The Canada Health Act
Introduction
The Canada Health Act is a significant development in healthcare in Canada. In 1947, hospitalization insurance was introduced to care for inpatient services. Ten years later, the Federal Government offered financial assistance to care for the costs of hospitalization. However, the federal government and the provinces decided to provide full support to the Canadians by providing funding beyond hospitalization. Healthcare providers, governments, and other stakeholders came up with two options; first, a multi-payer system where multiple entities would be allowed to collect the funds and pay for health service, and second is a single-payer system where the government could collect funds and pay for health care services. However, a health care commission supported a single-payer system as it could provide the same benefits to all populations, or in other others, everyone could be covered. However, the Canadian Health Act has limitations in that health expenditure does not cover medical innovation, drug, home health services, custodial care, and other services. A point to note is that majority of public services are covered by the federal government. This indicates that services such as prescription drugs and long-term care are not covered since there is no public-private mix. Many have raised argument that there is a need to revise the Act and improve it. In general, the Canada Health Act is a public system and it provides cost-effectiveness. However, the problems with the Act are limited services or in other words, it underperforms in the areas of core medical services and fiscal sustainability.
The Canadian health system has achieved its goal in access, quality, and satisfaction. However, the current issue is based on what services are provided, and how they will be funded. The Canada Health Act allows the government to manage the health insurance plans through accessibility, comprehensiveness, universality, and portability (Deber, 2003). However, the current universal health insurance is provincially run and adheres to the theme of 'medically necessity'. This means that universal health insurance excludes other services that could be provided by private providers. Firsts, it is important to note that Canadian health care is under the federal-provincial authority. Initially, each province financed health care but due to market failure, the national government provided funding programs for hospital and physician services (Deber, 2003). When the Canada Health Act was introduced, the national terms and conditions were maintained and the federal government continued to influence the policy directions. Today, a large number of expenditures for physicians' services and hospital care are provided by the public sector. Note that the public sector is unable to cover services such as dental care, long-term care, and more. This means that since the Canadian health policy is under the federal-provincial authority, it means that there is a private sector hence these services are not offered (Deber, 2003). Note that in the past, hospitals were independent boards. Today, all hospitals are under regional health authorities or in other words the provincial government encourages single-payer. The problem with this kind of management is financing the system, delivery, and allocation.
There is an issue in financing the system in that in the mid-1980s, the Canadian economy experiences a deep recession and for this reason, the federal government reduced the funding, as a result, the provincial government experiences problems such as lack of hospital bed, reduction of physician fees, and poor nursing employment market (Deber, 2003). This reveals the problem of sustainability and the leaders argued that there should be an alternative source of revenue to meet the total costs since the public sources were unable to meet the spending costs. Some argued that a single-payer should provide the insurance overeager. However, single-payer and government involvement has raised a debate on the issue of comprehensives. Note that the Canada Health Act defines comprehensiveness as providing all medically necessary services. This means that hospitals are not moving beyond the boundaries of public insurance yet patients with insurance coverage should receive all services including prescription drugs and home care (Deber, 2003).
Another problem with the Canada Health Act is the delivery of health care. Note that in Canada, delivery is managed by the regional health authority. In other words, the provincial and territorial governments have started a centralized administrative authority. This has created a conflicted relationship between the physicians and the regional bureaucracies. The regionals structure can be traced to the United Kingdom after World War one where public health authorities managed primary health centers (Deber, 2003). Canada adopted the UK idea of regionalization where Dr. Henry Sigerist recommended the creation of local government structures. Even though the regionalization promotes the provision of quality services in diverse health sectors, physicians experienced significant consequences in that there is no relationship between the regional health authorities and the physicians (Deber, 2003).This is because, normally, physicians work under the provincial government. However, when the physicians work under the regional health authorities, it means that they have a little interest in regional health authority. As a result, there is no system coordination hence embarrassing performances.
Thus, the regionalization of health care under the Canada Health Act is viewed as a failure. Note that the regionalization is associated with different financing arrangements and this has resulted in financing obstacles (Marchildon, 2017). The health system experts viewed the regionalization as the best strategy to manage health care facilities and coordinate the services. It is important to note that the purpose of regionalization was to provide primary health services to everybody, reduce costs, promote health prevention, improve service quality, meet the population needs, and promote decentralized decision-making and improve the allocation of resources (Marchildon, 2017). However, regionalization has not achieved integration. The solution to the problem of regionalization is that the regional health authority should be eliminated and all provincial governments should control the health systems. This means that there should be a single provincial health authority or in other words, physicians should work with the provincial governments (Marchildon, 2017). However, since the provincial government might not return to work with the physicians, then there should be reshaping of regionalization. For example, the provincial government should highlight the health needs and set goals that the regional health authorities should meet and failure should be accompanied by hard consequences (Marchildon, 2019). As stated above, there is no relationship between the physician and the local government. The provincial government should encourage the regional health authority to establish interventions that would promote collaboration with physicians in the geographical boundaries. Another recommendation is that physicians should participate in clinical governance (Marchildon, 2019). Thus, there should be a strong relationship between the physicians and the regional health authority so that physicians can collaborate with authorities in system management.
Conclusion
Unquestionably, the Canada Health Act needs to be reformed. The provincial government has been the primary authority for health-care services and when the universal health coverage was introduced, the Canada Health Act established guidelines that the health systems should adhere to access federal funding. The problem with the Canada Health Act is not about universal health coverage but the problem arises from financing the health coverage. The universal health coverage is funded through a single-payer system, it is also funded through public and private insurance, and finally, it is funded entirely privately. However, the federal government has a greater responsibility for coverage and this indicated that the universal health coverage is a single-payer system. First, this system restricts the provision of core medical services that could be accessed if private insurance were allowed to raise the funds. Secondly, Canada Health Act restricts patients from accessing core medical services. No privately funded payment is required and this means that patients only reduce medically necessary treatment funded through public schemes. Even though the federal government has greatly contributed to the areas of health care, there is a need for greater accountability and allow the provinces to adopt effective policies that increase the quality of care and provide patients with the freedom to use private insurance companies.
References
Deber, R. B. (2003). Health care reform: Lessons from Canada. American Journal of Public
Health, 93(1), 20-24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447685/
Marchildon, G. P. (2017). Physicians and regionalization in Canada: past, present and
future. CMAJ, 189(36), E1147-E1149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595555/
Marchildon, G. (2019). The integration challenge in Canadian regionalization. Cadernos de Saúde Pública, 35, e00084418.https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2019000800501
