Federal Health-Care Funding Paper
Federal Health-Care Funding Paper
The Canadian health care system has been a work in progress since its inception. Reforms have been made over the past four decades and will continue in response to changes within medicine and throughout society. However, the basic principles remain the same – universal coverage for medically necessary health care services to be provided on the basis of need, rather than the ability to pay. Canada’s publicly funded health care system can be best described as an interlocking set of ten provincial and three territorial health insurance plans.Known to Canadians as “Medicare”, the system provides access to universal, comprehensive coverage for medically necessary hospital and physician services. Despite the slow improvement that has occurred, it has become clear that since the implementation of the Canada Health Act in 1984, Canada’s health care system has been in decline and has fallen significantly behind nations like the U. K. , Sweden and Finland[1]. The degradation of the Canadian healthcare system has been a gradual process, which has had many negative consequences.Federal Health-Care Funding Paper
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Despite negative indications, policy trend in Canada saw a decrease in transfer payments as a percentage of GDP from the Federal to Provincial governments as well as the vertical downloading of responsibility to maintain social services like health care and welfare[2]. Under this scenario, the Provinces control immense power over the quality of health care given to citizens of each respective province, and due to the regional inequality and diverging ideology of the various dominant political parties, health care between the ten provinces varies widely[3].
Furthermore, there has been a developing trend towards moderate levels of privatization throughout Canada. Ontario has been allowed to operate over 900 private surgical, treatment and diagnostic clinics to work for-profit once they have satisfied the Provinces weekly requirement of public hours[4]. At the turn of the century, the Federal government recognized the many problems plaguing the Canadian health care system and attempted to fix the problem by creating the Health Council of Canada.
Canadian health care was at a gridlock, where the system, something Canadians felt as a “defining aspect of their citizenship”, could have either degraded to the point where this defining characteristic was nothing more than a fond memory, or could be improved and returned to its former stature among worlds top care systems. From a general perspective, the increased costs that exist in the health care system could be attributed to societal trends that have developed since the beginning of the millennium.Federal Health-Care Funding Paper
Many instances subsist where the aforementioned statement is proved to be true. First, labour shortages, which are the result of a decade of policy reversals, have driven up the cost of keeping doctors and nurses in the current system[5]. Second, the growing use of drug treatment to manage and prevent conditions has been a long-term trend that has astronomically increased the costs of maintaining the system[6]. Thirdly, due to the aging population, specifically the baby boomer generation, there has been a growing demand for resources and treatment[7].
Lastly, as the wealthiest generation in Canadian history are reaching old age, there is an increasing interest in the use of paid services and facilities. These general problems have been exacerbated by declining Federal health transfers to the Provinces, Provincial fiscal restraint, lack of accountability to the citizens of Canada and communication between the Federal and Provincial governments, lack of availability of rural and remote care and finally an increase in waiting times for diagnosis[8].
The Federal government has always been known as “a defender of Medicare”, yet over the past decade they have worked to reduce their responsibility for the increased costs and changing expectations for this public system[9]. Furthermore, in the wake of the decline of the Canadian health care system, the Federal government in 2002 conceded 20 billion dollars in revenue to tax cuts, which was money that could have been used to maintain social services like health care[10].
This fact naturally leads to the issue of vertical fiscal imbalance and resource allocation, which has become a growing concern. The Conference Board of Canada (CBoC) claims that the problem stems from the Federal governments increased reliance on personal income (47% of revenue), which is the fastest growing source of revenue in Canada, and consequently is the Provinces primary source of income in the form of Federal transfer payments, which by nature are relatively slow growing[11]. The discrepancy between the provincial governments and the federal governments occurs on the expenditure side.Federal Health-Care Funding Paper
The Provinces have a relatively large share of spending in the rapidly growing areas of social service, for example health care, education and old age security. Thus, due to the faster projected growth rate for provincial expenditures, at 3. 5% over the next 20 years, and the comparatively lower growth rate for Federal transfer payments, at 2. 2% over the next 20 years, it is inevitable that the provinces will be left in severe debt and the Federal government will have an estimated surplus of 126 billion dollars by 2025[12].
This lack of transparency with respect to federal contributions is not only causing dysfunctional intergovernmental relations, but is also hampering the process of health care reform. Secondly, the issue of Provincial restraint, coupled with declining Federal health transfers has caused immense problems. Theses problem have been accentuated in two ways. The first is due to the approach taken by several provincial governments, for example the former governments of Alberta and Ontario.
The second is the simple fact that some of the “have not” provinces have been forced to curb spending in order to meet the unresponsiveness of Federal transfers. In both scenarios this has resulted in the delay of much needed investment in the supply of health human resources, for example doctors nurses and technicians, and physical infrastructure, such as MRI and CAT scan machines[13]. Thirdly, a lack of accountability to the citizens of Canada and communication between Provincial and Federal governments has promoted irresponsible spending habits, which has led to dysfunctional relations between the levels of government.
This scenario can be best exemplified by the Medical Equipment Fund, which called for a 1 billion dollar investment by the Federal government in 2003. However, due to the lack of communication and accountability, the money that left Ottawa was enormously misused. In New Brunswick, for example, the fund was used to purchase lawn tractors, icemakers and floor scrubbers for the hospital, which is equipment that is neither geared towards diagnosis or treatment equipment, which was what the funds were originally designated for[14].Federal Health-Care Funding Paper
Despite this clear flaw in the system, Provincial governments have rejected the movement towards building accountability mechanisms into the system. In contrasts they have continually argued for more flexibility with respect to funding[15]. This scandal, along with others like the Canadian blood scandal have created a general mistrust of government action by the citizenry, which can be partially accountable for the decline of deference that has begun to occur in Canada.
Fourthly, the general lack of availability of rural and remote care has become a serious problem in Canada for many reasons. This problem presents many problems in maintaining equality in the system since communities exist where no doctors live. Therefore, the lack of these basic social services are partially responsible for destroying Canada’s rural communities as it is forcing families and elderly to move to urban settings to ensure medical attention and treatment[16].
Consequently this current model, without placing pressure on rural health care, has hurt rural society and health, while heightening the pressure on urban population growth and government spending to maintain urban social services. Finally, the trend of increasing waiting times for diagnosis has come to be a serious problem, as they have doubled in the last decade[17]. Currently, the average waiting time from referral from a GP to actual treatment is 17. 7 weeks, which percent jumped 7% from 2003-04[18].Federal Health-Care Funding Paper
To further demonstrate the disparity and lack of equality in the current system, Saskatchewan has the longest waiting time at 29. 9 weeks and Ontario has the shortest at 14. 3 weeks, which is a 15. 5 week disparity[19]. When doctors were polled by the Fraser Institute, 90 percent of the 3000 doctors from 12 specialties believe the delays are unreasonably long[20]. This is a simple exemplification of the deterioration of efficiency in the heath care system as the current equipment and quantity of human resources are clearly inadequate to deal with mounting demand.
The Federal government’s primary interest is to make “the Canadian health care system the best in the world and Canadian people the healthiest in the world”[21]. This primary objective could have been realistically obtained by renewing the foundations of Medicare, by ensuring that equality, accessibility and transparency are primary tenants of the reformation. Once the internal objectives have been completed there is a desire to move beyond Canadian borders to consider Canada’s role in improving health standards around the world.Federal Health-Care Funding Paper
