Health System Change and Reform in Canada

1. Health System Change and Reform in Canada Monitoring Health System Change/Health Reforms PAHO/WHO Seminar, Belize, 30 May 2006 Gregory P. Marchildon Canada Research Chair in Public Policy and Economic History Graduate School of Public Policy, University of Regina

2. Outline of Presentation • Organization • Fiscal Resources • Physical and Human Resources • Health Services • Health Reforms: Phase I • Health Reforms: Phase II • Performance Indicators G.P. Marchildon Graduate School of Public Policy

3. Public, Mixed and Private Systems of Health Care

4. Canadian Constitution Statistics Canada Transfer payments Provincial and Territorial Governments Federal Government Canadian Institutes for HealthResearch Federal-Provincial-Territorial Advisory Committees and Councils Minister of Health Regional Health Authorities Ministries of Health Canada Health Act, 1984 Health Canada Public Health Agency of Canada Patent Medicine Prices Review Board Mental Health and Public Health Home Care and Long-Term Care Single Payer Hospital, primary care and physician Services Provincial and Territorial Prescription Drug Subsidy Programs Canadian Institute for Health Information Health Council of Canada Canadian Coordinating Office of Health Technology Canada Health Infoway Canadian Blood Services Organization of the Public Health Care System

5. Revenue Sources for all Health Expenditures, 2003 G.P. Marchildon Graduate School of Public Policy

6. Total Health Expenditures 2005 $142 Billion Private Sector 30.4% Public Sector 69.6% Dental and vision care, drugs, complementary and alternative medicine, and some long term care and home care Other Public Sector 6.3% Provincial Government Sector 63.3% Physician Remuneration Regional HealthAuthorities Federal Direct 4.2% Private Health Insurance Out-of-Pocket Expenditures Other Provincial Drug Plans Municipal (Public Health) 0.7% Commercial Insurance Firms Hospitals Not-for-Profit Insurance Firms Long-term Care Social Security Funds 1.4% Community Care Worker’s Compensation Quebec Drug Insurance Fund Home Care Overview of Canadian Health System: Expenditure Perspective

7. Trends in Health Expenditures, 1976-2005

8. Canada Health Act Expenditures as a Share of Total Health Care, 2005 CHA $55.7B 39.2% G.P. Marchildon Graduate School of Public Policy

9. Annual Growth Rates of Prescription Drug (Rx) Plans, other Components of Health Expenditures and Canadian GDP, 1998-2004 (Current Prices) G.P. Marchildon Graduate School of Public Policy

10. Total Health care expenditures as a share of GDP in Canada and selected countries, 1960 to 2002

11. Public Health Care Expenditures as a share of GDP in Canada and selected countries, 1960 to 2002

12. Comparison of Selected Imaging Technologies (per million)

13. Health Care Personnel in Canada (per 1,000 people), 1991-2003

14. Decline in the number of recorded hospital admissions for Canada and provinces, 1995-2001 Note: The % decline is calculated on age-standardized hospitalization rates for all conditions, per 100 000 population

15. Comparison of Active Physicians (per 1,000), 1980 to latest year

16. Comparison of Active Nurses (per 1,000), 1980 to latest year

17. Health Services I • Public health • Primary care • Secondary/inpatient care • Rehabilitation/intermediate care • Long-term care, home care and other community care • Prescription drugs … G.P. Marchildon Graduate School of Public Policy

18. Health Services II • Palliative care • Mental health care • Dental health care • CAM products and services • Maternal and child health care • Services for informal caregivers • Aboriginal Canadians G.P. Marchildon Graduate School of Public Policy

19. Health Reforms I, 1988-1996 • Public fiscal restraint due to • Rapidly growing health care costs • High public debt • Cost-cutting and disinvestment and patient dissatisfaction but also… • Profound Organizational and Managerial change: integration and coordination • The regionalization revolution G.P. Marchildon Graduate School of Public Policy

20. Health Reforms II, 1997 to now • Public reinvestment and growing costs • Rival hypotheses as to cause and effect • Public-private debate: delivery and financing • Major Consensus • Primary Care Reform • Managing system: regionalization and integration • Post-Chaoulli • Move from delivery to heart of medicare • Single-payer administration and finance G.P. Marchildon Graduate School of Public Policy

21. Performance Indicators

22. Life Expectancy and Mortality Indicators, 1970-2001

23. Factors Influencing Health Status, 1981-2002

24. Province and Ranking Weighted Count Number of Indicators Reported Weighted Count per Reported Indicator 1. British Columbia 153 117 1.31 2. Alberta 133 119 1.12 3. Saskatchewan 125 111 1.13 4. Ontario 122 113 1.08 5. Quebec 121 99 1.22 6. New Brunswick 113 113 1.00 7. Prince Edward Island 104 104 1.00 8. Newfoundland and Labrador 98 103 0.95 9. Nova Scotia 98 114 0.86 10. Manitoba 92 114 0.81 Table 2.3A: Overall Provincial Performance Based on Conference Board of Canada’s Weighted Count of Health Indicators Source: Derived from Conference Board of Canada (2006), tables 1-2, p. 4.

25. Comparative Disease Indicator Rankings (OECD rankings in brackets), 2000

26. Satisfaction with Health Care and/or Health System G.P. Marchildon Graduate School of Public Policy