The Undermining of the Canada Health Act
The Undermining of the Canada Health Act
Thomas W. McIntyre
A paper submitted in Partial Fulfillment of the Requirements for
HSC 401 Health Care Administration
November 9, 2000
This paper is an overview of the Canadian Health Care system, and the Canadian Health Care Act. Below I discuss topics that are concerns for people under this system, which include the following:
? The Evolution of Canadian Health Care
? Universality and Accessibility vs. Choice
? Decreasing Cost vs. Non-Profit
? Efficiency and Quality
? Implications for Nursing Practices
? The Future of Canadian Health Care
This paper will also point out strengths and weaknesses in the Canadian Health Care system. With covering the above topics It is my intention for the reader to have an understanding of how the Canadian Health Care System functions, and what can happen in the near future.
In the past, Canada’s government-funded, universally accessible, health care system has been praised and admired both at home and abroad as one of the finest in the world. A great source of pride and comfort for many Canadians is that it
is based on five fundamental principles. Principles that are a reflection of the values held by Canadian citizens since the formation of Medicare in 1966. These principles were reinforced in the Canada Health Act, (CHA), of 1984 according to Gordon, Mintz and Chen (1998), state that “the Canadian system is universal, accessible, portable, comprehensive and non-profit.”
With increasing concerns of debts and deficits, Canada’s publicly funded health care system has recently become the target of fiscal attack. Efforts to reform and restructure the system have produced few results. Currently, some
Government officials throughout the country are looking towards a more radical approach. An approach that would see not only the reform and restructuring of the method of operation of the current system, but that would change the system entirely. The proposed idea? In provinces like Alberta, Ontario, and Nova Scotia, The Canadian Government is looking into increasing the role of the private sector in the current health care system. On December 29th, 1999, Nancy MacBeth leader of the Alberta liberal party was cited in the Edmonton Journal as saying: “ There’s ‘ample evidence’ that the Alberta government’s plan to expand the role of private health-care will contravene the Canada Health Act.” This is the strongest argument against privatization. It reflects the fears of many Canadians, the fear that a two-tier system similar to that of the United States will develop. The fear that the system, which was built upon values, reflected in five principles will be eroded and replaced and that they will be the ones left to suffer the consequences. According to Wilson (1995), Privatization of health care would undermine the principles of the Canada Health Act and as such would undermine the integrity of the Canadian Health Care system.
The Evolution of Canadian Health Care
In 1966 one of Canada’s most prided achievements to date was introduced to the Canadian Health Care system, and that was the implementation of Canadian Medicare. This new program of Medicare was a daring and innovative concept pioneered by Canadians for Canadians, Armstrong and Armstrong (1996). It revolutionized health care. Canadians overwhelmingly supported the new system as it reflected their values and the import they placed on universality and equal access to health care. Now, in the beginning of the new millennium, the ideals of the same system are in jeopardy. Canadians are at present feeling the effects of the restructuring of health care. Accessibility and quality are being threatened due to cutbacks coupled with a lack of funding.
There is a consensus now between medical professionals, the public, and the government that the health care system is deteriorating. It is failing to provide the quality of care promised in the Canada Health Act (CHA), and prided by so many Canadians. Due to the government restructuring the strings on the public purse continue to tighten. Transfer payments from the federal government continue to decrease as provincial debt loads increase. And, although the Canadian minister of health and premier assured the Canadian public that the costs of health care were doubling or even tripling, People from the providence’s of Alberta, Manitoba, and British Columbia have witnessed a steady decline in government spending on health care. The proportion of gross domestic product, (GDP), which Canada allocates to health care, is declining rapidly. Alberta is ranked last among the ten provinces in Canada, (Taft, 1997). Albertan’s now find themselves with a struggling health care system and a waiting list.
Unfortunately, Alberta is not an isolated instance, other providence’s such as Ontario, Saskatchewan, and Nova Scotia are finding themselves faced with the problem. The proposed solution from current Canadian government would see the health care system incorporate the private sector. According to government research this would decrease cost, increase accessibility and efficiency, Dirnfeld (1996).
Universality and Accessibility vs. Choice
Universality and accessibility go hand in hand. They are the principles that assure that each Canadian regardless of financial situation will have equal opportunity to access the same level of care, Norris (1999).
The lack of a private market in the current system, some Canadian officials will argue, limits the individual’s freedom of choice. Supporters of privatization maintain that these principles conflict with Canadians’ right to choose; the patient’s autonomy to choose to pay privately, and the physician’s choice to provide preferential treatments to those payers Dirnfeld, (1996), Gordon, Mintz and Chen (1998). Increasing choice in this manner would lead only to such detrimental practices as “cream skimming”, Dirnfeld (1996). Canadian Insurance companies would want only to provide coverage for those who meet certain “low-risk” physical criteria; physicians could care for those who could pay or for those who diagnosis proved to be the most profitable. This would be leading Canadians to take giant leaps backward in health care; moving towards the medical model of old that focused on disease and cure rather than health promotion and disease prevention.
With privatization comes private insurance, which can then delegate the what, whom, where and when health care services are accessed, in turn greatly limiting the individual’s choice (Armstrong and Fegan 1998). Utilization of a private for-profit system will be restricted to those who have adequate insurance coverage or the ability to pay out of pocket. Accessing services could also become dependent on hours of operation and rights to different facilities as dictated by private business owners and restrictions imposed by insurance plans. Accessibility will also be affected when for-profit hospitals determine where to be established. Many Canadians in the various provinces live in rural areas too sparsely populated to encourage free-market competition. As more populated areas are bombarded with a barrage of health care competitors vying for their money, rural communities will be abandoned. Businesses and employees will be lured away by the prospect of fatter pocket books as profit is exchanged for people.
