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Instead, at a December 2011 gathering of federal, provincial and territorial finance ministers, Federal Minister James Flaherty announced that when the 2004 accord expired in 2014, the Canada Health Transfer escalator would remain at 6% until 2017 and then grow for the next decade at the higher of 3% per annum or the 3-year moving average of nominal GDP growth %. 21 A provincial/territorial ...
- Table of Contents
- Introduction
- Background
- The Role of Government
- Health Expenditures
- How Health Care Services Are Delivered
- Timeline
- Additional Reference Sources
- Online Resources
•Introduction
•Background
•Evolution of Our Health Care System
•The Role of Government
•The Federal Government
•The provincial and territorial governments
Canada's publicly funded health care system is dynamic--reforms have been made over the past four decades and will continue in response to changes within medicine and throughout society. The basics, however, remain the same--universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay...
The basic values of fairness and equity that are demonstrated by the willingness of Canadians to share resources and responsibility are displayed in Canada's health care system, and have been reflected in the modifications and major reforms made to the system since its inception. The system has been and continues to be modified as the country's pop...
The organization of Canada's health care system is largely determined by the Canadian Constitution, in which roles and responsibilities are divided between the federal, and provincial and territorial governments. The provincial and territorial governments have most of the responsibility for delivering health and other social services. The federal government is also responsible for some delivery of services for certain groups of people.
Publicly funded health care is financed with general revenue raised through federal, provincial and territorial taxation, such as personal and corporate taxes, sales taxes, payroll levies and other revenue. Provinces may also charge a health premium on their residents to help pay for publicly funded health care services, but non-payment of a premium must not limit access to medically necessary health services.
Within the publicly funded health care system, health expenditures vary across the provinces and territories. This is, in part, due to differences in the services that each province and territory covers and on demographic factors, such as a population's age. Other factors, such as areas where there are small and/or dispersed populations, may also have an impact on health care costs.
According to the Canadian Institute for Health Information (CIHI), in 1975, total Canadian health care costs consumed 7% of the Gross Domestic Product (GDP). Canada's total health care expenditures as a percentage of GDP grew to an estimated 11.7% in 2010 (or $5,614 CDN per person).Footnote 1 In 2010, publicly funded health expenditures accounted for seven out of every 10 dollars spent on health care. The remaining three out of every 10 dollars came from private sources and covered the costs of supplementary services such as drugs, dental care and vision care.Footnote 2
Total Health Expenditures by Source of Finance, 1975
Note: Although the graph notes that provincial/territorial governments pay for 71% of health expenditures in Canada, the federal government supports provincial/territorial expenditures through fiscal transfers.
Source: Canadian Institute for Health Information. National Health Expenditure Trends, 1975 - 2010.
Total Health Expenditures by Source of Finance, 2010 Forecast
What Happens First (Primary Health Care Services)
When Canadians need health care, they most often turn to primary health care services, which are the first point of contact with the health care system. In general, primary health care serves a dual function. First, it provides direct provision of first-contact health care services. Second, it coordinates patients' health care services to ensure continuity of care and ease of movement across the health care system when more specialized services are needed (e.g., from specialists or in hospitals). Primary health care services are increasingly comprehensive, and may include prevention and treatment of common diseases and injuries; basic emergency services; referrals to and coordination with other levels of care, such as hospital and specialist care; primary mental health care; palliative and end-of-life care; health promotion; healthy child development; primary maternity care; and rehabilitation services. Doctors in private practice are generally paid through fee-for-service schedules that itemize each service and pay a fee to the doctor for each service rendered. These are negotiated between each provincial and territorial government and the medical professions in their respective jurisdictions. Those in other practice settings, such as clinics, community health centres and group practices, are more likely to be paid through an alternative payment scheme, such as salaries or a blended payment (e.g., fee-for-service payments plus incentives for providing certain services such as the enhanced management of chronic diseases). Nurses and other health professionals are generally paid salaries that are negotiated between their unions and their employers. When necessary, patients who require further diagnosis or treatment are referred to other health care services, such as diagnostic testing, and health care professionals, such as physician specialists, nurse practitioners, and allied health professionals (health care professionals other than physicians and nurses). Health Human Resources In 2006, just over 1,000,000 people in Canada worked directly in health occupations; this represented 6% of the total Canadian workforceFootnote *. Health care providers may be regulated (through professional colleges or other bodies) or non-regulated, unionized or non-unionized, employed, self-employed or volunteer. Most doctors work in independent or group practices, and are not employed by the government. Some work in community health centres, hospital-based group practices, primary health care teams or are affiliated with hospital out-patient departments. Nurses are primarily employed in acute care institutions (hospitals); however, they also provide community health care, including home care and public health services. Most dentists work in independent practices; in general, their services are not covered under the publicly funded health care system, except where in-hospital dental surgery is required. Allied health professionals include: dental hygienists; laboratory and medical technicians; optometrists; pharmacists; physio and occupational therapists; psychologists; speech language pathologists and audiologists. Footnote * Health Personnel Database, Canadian Institute for Health Information. Return to footnote* Referrer
