1. CANADA’S HEALTH CARE SYSTEM AND THE RIGHT TO HEALTH Rhonda Ferguson

2. Outline  What does it look like and how did we get there?  Historical antecedent and description  Canada Health Act  Key features of the CHA  Guiding principles and their relationship with human rights  What’s covered under Medicare?  How effective is the Canadian health care system and what are the challenges today?  Aboriginal health  The future of health care in Canada  Conclusions and questions

3. What does health care in Canada look like and how did we get there?  Historical antecedents  Health care delivery falls under the jurisdiction of provinces and territories, not federal government  National health insurance program: Medicare  Not a single national plan, but a program comprised of provincial (10) and territorial (3) health insurance plans  Publicly funded, publicly and privately delivered

4. The Canada Health Act  The Canada Health Act is the country’s federal health insurance legislation  It sets out the criteria and conditions which must be met by the provinces and territories in order for them to receive their share of the federal contributions  Cash and tax transfers form the federal contribution to provincial and territorial governments

5. Key features of the Canada Health Act  Key features  Public Administration  Comprehensiveness  Universality  Portability  Accessibility  Relationship to human rights  Congruencies with human rights principles, but fails to set out obligations and entitlements

6. What is covered?  Covered:  Physician care  Hospitalization (including drugs administered while in hospital)  Diagnostics  Services that are medically necessary/Emergency care  Some drugs (varies provincially)  Not covered:  Drugs (varies provincially)  Vision care  Dental (Children in Quebec covered)

7. Total amount spent on Health Care in Canada 1975 - 2011 National Health Expenditure Database, Canadian Institute for Health Information

8. Public- and Private-Sector Shares of Total Health Expenditure 1975-2011 National Health Expenditure Database, Canadian Insitute for Health Information

9. Total Health Expenditure by Use of Funds 2009 (Billions of dollars and percentage of share) National Health Expenditure Database, Canadian Institute for Health Information

10. Effectiveness & Challenges  Effectiveness:  Generally speaking, Canadians enjoy a relatively high health status on all major health indicators. E.g. life expectancy is 79 years for males, 83 years for females  Challenges:  Certain population groups experience illness disproportionately as well as limitations on access to timely and appropriate care  “The federal system of health care delivery for status First Nations people resembles a collage of public health programs with limited accountability, fragmented delivery and jurisdictional ambiguity. Moreover, current health care services remain focused on communicable disease, while mortality and morbidity among Aboriginal peoples are increasingly resulting from chronic illness. Social access to health care is similarly limited or denied to Aboriginal peoples through health systems that account for neither culture nor language, or the social and economic determinants of Aboriginal peoples’ health” (National Collaborating Centre for Aboriginal Health).

11. Aboriginal Health in Canada  Aboriginal groups in Canada consist of: First nations (“registered/status Indian”), Metis, and Inuit. Health care for First Nations and some Inuit fall are federal government responsibility  Aboriginal populations have a significantly lower life expectancy and experience higher rates of nearly all diseases. E.g. life expectancy for Inuit is 64 years for males, and 73 for females  Although Non-status Indians may face similar socio-economic conditions, they do not have access to federal insurance schemes for greater coverage  Geography, climate, and living conditions make health care less available  Aboriginals site not having regular access to family doctors, hospitals, or traditional healing methods as obstacles to their health and well-being  There is not enough data collected on some aboriginal populations (off-reserve Aboriginals, Metis, and Inuit) to understand health challenges  A human rights-based approach to care would ensure: Measurement of progress and Accountability: Ensure data is collected, including on vulnerable groups Vulnerable individuals and groups are given special consideration in policy formulation and care delivery Culture and traditional practices are considered Participation by aboriginals in decision making about their health and care  Not a problem with funding, but rather with management of health care programmes and delivery, geography and a failure to address social and economic determinants of health

12. Health Conditions Comparison Health Canada

13. The Future of Health Care in Canada  Romanow Report suggestions  Electronic health records  Greater accountability and monitoring needed, especially in regard to Aboriginal health and care  Common indicators needed to measure performance  Direction of care must be based on needs of the population  Health Accord  Aimed to ensure sustainability ‘for a generation’  Expires in 2014  Federal government poised to decrease contributions to provinces in 2016 Abdication of responsibility  Aboriginals excluded from talks

14. Conclusion  Overall, Canadians enjoy a high standard of health  However, the health of vulnerable populations are not adequately protected  Greater accountability and data collection needed to ensure progress and protection of vulnerable populations  Lack of political will at the federal level poses problems for provinces  Lack of explicitly defined entitlements and duties mean politics and hinder progress  Sustainability threatened by rising costs  Greater efficiency and cost-saving measures needed: More responsibilities to nurse practitioners Electronic records Purchase drugs as a group, rather than each province Emphasis on prevention  Trend toward privatization will increase cost of care, while decreasing access  Questions? r.ferguson1@nuigalway.ie