Wednesday, May 29, 2013

Canadian Health Care System

Canadian Health Care System Introduction LaPierre (2012) defines the health care system in Canada as a suite of socialized health insurance plans which offer coverage to the people of Canada. The system is funded by the public and its administration is overseen on territorial or provincial basis. However, the guidelines for administration are set by the federal government. Individual members of public, under the health care system, are offered preventative care as well as medical therapy by primary care physicians. They also have access to health care facilities (hospitals), dental surgery as well as other medical services. Every person in the country, with a few exceptions, is qualified for medical coverage, personal income, medical history, or living standard notwithstanding. The health care system of Canada is the topic of social and political debate and controversy. Some of those involved in the debate cite the issue of the efficiencies of the present system in delivering treatment in an opportune manner. Some have suggested that the country should implement a system similar to the one used in the United States. On the other hand, there are uncertainties that privatization would end up causing disparities in the Canadian health system, such that it will only be the well-off will be able to afford some kinds of treatments. Despite of the controversy and the debate, the country has one of the best life expectancies (approximately 80 years) as well as one of the least infant morality rates among the economically developed nations. This has been attributed to the health care system of the country (Schmid, et al. 2010). Health care in Canada is provided via a publicly-funded health care system. This system has most of its health care services offered by private entities and is most of the time free at the point of use. The health care system in the country is normally directed by the requirements of the Canada Health Act of 1984 (Schmitz, 1991). Federal standards are applied by the government in assuring the quality of health care. However, the Canadian government does not take part in the daily care or collection of whatever kind of information regarding the health of an individual. This information is normally confidential between an individual and the health care provider the provincially-based Medicare systems in Canada are cost effective in part due to administrative simplicity. The insurance claims are handled by the doctors in every province against the insurer at the provincial level. The person accessing the health care is not required to get involved in reclaim and billing. Private insurance in the country is jus a nominal part of the general health care system (Warren, 2008). According to LaPierre (2012) the Canadian health care system is founded on minimal advertising, therefore optimizing the proportion of income which goes to the health care directly. Generally, the costs of healthcare are reimbursed via finances from income taxes, apart from the health care system in British Columbia. This is the only province in the country which imposes a constant premium that is reduced or waived from the low income earners. On the basic health care, there are no deductibles and co-pays are enormously small or absent (depending on income, supplemental insurance like Fair Pharmacare could have deductibles). The Provincial Ministry of Health gives a health card to every person enrolling for that program and each one gets the same kind and degree of health care. Given that all the almost all the necessary basic care is taken care of, different plans are not necessary, such as maternity and infertility issues (Schmid, et al. 2010). On the basis of the province, vision and dental care may not be under the cover. However, they are mostly provided by employers via private insurance firms. Private supplemental plans, in a number of provinces, are accessible for patients desiring private facilities in case they are admitted in a hospital. Cosmetic surgery as well as some kinds of elective surgery is not included as necessary and therefore is not under the cover. Such health care services are normally paid out of the pocket or view insurance cover obtained from private insurance firms. There is no effect on health cover by change or loss of job, provided that the premiums are paid fully, and no lifetime restrictions or exclusions are there for pre-existing conditions (Hutchison, et al. 2011). There is coverage of pharmaceutical drugs public finances for the indigent or elderly, or via insurance covers bought by employers for their employees from private insurance companies. The federal government negotiates with the suppliers of drugs for their prices in order to control costs. Family physicians, also referred to as general practitioners or GPs in the country, are selected by the consumers. A GP normally makes a referral where a client desires to consult a specialist or is advised to consult a specialist. In Canada, early detection and preventive care are considered essential and people are advised to go for annual check-ups. The rationale behind early detection is that it increases quality of life and life expectancy as well as cutting down on the cost of care (Peiris, Brown and Cass, 2008). There is a considerable satisfaction with the health care system of Canada particularly from the members of public. Some of the members of the public have suggested in surveys that the health care system in necessary for national identity. Majority also argue that elimination of the public plan would cause serious change to the very nature of the country. However, this does