CANADA’S HEALTH CARE SYSTEM AND THE RIGHT TO HEALTH

Rhonda Ferguson

Outline

What does it look like and how did we get there? Historical antecedent and description

Canada Health Act Key features of the CHA Guiding principles and their relationship with

human rights What’s covered under Medicare? How effective is the Canadian health care

system and what are the challenges today? Aboriginal health

The future of health care in Canada Conclusions and questions

What does health care in Canada look like and how did we get there? Historical antecedents Health care delivery falls under the

jurisdiction of provinces and territories, not federal government

National health insurance program: Medicare Not a single national plan, but a program

comprised of provincial (10) and territorial (3) health insurance plans

Publicly funded, publicly and privately delivered

The Canada Health Act

The Canada Health Act is the country’s federal health insurance legislation It sets out the criteria and conditions which

must be met by the provinces and territories in order for them to receive their share of the federal contributions

Cash and tax transfers form the federal contribution to provincial and territorial governments

Key features of the Canada Health Act Key features

Public Administration Comprehensiveness Universality Portability Accessibility

Relationship to human rights Congruencies with human rights principles,

but fails to set out obligations and entitlements

What is covered?

Covered: Physician care Hospitalization (including drugs administered

while in hospital) Diagnostics Services that are medically

necessary/Emergency care Some drugs (varies provincially)

Not covered: Drugs (varies provincially) Vision care Dental (Children in Quebec covered)

Total amount spent on Health Care in Canada 1975 - 2011

National Health Expenditure Database, Canadian Institute for Health Information

Public- and Private-Sector Shares of Total Health Expenditure 1975-2011

National Health Expenditure Database, Canadian Insitute for Health Information

Total Health Expenditure by Use of Funds 2009 (Billions of dollars and percentage of share)

National Health Expenditure Database, Canadian Institute for Health Information

Effectiveness & Challenges

Effectiveness: Generally speaking, Canadians enjoy a relatively high health

status on all major health indicators. E.g. life expectancy is 79 years for males, 83 years for females

Challenges: Certain population groups experience illness disproportionately

as well as limitations on access to timely and appropriate care “The federal system of health care delivery for status First

Nations people resembles a collage of public health programs with limited accountability, fragmented delivery and jurisdictional ambiguity. Moreover, current health care services remain focused on communicable disease, while mortality and morbidity among Aboriginal peoples are increasingly resulting from chronic illness. Social access to health care is similarly limited or denied to Aboriginal peoples through health systems that account for neither culture nor language, or the social and economic determinants of Aboriginal peoples’ health” (National Collaborating Centre for Aboriginal Health).

Aboriginal Health in Canada Aboriginal groups in Canada consist of: First nations (“registered/status Indian”),

Metis, and Inuit. Health care for First Nations and some Inuit fall are federal government responsibility

Aboriginal populations have a significantly lower life expectancy and experience higher rates of nearly all diseases. E.g. life expectancy for Inuit is 64 years for males, and 73 for females

Although Non-status Indians may face similar socio-economic conditions, they do not have access to federal insurance schemes for greater coverage

Geography, climate, and living conditions make health care less available Aboriginals site not having regular access to family doctors, hospitals, or traditional

healing methods as obstacles to their health and well-being There is not enough data collected on some aboriginal populations (off-reserve

Aboriginals, Metis, and Inuit) to understand health challenges A human rights-based approach to care would ensure:

Measurement of progress and Accountability: Ensure data is collected, including on vulnerable groups

Vulnerable individuals and groups are given special consideration in policy formulation and care delivery

Culture and traditional practices are considered Participation by aboriginals in decision making about their health and care

Not a problem with funding, but rather with management of health care programmes and delivery, geography and a failure to address social and economic determinants of health

Health Conditions Comparison

Health Canada

The Future of Health Care in Canada Romanow Report suggestions

Electronic health records Greater accountability and monitoring needed,

especially in regard to Aboriginal health and care Common indicators needed to measure performance Direction of care must be based on needs of the

population Health Accord

Aimed to ensure sustainability ‘for a generation’ Expires in 2014 Federal government poised to decrease contributions

to provinces in 2016 Abdication of responsibility

Aboriginals excluded from talks

Conclusion

Overall, Canadians enjoy a high standard of health However, the health of vulnerable populations are not adequately

protected Greater accountability and data collection needed to ensure progress

and protection of vulnerable populations Lack of political will at the federal level poses problems for

provinces Lack of explicitly defined entitlements and duties mean politics

and hinder progress Sustainability threatened by rising costs

Greater efficiency and cost-saving measures needed: More responsibilities to nurse practitioners Electronic records Purchase drugs as a group, rather than each province Emphasis on prevention

Trend toward privatization will increase cost of care, while decreasing access

Questions?

r.ferguson1@nuigalway.ie