Tuesday, February 21st, 2017
Topic: Canadian Healthcare
- What’s working?
- What’s not?
- Are there other national models we can emulate?
- What about pharmacare?
- What about dental care?
Notes from the meeting:
We had 14 in attendance for our discussion on the present state of healthcare in Canada and what we would consider tweaking the system to make it work better for the country.
Before we started, Adrian Ludwin, Policy Chair for the Beaches Riding spoke to the group about an initiative to do outreach in areas with largely Conservative voters, focusing on getting them to talk about immigrants, refugees, and climate change.
The idea would be to use moral re-framing, active listening and other techniques to convince a segment of voters who normally don’t vote Liberal. For those interested in getting involved, contact Adrian at firstname.lastname@example.org
As for the healthcare discussion, we ranged over a number of issues. I provided some background context which I briefly referred to during our discussion and reproduce here.
Healthcare in Canada
Healthcare under our Constitution devolves to the provinces and territories. Not all healthcare services are covered by the provinces. Approximately 70% of total individual healthcare costs are covered. The remaining 30% are paid out of pocket or by third-party insurers.
All Canadian taxpayers contribute to publicly funded healthcare regardless of whether they use the system or not. The money raised from personal income tax is the principal means by which healthcare is funded. The distribution of contributions is slightly higher for the wealthiest. This allows the lowest income Canadians who would be at risk of going without, access to quality healthcare.
The Canada Health Act is the federal legislation that applies conditions to funds disbursed to the provinces and territories to fund each of their healthcare mandates. The federal contribution to the total cost of healthcare delivery has been declining for years. Public administration of healthcare under the Act must be delivered on a not-for-profit basis.
The Act covers hospitals, physicians, and surgical dentists. Does not, for the most part, cover other healthcare delivery services including dentists, optometrists, physiotherapists, and medications (other than programs for seniors in some provinces).
Provinces, at their discretion, may offer healthcare services going beyond those described under the Canada Health Act.
Employers or private individuals may purchase or provide supplementary insurance plans to cover dentists, corrective lenses, medications, homecare, physiotherapy, and other healthcare services.
It is, therefore, a more apt description to call Canada’s single payer system as primarily a physician care service.
The federal government runs its own programs to First Nations and Inuit, to military veterans, and to members of Parliament and the Senate. Measuring the quality of care delivered to reserve First Nations and Inuit indicates a quality level well below that delivered to other Canadians.
How does Canada’s system compare with other publicly-funded healthcare programs?
Austria – mandatory public health insurance
Belgium – health insurance for all major risks is compulsory
Denmark – a national health service funded from general taxation revenue – 85% publicly paid, 15% is user co-payment
France – compulsory insurance coverage for almost entire population for all healthcare services
Germany – a mix of private and public coverage
Greece – a national health service combined with private healthcare delivery services creates a two-tier system
Ireland – a national health service with some co-payment for services delivered. A combination of hospital doctors under salary and private physicians practices
Italy – compulsory health insurance with a national health service delivery model. Physicians either independent or employees of local health boards
Netherlands – compulsory insurance combined with private healthcare coverage
Portugal – national health service and compulsory health insurance. State-run health centers with salaried doctors
Spain – national health service covered by general taxation and compulsory insurance. Salaried doctors working in health centers
Sweden – comprehensive public healthcare delivery with revenue coming from national and local taxes. Physicians salaried
UK – national health service plus private care two-tier system. Private care sector is small. Doctors under national health service are salaried. Private care physicians are independent contractors
Costs of these country-based healthcare programs, as a percentage of GDP, vary from 6 to over 10% with the higher cost associated with mixed public-private programs. Canada is at 10.9% of GDP. In comparison the U.S. is at17.5%. Much of the burden of extra cost in the U.S. comes from administering their system.
The level and quality of care and services vary from country to country. Many have doctor shortages, a common problem for most of the national programs I surveyed.
The questions I raised for us to discuss included the following:
- Are Canadians best served by a public single payer system of healthcare? What’s working? What’s not?
- Can our single payer system absorb additional programs such as dental care, pharma care, physio and pain therapy, corrective lens and other mainstream healthcare services?
- Are there technologies that can make the delivery of the single payer system more economical and inclusive including improving healthcare access for remote First Nations reserves to overcome gaps in quality of service?
- Should the federal government be loosening the reins on the Canada Health Act to allow for jurisdictions to experiment with different delivery models including private primary and specialty physician clinical services?
- Or should the single payer system require all doctors to be salaried? We discussed all of these questions.
Points brought up by those in attendance talked about improving efficiency of the system (an electronic health record for example), recognizing the importance of mental health resources and accessibility, addressing programs beyond what is currently covered, getting the federal government to become the sole purchaser of pharmaceuticals in the country to drive down costs, expanding the formulary to include new breakthrough drug therapies for cancer and under life-threatening diseases, and experimenting with a mix of public and private delivery of healthcare services.
When asked if doctors should be salaried, those in attendance voted 11 to 3 in favour of salaries versus fee-for-service, the current primary physician model.
When asked if Canada should institute a co-payment strategy so that services could be expanded to include programs currently not covered under the single payer system, the response was unanimous in favour. Those in attendance added a proviso, that private insurance adjustments would have to be made, that there would have to be a safety net for the poor, and that co-payments would have a cap limitation beyond unaffordable costs to those receiving healthcare services.
Please add any additional observations you may remember from our meeting and share them with the group.
Our next meeting will be on Tuesday, March 14th.
The venue is yet to be determined. If you have recommendations for an alternate site to the Midtown Gastro Hub, or Grano’s (the latter may not be available for the foreseeable future because of family illness) then please let me know as soon as possible.
Our topic in March will be, based on your feedback from the attendance form, a look at Canada’s Economy: Employment, Environment, Trade and Trump.
Once again, thank you for your continued participation in these valuable conversations.