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Home Policy Articles: Health Care: Funding


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Health Care Reforms: Just How Far Can We Go? popular

Philippe H. Trudel, Bruce W. Johnston, and Michel Bédard explore what kinds of health care reforms can occur under existing laws. They also examine how much room the provinces have to manoeuvre under current federal legislation, namely, the Canada Health Act, as well as which laws reform-minded provincial governments could modify.

2028 or Bust: Ontario's Unsustainable Hospital Spending

This brief Fraser Alert argues that public spending in Ontario hospitals is on an unsustainable financial track.

A Time to Reap; Re-investing in Alberta's Public Services

This report advocates improving the many public service areas that were subject to budget cuts a decade ago in the interests of improving Alberta's debt. With extensive empirical evidence the study considers the advantageous position of Alberta's economy and financial situation as well as the social conditions that have been created by budget cutbacks. Finally this report points to a lack of accountability of government expenditures and makes recommendations to improve specific public services.

Accountability: Why Strings Need to be Attached to Health Care Dollars

Armine Yalnizyan’s article Accountability: Why Strings Need to be Attached to Health Care Dollars argues the federal government should not provide provincial health care funds without guarantees to how those funds will be used. Yalnizyan dismisses ‘no strings attached’ funding and argues that accountability for usage must be a prerequisite for federal health care funding. She claims that accountability demonstrates transparency and a readiness to be responsible to taxpayers. In the case of targeted funds, however, Yalnizyan recognizes the necessity for provincial flexibility, arguing that such funds may be diverted to another health care usage if provincial governments can demonstrate they have met minimum targeted standards. This is a necessity, she claims, for Canada to maintain its public health care system.

Beyond Romanow: Why $3.5 Billion is Not Enough

In this Canadian Centre for Policy Alternatives publication Armine Yalnizyan argues that the $3.5 billion in health care spending proposed by the Romanow Report does not constitute sufficient funding to implement the Report’s recommendations. While Yalnizyan notes the Romanow recommendations are critical first steps to securing public health care, she maintains that the level of funding proposed will leave many pressing health care needs unanswered. According to Yalnizyan, Canadian health care is in such dire need of increased funding that $3.5 billion will simply be absorbed into the system, leaving no room for substantive policy change. She contends that if funding is not increased to levels beyond the Romanow recommendations, the result will be the ‘passive-aggressive privatization’ of Canadian health care.

California Dreaming: The Fantasy of a Canadian-Style Health Insurance Monopoly in the United States

The stated purpose of Brett Skinner and Mark Rovere’s article is to “warn Americans about the dangerous ideas contained in the Universal Health Insurance bill.”

Can we Afford to Sustain Medicare? A Strong Role for Federal Government

This report, prepared for the Canadian Federation of Nurses Unions (CFNU), is intended to be a message from Canadian nurses to all provincial premiers. According to the CFNU, Canada has entered a new era of possibility for public health care: a new federal Parliament; new provincial leaders; a new health accord in the making; and, an unparalleled consensus that change must happen immediately.

Can We Finally Move Forward to Improve Health Care?

In this brief report, Kouri recommends ways to realize this vision for health care in the Province. She argues that residents of Saskatchewan must continue demanding high quality services; she also recommends a reorganization of primary care, and an increased emphasis on community-based care.

Canada’s Public Health Care System Through 2020: Challenging Provincial and Territorial Financial Capacity

This study, by Frank, McIntyre and O’Sullivan, projects real provincial and territorial health expenditures through to 2020, illustrating how trends vary across seven components. The results of this study call into question the financial sustainability of the Canadian health care system. Frank, McIntyre and O’Sullivan found that overall provincial and territorial spending on health will increase from 32 percent (of government revenues) in 2001 to 44 percent in 2020.

Canadian Health Care in a Global Context: Diagnoses and Prescriptions

This article by Åke G. Blomqvist summarizes the strengths and weaknesses of the Canadian health care system and highlights the problems associated with the division of powers between the federal and provincial governments, particularly in relation to financing and governance. Blomqvist then describes the US system and how it “may promote diversity and efficient institutional innovation,” in addition to examining its shortcomings. The author then analyzes the health policy reforms of the Netherlands, the United Kingdom, and Sweden, suggesting they are partially akin to the American model – a model characterized by competing insurance plans.

Canadian Pharmacare: Performance, Incentives, and Insurance

In this paper, Graham and Tabler examine provincial drug policy. They argue that since the 1970s, provincial governments have taken away the freedom of Canadians to choose the prescription drugs they use. The result has been that provincial drug-benefit plans account for almost one-half of Canada’s prescription drug spending, placing an undue burden on taxpayers. At the same time, they argue is has been difficult to see the benefit to patients who require the drugs.

