1. Health Care in Canada HCEC511, John Ries

2. The Health Care Act In contrast to the United States, health care in Canada is publicly administered. The Health Care Act is Canada’s federal health insurance legislation. Key definitions: “Insured health care services are medically necessary hospital, physician, and surgical- dental services.” Extended health care services are certain types of long-term residential, home care, and ambulatory care services. Roughly 70% of health care costs in Canada are paid by government. Public pays for part of the cost of home care, prescription drugs, ambulances, dental, and vision care.

3. The Health Care Act Five principles: –Public administration –Comprehensiveness (cover all insured services) –Universality (available to insured residents on equal terms) –Portability –Accessibility (reasonable access)

4. The Health Care Act Two key features No private provision of insured services User charges, extra-billing, and facility are prohibited as they constitute a barrier to access. Their use will result in a reduction in federal payments to that province. –Thus, users do not directly pay when they receive insured services (no-copayments)

5. Recent health care studies Clair in Quebec Mazankowski in Alberta Fyke in Saskatchewan Senate Committee—Kirby Commission of the Future of Health Care in Canada--Romanow

6. Challenges facing Canadian health care Rising costs, Wait lists –User fees? –Private provision? –Pay for Performance? Doctor/nurse shortages Delivery/Administration Other?

7. A Provincial Benchmarking Report Derek, Devon What is the “four step” process for improving health care? What is the benchmarking method? Which province came out on top? On the bottom? Into what three groups are the 119 indicators divided? How does BC rate across the three? What puzzling information emerges for BC and New Brunswick? Why might health status indicators not reflect the quality of health care in a province? Which province spends the most per capita? How is Canada doing internationally? In what areas is Canada performing well? Poorly?

8. RAND Health Insurance Experiment Lorena Karen Who was involved in this experiment and what period were they studied? What was the purpose of the study? How was the experiment set up? What was the relationship between medical use/expenses and the rate of co-insurance? What was the spending share of those with 95% copayment rate relative to those with no copayment? How did this vary across treatments? Why should policymakers be concerned that individuals may reach the maximum dollar expenditure (MDE)?What was the effect of copayments and health outcomes? Is Canada the only OECD country that does no cost sharing of primary health care?

9. Funding Health Care Anureet, Garth What is the problem with allowing private insurers insure against health risks? What are the benefits associated with introducing copayments in Canada? What potential problems arise concerning the poor? How are co-payments calculated? According to Table 1, how would people pay with income less than $10,000? $10,000-$30,000? $30,000-60,000? Why do these amounts vary? What do the authors estimate will be the percentage reduction in demand resulting from these fees? What are the savings on public health expenditures associated with the copayment scheme? What do the authors propose be done with this “dividend”? In order to charge individuals a portion of their medical expenses, prices will have to be established for each service. Will this be difficult? Would it provide benefits beyond those associated with this plan?

11. “Visions of Health Care: Is a Parallel System the Answer?” Lisa, Sandy What is a parallel private system? At the time this article was written, 1996, what percent of doctors favoured a parallel system? What is the “subsidized queue-jumping” used in Alberta’s ophthalmology clinics? What is the federal response to these activities? Why did the study see a much larger private sector as inevitable? What are Coffey’s arguments for a private health care sector? Why would it be necessary to expand the health insurance industry? Is this a problem for Canada? Why is private insurance for some medically necessary treatment unlikely? What are the arguments against a parallel system?