures all services in a hospital, done by a medical practitioner, or any surgical dental procedures
3)
Universality
-all insured persons are covered on uniform terms and conditions
4)
Portability
-because provinces administer healthcare based on their own policies, the CHA says all provinces need to operate so that citizens can move about and seek healthcare in another provinces. There are sometimes sticky situations here, especially with Quebec (who doesn't have an agreement with provinces, except for between hospital charges).
5)
Accessibility

-reasonable access for everyone
http://www.health.gov.on.ca/en/public/publications/ohip/services.aspx
How are other health needs covered?
Main objective of the CHA as outlined in section 3: "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."
This leaves all services that are not covered through OHIP to be paid for by the individual.
private insurance can be purchased
employers insurance may be used
Ontario Drug Benefit can be accessed for those on social assistance, seniors, those whose drug costs are high relative to their income, and if you are in long term care or enrolled in the Home Care system
The Link to Social Determinants of Health
IFHP Cuts
Our current system starts to show how our health care is
not
the same for everyone in the population
Certain people experience more health benefits while others experience poor health benefits
"Health Services" is one category that Raphael states is a determinant of health
"Nevertheless, there are continuing issues to access of care. The bottom 33% of Canadian income earners are - as compared to the top 33% of income earners - 50% less likely to see a specialist when needed, 50% more likely to find it difficult to get care on weekends or evenings, and 40% more likely to wait 5 days or more for an appointment with a physician" (Raphael, 2010, p38).
More Raphael
These Cuts included:
“1. All refugees (excluding government assisted refugees) lost access to medication coverage, vision and dental care though IFHP”
 
2. People from designated countries of origin (DCO) no longer have health coverage including for urgent or essential care except what is covered below:
- Issues of public health concern-these are infections that are on the Public Health Agency of Canada notifiable diseases list and involve human to human transmission
(note this does not include common infections such as pneumonias, pyelonephritis etc. or even conditions such as malaria)

- Issues of public security concerns-this is defined as psychotic conditions where a person has been identified as being a danger to others (this does not include suicidal intent)

(Doctors for Refugees)

"Canadians with below-average incomes are
three times
less likely to fill a prescription due to cost than above average income earners. Even average-income Canadians are almost twice as likely to have problems getting prescriptions filled and paying medical bills than above-average earners" (Raphael, 2010, p 39).
If we can eliminate these determinants as barriers, health will be more consistent across the country
if we cannot eliminate these determinants we should at least create a health care system that does not increase the barriers for people at risk
Raphael's Recommendation: Pharmacare
http://pharmacare2020.ca/#!/
Government's Reasoning for IFHP Cuts
1.)
Cost-
The government believed these cuts will save Canadian taxpayers “100 million dollars over the next 5 years.” (Doctors for Refugees)

2.)
Deterrence
-
The government believed many refugees come to Canada for the primary reason of seeking better health care. Thus, cutting health care will deter refugees from Canada. (Doctors for Refugees)

3.)
Equity-
The government believed the
previous IFHP provided refugees with
superior health care compared to a
Canadian citizen. (Doctors for Refugees)

DCO's: will include countries that do not normally produce refugees, but do respect human rights and offer state protection.
Basically, those countries that the Canadian government considers to be "safe."
Pros
Cons
OMG, do we have a socialized healthcare system?!
NO!
increased pay for doctors which will give more incentive to stay within Canada to practice
decreased wait times - those who can afford private practice will have a smaller pool of patients, this will also decrease the numbers relying on public health care

We have a socialized
INSURANCE
system.

This means that doctors still work in the private sector -- it's not public delivery (like in the UK), it's public FUNDING or coverage for a combination of public and private delivery!
Here's a video describing the system and contrasting it with America's medicare:
will not solve as many problems as initially thought
most people will still rely on public health care for majority of services because they are receiving them for free
wait times will actually increase as doctors move from the public to private sphere
For your own reading...
What kind of social policy model does this reflect?
Here are some articles discussing some of the deficits of a two tiered health care system.

http://www.theglobeandmail.com/globe-debate/how-canadas-health-care-system-contributes-to-inequality/article17691727/

http://www.canadiandoctorsformedicare.ca/Press-Releases/two-tier-health-care-not-the-solution-for-doctors-or-their-patients.html
http://www.health.gov.on.ca/en/public/programs/drugs/benefits/odb/odb.aspx
- “There is concern that the changes in healthcare coverage will lead to a worsening of the health disparities in already vulnerable populations, worsen health outcomes and increase health care costs ” (Evans et al., 2014).

