Lecture Outline: State Medicine Introduction: British North America Act (1867) policy formation & implementation 2. Building Blocks for Canada: post-World.

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Presentation transcript:

Lecture Outline: State Medicine Introduction: British North America Act (1867) policy formation & implementation 2. Building Blocks for Canada: post-World War Two legislative initiatives – provincial & federal 3. Historical Models: Poor Law Citizenship/Maternal Feminism Professional Health & Welfare State 4. International Context: Britain - Switzerland - France - Sweden - United States 5. Dilemmas in State Medicine: cost politics scope

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British North America Act Act to establish Canada Provinces responsibility Limited role for federal government

Federal Government VeteransProvincesAboriginals Military Prisons RCMP Doctors Hospitals Drug Plans Structure of Canadian Health Care System

Healing Journey Program idea + funding + staff + space + program = POLICY How policy gets created

Post-World II War Legislation Federal-Provincial Conference on Reconstruction Saskatchewan Hospital Insurance Plan National Health Program 1943 – Marsh Report Hospital Insurance & Diagnostic Services Act Medicare in Saskatchewan Royal Commission on Health Services Federal Medical Care Act Tommy Douglas

Federal Medical Care Act - 5 key principles 1. Universality of eligibility 2. Comprehensive coverage 3. Portable between provinces 4. Prepaid by taxes 5. Non-profit and publicly administered

Poor Law State mixed economy of health provision: philanthropy, poor law & free enterprise paternalism & the local the ‘worthy poor’ & ‘less eligibility’

Citizens’ Health State middle class rights- based society maternal feminism & health provision health care as a national investment

Professional Welfare State ‘experts’ Leonard Marsh, Harry Cassidy, George Davidson health care & good citizens

International Context: Britain National Insurance Act– 1948 National Health Service (NHS) Switzerland Sickness & Accident Legislation France – st compulsory health system, expanded post-1945 Sweden – 1891, 1910, 1931 sickness fund laws + government hospitals – 1946/47 full health insurance United States – national health insurance proposals of Progressive Era ( ) & Truman Era not implemented

The Cost of Health Care Graph needed showing raising costs of health care Canadian health services: $3.3 billion $40 billion problem = hospitals

The Politics of Health Care federal & provincial negotiations 1977 Bill C-37 federal contribution 25% 1984 Bill C-3 federal payments reduced relative to user fees

The Politics of Health Care federal & provincial negotiations 1977 Bill C-37 federal contribution 25% 1984 Bill C-3 federal payments reduced relative to user fees

The Scope of Health Care? 1974 Lalonde Report evidence-based medicine determinants of health health concept field

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