Canadian Health Care

The Canadian Health Care System (Medicare) was designed to provide equal access to health care benefits for all Canadians. The system, partly funded by the Federal Government, is under the control of the various provincial governments.
 

In 1966 the Liberal government, under Lester B. Pearson, passed the National Medical Care Insurance Act (Medicare).  This Act was implemented 2 years later.  It offered the provinces a fifty-fifty cost sharing for medical and hospital services as long as certain conditions were met.

The conditions that had to be met were:
 

1.     Services had to be comprehensive
2.     Services had to be reasonably accessible
3.     Universal coverage had to be provided
4.     Services had to be portable from  province to province
5.     Public Administration of health care

By 1971 all Canadian provinces were participating in Medicare.  In 1977 the Liberal government, under Pierre E. Trudeau, negotiated with the provincial governments to produce the Established Programs Financing Act which replace the cost sharing with 'block funding'.  This funding was to grow at the same rate as the Gross National Product.  In 1984 the Canada Health Act was passed by the Liberal government which set out penalties for provinces that allowed user fees or extra billing (both violations of the conditions listed above).

After 1977 various Acts eroded the level of funding that the provinces received.   There is an on-going debate between the provinces and federal government regarding the level of funding.   The Canadian Institute for Health Information states that health care spending in 2004 was likely to exceed $130 billion.    In British Columbia health care spending is expected to be over $11 billion in 2005/2006.  The increasing cost of health care is threatening the foundations of our health care system.  The Fraser Institute has looked at health care spending in Canada and proposed some suggestions. Change is inevitable but any change to the system will impact both providers and consumers of health care. 

Proposed Solutions

Alberta, on May 10, 2000, passed Bill 11.  This Bill, designed to protect and preserve the public health care system and ban private hospitals, has introduced surgical facilities which would be accredited by the College of Physicians and Surgeons.  There is great controversy about this Act and its implications for Canadian Health Care system.  

Ontario has unveiled Ontario's Health Action Plan to meet the health needs for the province for 21st century.  In an open letter to all residents of the province Elizabeth Witmer, MPP, Minister of Health and Long Term Care stated that this plan would mean:
                -  more nurses in hospitals and in our communities
                -  reduced waiting time for critical care
                -  improved emergency services
                -  more beds in long-term care centres
                -  better health care services in your home.

P3s

P3s is a Public-Private Partnership.  Private corporations finance and build a public hospital. The Provincial government then  leases the use of the facilities (like patients' rooms, operating and emergency rooms and equipment) and purchase food, laundry and cleaning services from the private corporation.  This is an idea that started in Great Britain in 1992 when Private Finance Initiatives (PFI) were introduced.  Now it is being tried in Canada.

Private Health Clinics

In British Columbia and other jurisdictions in Canada we have seen a move to private health care clinics.  This is not a new initiative.  Dr.  Morgentaler opened private abortion clinics in Canada in the 1980's.  We have seen more and more clinics opening in the past 10 years.  We have eye clinics, minor surgery clinics, orthopedic clinics, MRI clinics etc.  There is a growing concern in Canada about the impact of these clinics in Canada.  The BC Health Coalition has a number of articles regarding this topic.  Other sources of information include:

    Ontario Health Coalition

    Canadian Centre for Policy Alternatives

In addition private health care clinics have web sites promoting  their service:

    False Creek Surgical Centre

    Canada Diagnostic Centres 

Romanow Commission

The Commission on the Future of Health Care in Canada, headed by Roy Romanow, has made recommendations on  sustaining a publicly-funded health system.  Highlights of the report developed by the Canadian Press include:

• Expand medicare with federal cash infusion of $15 billion through 2005-06.
• Ensure Ottawa funds a minimum of 25 per cent of insured health services, $6.5 billion more.
• Spend $1.5 billion over two years to improve access to care in rural areas.
• Spend $1.5 billion over two years to improve wait times for diagnostic services.
• Support primary care delivery with $2.5 billion over two years.
• Start building a national home care program with $2 billion over two years.
• Help people who require expensive drugs with $1 billion in 2004-05.
• Create Health Council of Canada to set benchmarks for care and ways to measure performance.
• Establish Canadian Health Covenant outlining responsibilities of citizens, health providers and governments.
• Consolidate native health funding.
• Co-ordinate waiting lists to reduce wait times.
• Create an electronic database of personal health records.
• Examine drug patents to reduce costs.

      The Friends of Medicare (an Alberta Lobby group) refer those that have concerns about the cost of implementing the Romanow report to the Keep Medicare Public Website.

There has been a response to this report by both government bodies and professional associations across Canada.  Comments have been issued by:

• Canadian Medical Association
• Canadian Nurses Association
• College of Registered Nurses of British Columbia
• Canadian Federation of Nurses Unions
• British Columbia Nurses Union
• Government of British Columbia (Picture of Health)

The Shortage of Nurses

    On 4 November 1997, the Canadian Nurses Association released a study that showed there would be a shortage of nurses in Canada by 2011.   The independent study stated that this shortage may range from 59 000 to 113 000 registered nurses.

    The Canadian Institute for Health Information has statistics that support the acute shortage of nurses in Canada.

    In 2001, Canada had about 74.3 registered nurses working per 10 000 population.  British Columbia had only 66.7 registered nurses per 10 000 population. This rate has dropped for the past 4 years. 

    The shortage of nurses will be even more critical in the future as the population of nurses continues to age.  The average age of nurses in Canada is 43.7 years of age.  British Columbia is above the national average with 44.8 years of age.  This is the oldest workforce in Canada.

   Why is the profession facing a shortage at this time?  There are a number of factors that have contributed to the shortage, including:

• decreasing number of graduates
• decreasing enrolment and interest in nursing as a career
• closing of hospital beds and hospitals, decrease in full time jobs for recent graduates
• an aging workforce

     While the prediction of a nursing shortage continues the provincial governments only recently began to increase the number of seats for prospective students.  The government of British Columbia announced in December 2002 that more money would be spent to try to deal with the shortage of nurses in BC. An attachment to the press release provided background information about improving patient care.

   Nationally, Canadian nursing stakeholders are looking at a long term strategy to resolve the on-going shortage of nurses to ensure that Canadians receive quality care. Building the future is an integrated strategy for nursing human resources in Canada.
  

    This Spring (2006) the Ontario Nurses Association has launched a campaign (Still Not Enough Nurses) to highlight the critical shortage of nurses in Ontario.

    Recent articles on the topic include:

    Where Have All the Nurses Gone?

    Nursing Shortage: Solutions for the short and long term

    RNAO - Nursing Shortage

    The International Nursing Labour Market

    Nurse Patient Ratios - Useful Roadmap to Retaining Nurses?

    In addition to the above there is a move to recruit nurses from third world countries to fill the need for nurses in developed countries.

Health Professional Act

The Health Professions Council in British Columbia has the authority under the  Health Professional Act  to review the scope of practice and the legislation for all recognized health professional in the province.

The Licensed Practical Nurses of BC have seen a dramatic increase in what they are allowed to do clinically.  In the Vancouver Health Authority the LPN works as a full scope LPN.

The Health Professions Act clearly outlines the scope of practice for the LPN and the RN. The College of Registered Nurses of British Columbia has developed a document for BC nurses regarding scope of practice.