not mean that the health care system has not been without some challenges (Shah, 2003). In Queens University in Kingston, Ontario, a study was carried out in 2007 that suggested that regardless the fact that there has been a change in public opinion towards the positive side, most of the people in the country have argued that the system is indefensible and needs immediate substantive reform. Most of the concerns by the public in the country are regarding difficulty of access and long wait times (Hutchison, et al. 2011). Regardless the fact that some of the life-threatening situations are handled promptly, there are services which are needed but are considered non-urgent. In such cases, the patients are not seen immediately, but on next-available appointment in a local facility of their choice. The average wait time in the country to consult as a specialist is a slightly more than four weeks with 89.5 percent waiting less than 90 days. For diagnostic services like CAT scans and MRI, the average median wait time is 14 days with 86.4 percent waiting less than 90 days. For surgery, the median wait time is 28 days with 82.2 percent waiting less than 90 days. The same study also revealed extensive support for increased health care expenditure (Peiris, Brown and Cass, 2008). While this criticism persists, it has been revealed from research that complete elimination of waiting time is not idyllic. In the situation where waiting lists emanate via a prioritization procedure on the basis of physician-determined medical exigency and the risk of the procedure, (as opposed to the capability of the patient to pay or productivity for the doctor), the waiting lists have been found to be important for the patients. Schmid, et al. (2010) suggests that health care system of instantaneous care can be harmful for best patient outcomes because of then avoiding of needless or unproven surgical procedures. The health care system of Canada has undergone various reforms since its beginning. Significant reforms have been carried out in the last four decades. Peiris, Brown and Cass (2008) argue that changes will continue in the system in reaction to developments as well as changes in the society as well as in medicine. However, it is important to note that the basics of the health care system in Canada have remained the same amid the changes (general coverage for medically essential health care services offered based on the need, instead of the capacity to pay). Such basics are likely to continue in the future. The health care system in the country funded by the public has been defined as an interlocking suite of three territorial and ten provincial health insurance plans. This system has been providing and will continue to provide access to universal, inclusive coverage for health care services in the country (Hutchison, et al. 2011). In the face of the changes and the basics of the health care system in Canada which have remained the same, there are major implications for the various stakeholders in the health care system. The public, the federal government, the three territories, the ten provinces, the health care professionals and the system in general have important roles to play in the provision of quality health care. The mandate of the health care system in the country continues to be helping the people of Canada to maintain and enhance health. The public will continue to fund health care in the country through income to an unforeseeable future. Health Canada's responsibilities for health care, among other actions, have the role of establishing and administering national principles and policies for the system. This is achieved through the use of the Canada Health Act. The professionals have the responsibility of making accessible health care services to particular populations. The professionals have the responsibility of ensuring quality of care in the country’s health care system (LaPierre, 2012). Conclusion In the discussion of the health care reforms in the developed nations, the Canadian model emerges as one of the possible models for other countries such as the United States. The Canadian health care system is publicly funded through the use of income tax. This is different from the United States model which is normally privately funded. A great deal of the attraction of the health care system in Canada is that it tends to more for less. The country offers universal health care to its people. The country uses less of its GDP on the system (10.4 % compared to the 16% spent in the United States. The country also performs better in terms of health care compared to other industrialized countries like the United States. References Hutchison, B., Levesque, J., Strumpf, E., & Coyle, N. (2011). Primary Health Care in Canada: Systems in Motion. Milbank Quarterly, 89(2), 256-288. LaPierre, T. A. (2012). Comparing the Canadian and US Systems of Health Care in an Era of Health Care Reform. Journal Of Health Care Finance, 38(4), 1-18. Peiris, D., Brown, A. & Cass, A. (2008). "Addressing inequities in access to quality health care for indigenous people". Canadian Medical Association Journal 10 (179): 985–6. Schmitz, A. (January/February 1991). "Health Assurance". In Health 5 (1): pp. 39–47. Schmid, A., Cacace, M., Götze, R., & Rothgang, H. (2010). Explaining Health Care System Change: Problem Pressure and the Emergence of "Hybrid" Health Care Systems. Journal Of Health Politics, Policy & Law, 35(4), 455-486 Shah, C. P (2003). Public health and preventive medicine in Canada (5th ed.). Toronto: Elsevier Canada. Warren, P. (2008). "Physician advocacy essential for Canada's First Nations". Canadian Medical Association Journal 179 (7): 728.