Health Care Transformation A Guide for Canadian Medical Students

Health Care Transformation

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The Canada Health Act The Canada Health Act (CHA) is the federal legislation that governs the

operation of health care insurance in Canada. Under Canada’s constitutional framework, health care policy falls predominately under provincial authority

and jurisdiction. However, the federal government plays a significant role in health care policy due to its constitutional spending powers. It provides

federal funds to the provinces and territories in support of their health insurance through cash and tax transfers called the Canada Health Transfer.

In order to qualify for full federal funding, the federal government has laid

out nine requirements the provinces and territories must fulfill in order to qualify for full federal health funding. These include five criteria, two specific

provisions, and two conditions.

The five criteria (referred to as the “national principles,”):

1. Public administration

Each provincial health care insurance plan must be administered on a non-profit basis by a public authority, which is accountable to the provincial

government for its financial transactions.

2. Comprehensiveness The health care insurance plan of a province must insure all services that are

“medically necessary.” The criterion of comprehensiveness refers in a way to a minimum basket of services, because the Act neither mentions the

quantity of services to be provided nor gives a detailed list of what services will be insured; provincial governments can define these. Thus, the range of

insured services may vary among provinces and from one year to the next.

3. Universality

All residents in the province have access to public health care insurance and insured services on uniform terms and conditions.

4. Portability

Requires provinces to cover insured health services provided to their citizens while they are temporarily absent from their province of residence or from

Canada. � For insured health services provided in another province, payment is

made at the rate negotiated by the governments of the two provinces.

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� For out-of-Canada services, the Act states that the amount paid will be at least equivalent to the amount the province of residence would have

paid for similar services rendered in that province.

5. Accessibility Insured persons must have reasonable and uniform access to insured health

services, free of financial or other barriers. No one may be discriminated against on the basis of such factors as income, age, and health status.

The CHA lays out key federal conditions that must be met by the

provinces/territories if they are to receive federal health care funding. The objective of the Act is to ensure that all Canadian residents have reasonable

access to health services without financial or other barriers. The purpose of this Act is to promote this reasonable access by setting out national

standards for provincial/territorial health insurance schemes.

The two provisions:

Free access to insured health services is the key factor of the Canada Health

Act. The two provisions of the Act specifically discourage financial contributions by patients, either through user charges or extra-billing, for

services covered under provincial health care insurance plans.

6. Extra-billing If a medical service is covered by a provincial or territorial health insurance

plan, medical practitioners and dentists are prohibited from directly charging the patient any additional fees related to that service.

7. User charges A user charge is any fee charged directly to a patient for using a publicly

insured medical service and is prohibited by the act.

The two conditions:

1. Provision of provincial information

Provincial governments are required by regulation to provide annual estimates and statements on extra-billing and user charges. They are also

required to provide an annual statement describing the operation of their plans as they relate to the criteria and conditions of the Act. This information

serves as a basis for the Canada Health Act annual report.

2. Provincial recognition of federal contributions Provinces are required to give public recognition of federal transfers.

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Health Care Transformation An Overview

Broad consultations are occurring across the country as we approach the expiration of the 2014 Health Accord. Decision makers, health care

providers, patients and their families are all talking about it. It’s time for medical students to join the conversation. Input from the future physicians

of Canada is of immeasurable importance to the process of health care transformation, in addition to valuable input from the other parties. Indeed,

health care transformation and its utility in enhancing the health care system is founded on such discussion.

As future health care leaders, we have a responsibility to maintain and

improve our current system so that it is sustainable for years to come.

While Canadians take great pride in Medicare and the Canada Health Act (1984), the current publicly funded system faces serious challenges in terms

of affordability and meeting the basic needs of Canadians in a timely manner.

Canada’s health care system is a cherished social program and an important contributor

to our country’s economic success. Our prized Medicare system is facing serious

challenges and cannot continue on its current path. Against this backdrop, in 2010, the

Canadian Medical Association launched a national public dialogue to initiate an open

discussion of what Canadians envision for our health care system and how to achieve

this. Based on cross-country consultations, the CMA, together with the Canadian Nurses

Association, developed common principles to guide the transformation of the health care

system to make centred on the needs of patients. As of January 2012, over 60 medical

and health and 14 patient advocacy groups have endorsed the CMA-CNA Principles to

Guide Health Care Transformation.

The CMA-CNA Principles are summarized as follows:

• Patient-centred: Patients must be at the centre of health care, with seamless

access to the continuum of care based on their needs.