Challenging Health Care System Sustainability: Understanding Health System Performance of Leading Countries

This report, by Prada, is a follow-up to the Conference Board of Canada’s March 2004 Report, Understanding Health Care Cost Drivers and Escalators. In that report, a comparison of Canada’s health care system to those of 23 other countries found that Canada is the third largest spender on health care, but ranked near the middle with respect to performance. Prada’s report closely examines the top six countries – Australia, France, Spain, Sweden, Switzerland, and New Zealand – and attempts to explain why their systems perform and produce better results than does the Canadian system.

Community-Based Mental Services in BC: Changes to Income, Employment, and Housing Supports

While British Columbia has been a leading province in mental health care reform and recovery treatments for people with mental illness, this has been greatly undermined in recent years.

Community-Based Mental Services in BC: Changes to Income, Employment, and Housing Supports

While British Columbia has been a leading province in mental health care reform and recovery treatments for people with mental illness, this has been greatly undermined in recent years.

Definitely NOT the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Health Care

Based on statements made by Roy Romanow prior to his Commission’s study of Canadian health care, the Atlantic Institute for Market Studies published Definitely NOT the Romanow Report: Achieving Equity, Sustainability, Accountability and Consumer Empowerment in Health Care. The report argues that spending for Canadian health care is not sustainable in its present form. The authors assert that health care spending has only remained stable through a reduction in services, increased closures, limited hiring, controls on compensation, and increased wait times.

Elder Care: The Nexus for Family, Work and Health Policy

Satya Brink presented this paper at an annual conference of the Canadian Association of Gerontology in Montreal in October 2002. In her paper, she discusses the wide-reaching impact of elder care on individuals, families, work, and public policy.

Every Number Tells a Story: A Review of Public and Private Health Expenditures and Revenues in Canada, 1980-2000

This article by Glenn Brimacombe analyzes public versus private health care spending in Canada from 1980 to 2000. In this regard, the author finds there has been no drastic move towards increased private spending, even though the author does note some increases. Brimacombe underscores that there are important differences within the health care field, with sectors functioning in fundamentally different manners from one another (physicians versus other professionals, for example). Accordingly, Brimacombe argues that Canada must bring together these sectors in a more “financially seamless structure” prior to embarking on health care reform. Finally, the author considers the particulars of Canada’s situation vis-à-vis other international cases (such as Australia).

Expenditure on Medical Care in Canada: Looking at the Numbers

Brian Ferguson’s paper Expenditure on Medical Care in Canada: Looking at the Numbers, argues the only option to afford the level of health services Canadians have become accustomed to is to allow greater private spending. Ferguson asserts the way Canadians pay for health care has changed. In the past, governments had “the luxury” of running deficits and Medicare was financed based on borrowing. Today, however, Ferguson points out health care must be paid out of current revenues. These higher costs leave governments with the option of raising taxes, reducing services, or turning to private funds.

Fair Pharmacare?

Sylvia Fuller provides a backgrounder on the BC government’s changes to the provincial pharmacare program. The Government has presented the recent restructuring of the pharmacare program as a reasonable solution to the problem of increasing drug costs; pharmaceuticals have been consuming an ever larger proportion of the health care budget, so the Government is seeking to limit its role in paying for prescriptions.

Federal-Provincial Transfers for Social Programs in Canada: Their Status in May 2004

Stephen Laurent and Francois Vaillancourt wrote this unrefereed working paper to explore the structure of federal funding arrangements for social programs in Canada.

For the Good of the Patients: Financial Incentives to Improve Stability in the Canadian Health Care System

This article by Grant L. Reuber and Finn Poschmann analyzes the costs of public health care in Canada and the means of reform. The authors believe incorporating direct financial incentives into the system would “temper growth in demand for health services and place market pressure on providers to improve their efficiency and reduce costs” while still respecting the Canada Health Act. Reuber and Poschmann believe the best way of operationalizing the aforementioned financial incentives is through a provincial tax credit which would be tied to usage of the health care system.

From Support to Isolation: The high Cost of BC’s Declining Home Support Services

In this paper Cohen, McLaren, Sharman, Murray, Hughes and Ostry examine the nature of home support within the BC health care system.

Funding Hosptial Infrastructure: Why P3s Don't Work, and What Will

This report examines the consequences of adopting a “public-private partnership,” more commonly known as a P3 model, for the delivery of health care infrastructure and services.

Funding Public Provision of Private Health: The Case for a Copayment Contribution through the Tax System

This article, by Shay Aba, Wolfe D. Goodman and Jack M. Mintz, builds the case for a new outlook regarding the funding for public health care in Canada – an outlook based on a “user-pay” system. The authors propose that payments be made based on the level of service use, using the existing income tax system as a model. In this vein, the more a citizen uses the health care system, the higher his or her contributions would be.

Getting Better Health Care: Lessons from (and for) Canada

This paper attempts to examine the nature of Canada’s health care system to determine what lessons have been learned and assess forward movement in the debate over health care reform.

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