Introduction
Canada is a progressive country, not far behind the United States, the UK, and other developed countries in Europe. But it has a big problem with its health care system. There are discrepancies in the implementation of health care plans at the federal level down to the provincial level.
The health care needs of a people, like other basic needs, should first be addressed by a government before anything else. But when a country has grown so rapidly and the many programs of government have become intertwined, a solution might be difficult and may take too long to implement.
The Canadian health care plans which are admired throughout the world are under threat because of various factors, like lack of communication between the provincial and federal governments, lack of proper funding from the federal government, undefined roles of the various stakeholders in the health profession, and many more. Federal funding for health care had declined since the 1970s and provincial governments were pressured to fund the programs and control the increasing rates. Many provinces were forced to reduce the hospital bed supply and similar aids to the hospitals. Health care has also been very much affected by rising costs.
Set against the backdrop of the twenty-first century, with all the globalization and information technology (IT) complexities, collaboration is seen as a powerful force by public and private sectors in service delivery especially in the health sector. But this seems to be what has been lacking between the Canadian provincial and federal governments. Sources of funding have to be clearly defined because this is one of the primary causes at a time when the federal government reduced it to the minimum.
There is also the question of quality. Quality in health care refers to some areas which have to be addressed in delivering health care to a big population. There are three areas involved which are cost, quality, and access. Poor quality health care is not health care when it does not deliver what is expected of it. Cost should be one that is affordable and accessible.
Quality includes safety for clients or patients. Support workers and carers must wear appropriate protective clothing when taking care of a patient’s body, such as disposable aprons and gloves. The duty of care of private and public caregivers goes as far as providing the best care that they should give. The duty of best care should be provided to all needing care without exception. Support workers must exercise ‘reasonable skill and care in their relationship with their employers and clients. Quality also recognizes diversity, equality, inclusion and promotes the rights of individuals.
How to provide adequate care for people needing care is the responsibility of both the public and private sectors. The government must provide the tools and the motivation. There has to be a good communication process between the various stakeholders. Collaboration between public and private agencies is a must. This is where quality health care is most needed.
Background
The Canada Health Act of 1984 restored the people’s belief that every citizen should have the necessary health care that is timely, portable, and equitable and should not depend on one’s capacity to pay. Canadians believe that this is part of their heritage.
The Canada Health Act embodies five basic principles that reflect Canadian cultural values, a guide for public policy. The “principle of universality” fosters equality for all Canadians. The “principle of comprehensiveness” states that all hospitals and clinics including physicians and staff, and even dental cases that need hospitalization, should be covered by insurance. The “principle of accessibility” provides the elimination of financial barriers so that every citizen is afforded health care services regardless of income. Lastly, the “principle of portability” ensures that Canadians are provided health care insurance regardless of where they are in any part of the globe.
The Act is comprehensive and covers every aspect of human need with respect to health care. But what is wrong with the Act now? What went wrong along the way? And why are Canadians having a problem with the health care services of the government despite this good piece of legislation?
To us, this is a problem of implementation. A fact that can be cited as an example is that the government spends more than $47 billion annually for the hospitalization of its citizens and also has 70,000 hospital beds believed to be available for everyone. But accessing these benefits is a problem. Therefore, it is a problem of implementation, the implementers, and the wrong programs that have implemented the plans.
The Problem
Patient waiting time for diagnostic and surgical procedures, unavailability of high-tech equipment, and lesser staff positions are some of the problems associated with the Canadian health system.
Reducing patients’ waiting time in diagnostics and surgery is one of the major problems. This pertains to the amount of time spent by patients while waiting. Studies have found that patients would just leave the clinic without being attended to after a certain lapse of time. Steps have been instituted to help patients suffer the fate of waiting without acquiring the necessary medical service they have waited for. Concern with long waiting time is not unique in this age of the information revolution. The issue of reducing patients’ waiting time has been present for many decades. But this is only the tip of the iceberg. What is serious is the problem of funding.
Apart from funding is the issue of structure which had long been neglected by the federal government. Provincial governments were unguided and those which saw some light of day made successful independent programs, i.e. without the help of the federal government. These programs included integrating hospitals, private nursing homes, and other medical practices. The provincial governments were successful in reaching the rural areas. Quebec, on the other hand, formulated a program known as Community Health Centres. Others followed integrating district health services and regional hospitals. In other words, from the beginning the federal government allowed the provincial governments to go their own way, be independent, or solve their own problem with respect to health care. And what was worse was that instead of increasing the funding, it was reduced.
To further address the many problems and complaints, the federal government instructed a Royal Commission to conduct an investigation on the future of health care, particularly the funding problem. The Royal Commission made a report to Parliament in 2002 entitled “Building Values: The Future of Health care in Canada”, which stated, among others, that the problem with the Canada Health Act was its implementation. There is no question with the principles; this should be retained as a matter of fact but other problems have to be addressed as soon as possible.