- Individuals not only lose access to medical care but they also lose “psychological support services for refugees who are survivors of torture, rape or other organized violence” (Canadian Council for Refugees).

- These IFHP cuts will lead to a greater deterioration to an already vulnerable population.

Because it's a
universal
policy, it could reflect the following model:

"
The Rights Model
(Marshall, 1965) which argues that the best way to ensure the welfare of citizens is to institute
universal entitlement
to the following three rights: (1) civil rights that guarantee individual liberty and equality before the law; (2) political rights that ensure the right to vote and seek political office; and (3) social rights that ensure equal access and opportunities to all social institutions."

Source: Graham, J. R., Swift, K. J., & Delaney, R. (2012) Canadian social policy: An introduction (4th
ed.), Toronto: Pearson.

References
Martin, Danielle. 2010. Two tier health care not the solution for doctors or their patients.
Canadian Doctors for Medicare
. http://www.canadiandoctorsformedicare.ca/Press-Releases/two-tier-health-care-not-the-solution-for-doctors-or-their-patients.html
Take this quiz to test your knowledge on how Canada's health care system works!
True or False
Source: Canadian government website: http://laws-lois.justice.gc.ca/eng/acts/c-6/index.html
1) Doctors are government employees.

2) Canada's health care is controlled by the federal government.

3) Health care services are funded equally across the country.

4) Patients cannot be charged a 'user fee' for services.

5) Financing for health care comes from both private and public sources.

Answers
1) Doctors are government employees.
FALSE - Most doctors are self employed. They earn money by billing the government for the services they provide.

2) Canada's health care is controlled by the federal government.
FALSE - Canada technically has 15 different health care systems. While all of the funding comes from the federal government, each province and territory controls its own health care. They have different different things that are covered, and different criteria for determining coverage.

3) Health care services are funded equally across the country.
FALSE - The Canada Health Act requires certain things to be the same across the country, but each province decides how most of the money is spent.

4) Patients cannot be charged a 'user fee' for services.
TRUE - Doctors cannot charge a user fee for services that are already being funded by the Canadian Health Act Doctors receive money from the government for these services and cannot charge you.

5) Financing for health care comes from both private and public sources.
TRUE - Our health care is not fully funded by public funding. Canadians pay for approximately 30% of their health care.


IFHP Impact on the Health-Care System
- Although the IFHP will reduce the costs at a Federal level, these changes are leading to “a downloading of the costs for refugee care to hospitals and therefore, provinces” (Evans et al., 2014).

- Many of these doctors and hospitals do not want to refuse care to patients in need, and thus take on the costs themselves (Doctors for Refugees).

- Thus, the projected savings as a result of the IFHP cuts are not as great as projected, and instead only a transfer of where the money is coming from.

Social Worker's Role in Advocacy
-The
Canadian Association of Social Workers
has been one of many professional organizations to appeal to the Citizenship and Immigration Minister to advocate for changes (Evans et al., 2014).

Martin, 2010
Other Professional Organizations involved in Advocacy...
Stabile, 2014
- Canadian Medical Association

- Canadian Federation of Nurses’ Unions

- The Public Health Physicians of Canada

- Canadian Nurses Association College of Family Physicians of Canada

- Canadian Association of Emergency Physicians

- Canadian Psychiatric Association

- Canadian Federation of Medical Students

- Canadian Doctors for Medicare

- Canadian Pediatric Society

- Canadian Society of Internal Medicine

- Canadian Association of Community Health Centre’s
(Doctors for Refugees)
Stabile, Mark. 2014. Why a two tiered health care system wont solve our woes.
The Globe and Mail
. http://www.theglobeandmail.com/globe-debate/how-canadas-health-care-system-contributes-to-inequality/article17691727/
Impacts of Advocacy
“After significant
public opposition
and a legal challenge on the basis of
violation
of the Charter of Rights and Freedoms, in July 2014, a federal court deemed the cuts to the refugee health program '
cruel and unusual
' treatment. The federal government was given four months, until November 4, to reinstate the original policy, and at the last minute, asked for a delay to reinstate the program. That delay too was denied by the Federal Court on October 31, so the government announced what it deems "
Temporary measures
for the Interim Federal Health Program," not quite a full reversal, while they plan to pursue a formal appeal.”