What Happens Next (Secondary Services)
A patient may be referred for specialized care at a hospital, at a long-term care facility or in the community. The majority of Canadian hospitals are operated by community boards of trustees, voluntary organizations or regional health authorities established by provincial/territorial governments. Hospitals are generally funded through annual, global budgets that set overall expenditure targets or limits (as opposed to fee-for-service arrangements) negotiated with the provincial and territorial ministries of health, or with a regional health authority or board. Although global funding continues to be the principal approach for hospital reimbursement in Canada, a number of provinces have been experimenting with supplementary funding approaches. Secondary health care services may also be provided in the home or community and in institutions (mostly long-term and chronic care). Referrals to home, community, or institutional care can be made by doctors, hospitals, community agencies, families and patients themselves. Patient needs are assessed by medical professionals, and services are coordinated to provide continuity of care. Care is provided by a range of formal, informal (often family) and volunteer caregivers. For the most part, home and continuing care services are not covered by the Canada Health Act; however, all the provinces and territories provide and pay for certain home and continuing care services. Regulation of these programs varies, as does the range of services. The federal department of Veterans Affairs Canada provides home care services to certain veterans when such services are not available through their province or territory. In addition, the federal government provides home care services to First Nations people living on reserves and to Inuit in certain communities. In general, health care services provided in long-term care facilities are paid for by the provincial and territorial governments, while room and board costs are paid for by the individual. In some cases, payments for room and board are subsidized by the provincial and territorial governments. Palliative care is delivered in a variety of settings, such as hospitals or long-term care facilities, hospices, in the community and at home. Palliative care focuses on those nearing death and their families and includes medical and emotional support, pain and symptom management, help with community services and programs, and bereavement counselling.
Additional (Supplementary) Services
The provinces and territories provide coverage to certain people (e.g., seniors, children and low-income residents) for health services that are not generally covered under the publicly funded health care system. These supplementary health benefits often include prescription drugs outside hospitals, dental care, vision care, medical equipment and appliances (prostheses, wheelchairs, etc.), and the services of other health professionals such as physiotherapists. The level of coverage varies across the country. As noted earlier, those who do not qualify for supplementary benefits under government plans pay for these services through out-of-pocket payments or through private health insurance plans. Many Canadians, either through their employers or on their own, are covered by private health insurance and the level of coverage provided varies according to the plan purchased.
1867 British North American Act passed: federal government responsible for marine hospitals and quarantine; provincial/territorial governments responsible for hospitals, asylums, charities and charitable institutions.
1897 to 1919 Federal Department of Agriculture handles federal health responsibilities until Sept. 1, 1919, when first federal Department of Health created.
1920s Municipal hospital plans established in Manitoba, Saskatchewan and Alberta.
1921 Royal Commission on Health Insurance, British Columbia.
1936 British Columbia and Alberta pass health insurance legislation, but without an operating program.
1940 Federal Dominion Council of Health created.
Accords
2000 - First Ministers' Communiqué on Health 2003 - First Ministers' Accord on Health Care Renewal 2004 - First Ministers' A 10-Year Plan to Strengthen Health Care
Commission Reports
Commission on the Future of Health Care in Canada (Romanow) Standing Senate Committee on Social Affairs, Science and Technology (Kirby)
1.Federal Departments and Agencies
•Health Canada
•HealthyCanadians
•Public Health Agency of Canada
•Canadian Institutes of Health Research (CIHR)
•Patented Medicine Prices Review Board (PMPRB)
1950s and 1960s. Health and social transfers were either provided as cash grants or were cost-shared to encourage the establishment of national social programs. In 1966, the Canada Assistance Plan (CAP) was introduced, creating a cost-sharing arrangement for social assistance programs. Conditions were attached to federal funding, including the ...
May 8, 2024 · Health financing. Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. Today, millions of people do not access services due to the cost. Many others receive poor quality of services even when they pay out-of-pocket.
May 13, 2021 · In 1977, the Established Program Financing (EPF) block transfer was introduced to replace the cost-sharing grants for healthcare and post-secondary education. EPF was made up of roughly equal parts cash and tax point transfer. The tax point transfers were 13.5% of federal personal income tax and 1% of federal corporate income tax.
The age of universal health care in Canada had arrived. In 1984, the federal government passed the Canada Health Act which set out five guiding principles for provinces to receive federal health-care funding. Some critics of the public system have pushed for an increase in privatized health care. They argue Canadians should be able to pay to ...
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Yet, in 1977, barely a decade after the MCA's enactment, the Established Programs Financing Act 1 (EPF) crucially shifted federal health-care financing from match funding to block funding. It also featured a transfer of tax points to the provinces and territories equivalent to 13.5 percent of federal personal income taxes and one percentage point of the federal corporate income tax (Mou, 2021 ...