Benjamin Freedman and Francoise Baylis analyzed the health care problem and argued that society has a moral obligation to provide health care to its members “as a social insured service”. Medical health care should not be restricted to medical procedures, or “purposive rather than functional approach” because this will result in inequalities and ignore important values for the delivery of health care”. With a functional approach, the health care system should address the needs of the people outside of the traditional model. Freedman and Baylis suggested that care should also be given to families of dying patients and similar other support systems – this is the functional approach. These forms of care should be covered within the realm of the health care system and not from other institutions.
There are other factors that the Romanow Commission would like to argue and advocate.
Will public-private partnerships ease the situation? It may but there has been no evidence that this is forthcoming, according to the Report of the Romanow Commission.
The Report cited Canadian values that should be the basis for providing health care. Canadians view health care as a moral obligation rather than a business. Some sectors would like to scrap the values argument, forgetting about equality, or let those who have money have access to health care. That is betraying the public trust. But we have also to recognize that in the 1920s and 1930s, public health care was a combination of business and public health care systems. Canadian health care system was not an organized system; it evolved according to what public and private institutions could provide including public wishes and perceptions. We have also to face the fact that the private sector has a great role to play in the public health system.
Some Solutions
The Canada Health Act should be reformatted with the principles of comprehensiveness and accountability further defined clearly. The principles are well defined but there are many loopholes that need to be filled and ironed out.
A clear division of labor between public and private sectors should be stated, for example with respect to health services (hospital and medical care) which should be provided by public institutions, while food preparations and maintenance services should be done by the private providers. There are also medical services provided by new technology like the MRI (magnetic resonance imaging) which can be provided by private clinics while treatment can be instituted by government facilities using MRI results from private clinics. Fast-track diagnostic services can also be used to provide compensation benefits.
A new Canadian Health Covenant that states the responsibilities of Canadians including health providers, private and public institutions should be the main focus of the government. Another is the formation of a new Health Council of Canada that will foster collaboration among health workers, public and private, and define the roles of the different health stakeholders from the provinces up to the federal level of government.
As mentioned, one of the main problems of the Canada Health Act is funding. There should be stable funding with emphasis on increased federal funds. The funding should be realistic with advanced funding of up to five years. Benjamin Freedman and Francoise Baylis state that there should be a demarcation principle on government-funded health insurance on what cases should be provided medical services or which ones should be given priority.
The Report recommended the following funds:
- A Rural and Remote Access Fund – which will help solve funding for the rural and remote areas;
- A Diagnostic Services Fund – that will reduce waiting time for diagnostics;
- A Primary Health Care Transfer – that will help in removing barriers to delivery of primary health care;
- A Home Care Transfer – that will help form a national home care strategy;
- A Catastrophic Drug Transfer – that will help provincial drug programs to cover remote areas.
This demarcation principle can help in allowing the government to be realistic in delivering health care to Canadians. For example, the Preamble to the Ontario Health Insurance Plan’s Schedule of Benefits limits insurance benefits to only those which are “medically necessary”, further stating an example that fitting of contact lenses cannot be covered in the insurance unless it is used to correct sicknesses like “aphakia, myopia greater than nine dioptres, irregular astigmatism, or keratoconus”.
Government health care funding should follow the functional approach which means that funding decisions should be based not on health alone. This means funding will also deal with the circumstances surrounding the sickness. For example, what causes the sickness? The demarcation principle in government-funded health insurance can help determine which cases should be funded.
Roy Romanow’s recommendation for expansion of Medicare is a welcome move and in fact, this was hailed by many, especially the women. The provinces and the Federal government signed a collaboration agreement known as the Health Accord which released $34.6 billion from the federal reserves to the provinces over a period of 5 years. This amount is in addition to the already implemented funding of $47 billion in hospitalizations a year.
Apart from the Royal Commission Report, a separate study was conducted in 2003 by the Canadian Institute for Health Research which identified several factors that would help improve Canada’s public health system. These elements are:
- The federal and provincial governments should reach a consensus on the various health functions that should be provided with an infrastructure for the public health system;
- A strong collaboration between private and public institutions and other stakeholders within the decentralized system;
- A collaborative effort to support service delivery including development of health personnel and physicians;
- Establishing a national leadership that would promote the aims of public health policies and legislations.
Conclusion
We have cited in this essay the various problems in the Canadian health care plans and programs. We also identified these problems and provided some solutions – solutions that were cited and recommended by several experts who were involved in studies of the Canadian health care programs. It cannot be said now that Canada’s health care plans are a colossal failure because there are positive moves instituted by the federal and provincial governments in collaboration with the private sector.
The moves will entail issues such as structural (pertaining to health and social services, for example, gaps in services); procedural matters that will entail joint planning and budgetary cycles; financial factors which involve funding and flows of financial resources; legitimacy that refers to the private and public agencies involved; and professional issues that may include competitive ideologies and values.
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