• Quality: Canadians deserve quality services that are appropriate for patient

needs, respect individual choice and are delivered in a manner that is timely, safe,

effective and according to the most currently available scientific knowledge.

• Health promotion and illness prevention: The health system must support

Canadians in the prevention of illness and the enhancement of their well-being,

with attention paid to broader social determinants of health.

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• Equitable: The health care system has a duty to Canadians to provide and

advocate for equitable access to quality care and commonly adopted policies to

address the social determinants of health.

• Sustainable: Sustainable health care requires universal access to quality health

services that are adequately resourced and delivered across the board in a timely

and cost-effective manner.

• Accountable: The public, patients, families, providers and funders all have a

responsibility for ensuring the system is effective and accountable.

The Health Accord is set to expire on March 31, 2014, creating a window of opportunity to urge the federal government to take action. As medical

students and future physicians, these changes will affect us in a number of

ways. We have a chance to influence how we will deliver care to our patients. It is crucial to organize and develop a position reflecting the

interests, opinions, and concerns of Canadian medical students in order to have the greatest effect.

The Political Advocacy Committee (PAC) of the Canadian Federation of

Medical Students (CFMS) is hosting town hall discussions across the country in order to engage the medical leaders of tomorrow. A document outlining

the voice of Canadian students will be formulated, and this that will serve as a vehicle for advocacy, leadership, and education surrounding Health Care

Transformation. Broad consultation is essential in order to promote collaboration and commitment to sustainability.

With the ten-year-old Health Accord expiring in 2014, health care reform is

at the forefront of conversation between the provinces, the territories, and

the federal Minister of Health. It’s time for us to take action. Let’s advocate for targeted health care initiatives that will ensure the sustainability of our

current system and the delivery of the highest quality care to all Canadians for years to come.

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Topics of Discussion Topic 1: Targeted Initiatives to Enhance the Health Care System

The Canada Health Act as it stands today, covers only doctors and nurses, and has specific requirements for the provinces in order to receive federal

funding. What do you want to see added to the CHA?

Ideas for Discussion • The development and enhancement of electronic medical records

(EMRs); • National dental care strategy;

• National pharmacare strategy; • Strategies to address the social determinants of health (poverty,

violence, environment, housing, education, equity);

• Other

Topic 2: Sustainable Health Human Resources: Supply and Demand Canada's Health Human Resource Strategy (HHRS) was launched in 2004-05

and it aims to ensure that Canadians have access to the health providers they need though co-ordination and collaborative planning of health human

resources across the country. How can we deliver appropriate, timely and effective care now and in the future? How can we prepare and retain

sufficient highly skilled physicians in all specialties across the country?

Ideas for discussion: • A national strategy to ensure medical school and residency positions

are in line with projected demand in the Canadian population; • Invest in recruitment and retention strategies for physicians, nurses

and other health care providers;

• Delivery of health care services on reserves; • Introduce new providers, such as physician assistants and nurse

practitioners, to the health care workforce; • Other

Topic 3: Improving Value for Money

The sustainability of Canada’s health care system is in question. The amount Canadians spent on health care in 1997 has increased every year between

1975 and 2009 from $39.7 billion to $137.3 billion and the per capita spending has more than doubled. Despite the relatively high spending levels

vis-a-vis our peer countries, international comparisons consistently show that Canada’s health care system is an average performer at best.

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The Minister of Finance recently announced his plan to finance Canadian health care from 2014 to 2024. As it stands, the plan is for the federal

government to maintain a 6% annual increase in transfer payments for the first three years, after which point the annual increases will be determined

by the growth in nominal gross domestic product, with a minimum increase set at 3% per year.

How can we increase the quality of care provided and increase value for

money? What new standards for Canadian health care do you think would improve efficiency and value for money?

Ideas for discussion:

• Activity-based funding (i.e. incentives for efficiency) for hospitals in Canada to increase quality and efficiency of care;

• What are some best practices across Canada in terms of efficiency and

value for money; • Other

The Canadian Federation of Medical Students (CFMS) is a national organization that

represents over 7500 medical students at 14 medical schools across Canada.

With the support of:

The Canadian Medical Association (CMA) is the national voice of Canadian physicians.

Founded in 1867, CMA’s mission is to serve and unite the physicians of Canada and be the

national advocate, in partnership with the people of Canada, for the highest standards of

health and health care. The CMA is a voluntary professional organization representing over

76,000 of Canada’s physicians and comprising 12 provincial and territorial medical

associations and 51 national medical organizations.