Decreasing Cost vs. Non-profit
One of the driving forces behind privatization is that it will cut and control increasing health care costs.
There is a belief that a private for-profit market will create competition between health care providers. This would then reduce cost to the consumer as the different companies compete to obtain business. There have been however, many instances that have shown the effects of privatization to be just the opposite. For example, in order to remain competitive, money will have to be invested in advertising and marketing, a cost that is not present in the Canadian Health Care system as it stands, (Wilson, 1995). Health care is not a place for the free-market competition. As a consumer one is driven to shop around for the best product for the best price.
It is simply not feasible for an individual to wait for a medical service to go on sale or to exchange the same if not 100% satisfied. Nor is it consistent with the principles of the Canadian Health Act that explicitly state that ‘the provision of medically necessary services shall not be for profit and shall be publicly funded,” according to Armstrong & Armstrong (1996). It explicitly contradicts a value on which Canadians founded their beliefs of what constitutes Health Care in Canada.
Simply the operation of a private system will likely lead to increase of costs. Less bureaucracy in a public system eliminates the extra expenses often attributed to the higher overhead and increased operating rates, (Armstrong & Fegan, 1998). These costs are incurred from the paperwork and administration necessary to regulate a private system. In Canada’s single-payer system it is not necessary to make an itemized list of the equipment used per individual patient in order to draw up a bill for services. In a single-payer system it is also not necessary to keep records of each individual’s insurance plan and their payment and treatment options. In fact, in the past, when Canada has moved to de-insure medical services, (i.e., eye exams, and prescriptions), it has actually indicated increased cost for the consumer, (Armstrong & Armstrong, 1996). In all, increasing privatization will likely do little to reduce operating costs of the health care system; rather it will simply shift the burden of cost. With increasing privatization, the responsibility for payment will no longer fall on the public purse and government, but will instead become the responsibility of the individual, (Armstrong & Armstrong, 1996).
Efficiency and Quality
The increasing competitiveness that comes along with for-profit markets, many believe, will reduce waste and increase efficiency. Because the private market is more concerned with controlling costs in order to increase profit many believe that there would be more efficient waste management and less abuse or misuse of health care resources. However, there is little solid evidence that the current system is abused or subject to overuse, (Armstrong and Fegan, 1998, Wilson, 1995). In fact, if the private sector allows money to govern health care administration the possibility exists that business will diagnose and treat simply for the sake of profit, as stated previously.
Both those who support and those who oppose private health care recognize that the quality of care is suffering. Supporters of privatization believe that it is the “tyranny of a single-payer, which has led to rationing through the use of queues, (waiting in line), to decreasing accessibility and to diminishing quality”, (Dirnfeld, 1996, p.409). Supporters of private health care believe that a private option in health care would decrease waiting lists for public facilities. This, in turn, would improve access for those using the public system. According to Gordon, Mintz, and Chen (1998), evidence shows that an introduction of the private sector would not reduce waiting lists, rather it would alter the way waiting list are structured and prioritized. Instead of greatest necessity being moved to the top of the list, those who could pay would jump the list and receive the care they required.
Implications for nursing practice
Nursing is a profession based on ethical principles. One of these principles states that nurses must be accountable for their actions and the care they provide. If there is an influx of the private for- profit sector into the Canadian Health Care system accountability is threatened as hospitals decrease standards in order to increase profit. “Nurses are also ethically responsible for assuring that clients are provided with safe, competent, quality care” (CAN, 1997). As previously stated, a decrease in quality is inevitable as money becomes the driving force behind health care provision. The ethics of fairness and equitable distribution dictate that health care should be based on need rather than ability to pay. This belief is reinforced by the AARN who, in their position statement on privatization, affirms its loyalty to the maintenance of the principles as stated in the Canada Health Act (AARN,1995).
Nursing also prides its self as a profession that takes a holistic approach to providing care for the individual. As the medical model and profit align to affirm their position of authority in health care it is the client who would suffer.
There would be an urge to focus on a quota of parts to be fixed in a specified time frame rather than to focus on the individual and their specific needs.(Armstrong & Armstrong, 1996). Neglecting the principles of the CHA in order to incorporate privatization will have detrimental effects on the integrity of nursing practice.
The Future of Canadian Health Care
The British Columbia Office of Heath Technology Assessment or (BCOHTA) as it is commonly called is based at the University of British Columbia in Canada. The purpose of the (BCOHTA) is to develop collaborative partnerships with evidence based Health Care programs that include the:
? British Columbia Cancer Agency
? British Columbia Center for Disease Control
? Center for Applied Ethics, USB (University of British Columbia)
There are more than 25 programs that the BCOHTA has a partnership with. What does this mean? It means that with theses partnerships can analyze problems that Canada is having with the current health care system. They do it in the following ways: First they provide a replicable, defensible method to determine the state of scientific knowledge in any given clinical discipline or health program. Second they can direct researchers within an institution towards significant knowledge gaps. Finally, this approach will help institutions give priority to topics with impact on patient health and health care costs, and thus serve a substantive public interest.
All of this is by no means meant to indicate that the current Canadian Health Care system is ideal. Nor does it stand to say that radical restructuring is not necessary in the evolution of Canada’s Health Care system. Rather that the
restructuring necessary for the system to thrive needs to be undertaken as a holistic approach, not simply focused on cutting costs for the public sector. Cutbacks and downsizing are not the means by which to rejuvenate an ailing Canadian Health Care system. Nor is the introduction of investor-owned hospitals that strive to maximize profits, not to decrease costs. Reform and restructuring need to start at the bottom; fundamental changes need to be made in the way we view health and health care.
The focus needs to continue to move away from the medical model of the past to one that promotes health and prevents illness, accommodating the needs of a changing population, while maintaining the fundamental principles of the Canada Health Act.