Arnold, 2007
Goel, 2014
Arnold, Rory. 2007. Should Canada allow two tier healthcare?
The Iron Warrior
. http://iwarrior.uwaterloo.ca/props/?module=displaystory&story_id=2969
Although this change represents great progress and advocacy work, the changes implemented are only
temporary,
as the government plans to appeal them. Thus, further advocacy needs to continue to occur in order to ensure the rights of refugees are protected.
Government of Ontario (2014). The Ontario Drug Benefit (OBD) Program. Retrieved from http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/odb.aspx
Value Competition Model and IFHP
Government of Ontario (2012). Health Services - Ontario Health Insurance (OHIP). Retrieved from http://www.health.gov.on.ca/en/public/publications/ohip/services.aspx
- Value Competition Model
(Rein, 1974) states, "society consists of people holding diverse values (world views) who are in competition with one another and, consequently, with one another’s values, in an effort to achieve
maximum power
” (Graham, Swift, & Delaney, 2012).

- The IFHP cuts were made with the conservative values and viewpoint of refugee care. This represents one world view. Those who advocate against these cuts represent an opposite world view.

- A competition occurred through actions of law in order to "achieve
maximum power
" of their beliefs.

Mikkonen, J. Raphael, D. 2010. Social determinants of health: The Canadian facts. Toronto: York University School of Health Policy and Management
Recommendations and the Role of Social Workers
References
Canadian Council for Refugees. Refugee health care: interim federal health program. Retrieved from http://ccrweb.ca/en/ifh

Canadian Doctors for Refugee Care. The issue. Retrieved from http://www.doctorsforrefugeecare.ca

Evans, A., Caudarella, A., Ratnapalan, S., & Chan, K. (2014). The cost and impact of the interim federal health program cuts on child refugees in canada. PLoS One, 9(5) doi:http://dx.doi.org/10.1371/journal.pone.0096902

Goel, R. (2014, 12, 25). What you need to know about canada’s refugee health program. Huffington Post Politics. Retrieved from http://www.huffingtonpost.ca/ritika-goel/canada-refugee-healthcare_b_6104694.html

Government of Canada (2014). Health care-refugees. Retrieved from http://www.cic.gc.ca/english/refugees/outside/arriving-healthcare.asp

Graham, J. R., Swift, K. J., & Delaney, R. (2012)
Canadian social policy: An introduction
(4th ed.), Toronto: Pearson.


The Canadian healthcare system clearly has some gaps. Our recommendations include:
replacing our current healthcare system with one that covers more, benefiting everyone in the population (ie including dental procedures, eye glasses, prescription drugs)
advocating for refugee rights, including fair treatment and access to medical treatments, interventions, medications etc.
The Royal Commission on the Future of Healthcare in Canada released a report (known as the Romanow Report) in 2002 suggesting that our system needs to modernize with the times - as healthcare moves away from hospitals and into homes, coverage should too.
Social Workers
we can commit ourselves to learning about the healthcare system in order to ensure we are knowledgeable, especially with respect to how to advocate (which level of government do you approach? etc)
we can contribute to the advocacy of human rights for refugees within Canada
we can learn about other subsidies (ie ODB) that can assist some of our clients
Please complete
2
of the 3 questions posted in the forum
References:

Canada. Department of Finance.Federal-Provincial Relations Division. (2005). Canada health transfer: CHT. (). Ottawa: Federal-Provincial Relations Division, Department of Finance.

Canadian Health Care Association. (1999). Funding canada's healthcare system: CHA policy brief. Ottawa: CHA Press.

Graham, J. R., Swift, K. J., & Delaney, R. (2012) Canadian social policy: An introduction (4th ed.), Toronto: Pearson.

Lee, J. K., & Noble, J. (2003). Understanding the romanow report. University of Toronto Medical Journal, 80 doi:10.5015/utmj.v80i2.805

Marriott, J., & Mable, A. L. (2012). Canadian primary healthcare policy: The evolving status of reform Canadian Health Services Research Foundation.
Full transcript