3 Proposed reforms

Though most Canadian politicians and citizens acknowledge that there are some problems with the system, the proposed solutions often spark passionate debate. On one hand there are those who believe that the problem is simply one of under funding. They point to the rise of neo-conservative economic policies in Canada, and the associated reduction in welfare state expenditure (particularly in the provinces) from the 1980s onwards as the cause of degradation in the system. However, it is commonly estimated that costs associated with the medicare system have still been creeping upwards as a percent of total government expenditures. Again, many critics argue that neo-conservative governments merely made huge cuts to other programs as a reason for health care creeping to high percentages of government spending. The increasing costs are also directly linked to Canada's ageing population.

On the other hand, there is a small minority who argue that the system in its current form is financially unsustainable. They suggest that the rising cost of medical technology, infrastructure and wages are partly to blame. Canada's proximity to the United States is also cited as a serious problem, on account of the infamous " Brain Drain" - a phenomenon which describes the migration of Canadian-trained doctors and nurses (as well as other professionals) to the United States, where private hospitals can pay much higher wages and income tax rates are lower. However it has been noticed lately that a significant proportion of doctors and nurses that leave Canada to work in the US later return to Canada and practice here.

Currently in Ontario, people with a high enough income must pay an annual health care premium. It can range from $300-$800, depending on one's annual income. This payment is charged for those having salary above CN$38,000. Before this, funding for medicare in Ontario came from an employer tax. Premiums are not new in Ontario however. They existed into the 1980's at which point they were replaced by the employer tax. Premiums also exist in British Columbia and Alberta, though as Alberta approaches debt-free status, there has been talk of removing it.

There are other proposed reforms that come from the populist left and centre wings and also those with a special interest in health care. While right wing reforms often get more attention, there is a grass roots movement to try and keep medicare public in Canada and to avoid privatization.

When Canadians are polled, they consistently rate health care as a high concern and medicare as something they are proud of. Looking at other polls it becomes obvious they are willing to pay to keep health care public (in aggregate of course, not everyone). The main concern is often that the money used actually go to health care. Also people would like to see solid, visible, results from these funding changes such as reduced waiting periods. This tracks the usual story arc of socialism where invisible infrastructure and maintenance accounts are robbed to continually provide "visible proof" that government domination of a sector provides superior results. While the long-term costs of this create misery, this misery is visited on later generations. The robbing of road and bridge maintenance funds in NYC, for example, only really showed up 3 decades after it started in the 1940s with the 1973 partial collapse of the elevated West Side Highway.

While Canadians may not get the same very high standard of care that a wealthy US citizen will get, most Canadians are aware that Canadian citizens are by far better covered on average. The system is much more affordable for certain items such as on patented drugs. Older medicines that are off patent tend to be somewhat more expensive due to less competition as entry into the Canadian market suffers from government barriers. Canada spends the same amount per capita on health care as the United States but almost every citizen is fully covered. In the United States there are large percentages of the population who are uncovered or only marginally covered. Even more are just a job loss away from not having coverage (although in most cases the employer must maintain health care with copayment of the patient for a period of time after employment in the United States.) though recent reforms have introduced individual health accounts in 2004 which are job independent.

Since the early 1990s Ontario, as with other provinces, has worked at trying to reduce health care costs. Some examples of ways that costs were reduced or could be reduced follow. None of these systems are forced on patients at the moment, but they attempt help to make the system more financially sustainable. This makes them substantially different from Health Maintenance Organizations (commonly referred to as HMOs in the US) and other somewhat similar looking attempts by the United States to reduce health care costs, which appear to have reduced the average patient's access to medial care. Therefore they have been better accepted by the public.

3.1 Medical clinics

Proposals to reduce costs have been varied. There is a movement in Ontario to try and get 24-hour drop in medical clinics. This would mean that if someone were ill, no matter what the time of day, they would be able to see a doctor without going to a hospital. As many evening hospital visits are because there is no available medical service for problems that cannot to wait until morning, it is likely that this would reduce costs considerably. A registration at a hospital costs at least $250, while a visit to a doctor is often less than $30 for a general doctor. It has been proposed that doctors working late hours would get paid more per visit as an incentive. Still, the savings quickly become clear. This development parallels the more well established US "urgent care" system of private clinics that compete with hospitals for simple medical emergencies.

3.2 Alternatives to fee-for-service

There is also a movement to try and move the system away from bill for service. The Ontario government in the early 1990's helped develop many community health care centres which provide both medical and social support The emphasis is on medical care but the over-all approach is holistic. Collective kitchens, Internet access, anti-poverty groups and groups to help people quit smoking are common and funded in various ways. While funding has decreased for these centres, and they have had to cut back, they have been quite cost effective. They are often located in low income areas. If it is possible to reduce illness before it reaches a hospital a lot of money can be saved, although it is often hard to estimate how much and thus it is easier to cut these programs. Many of these centres are filled to capacity in terms of general doctors, and there are often fairly long waiting lists, although drop in health care is provided, often for those who have no other doctor. The centres also make use of nurse practitioners , who reduce the workload on the doctors and increase efficiency.

3.3 Midwives

Ontario has also recently licensed midwives and is teaching a new generation how to provide the help necessary for pregnant mothers. While midwifery cannot always take the place of a doctor, it can still reduce costs. If the mother wishes it and the birth appears uncomplicated, a hospital need not be involved. However,hospitals are now introducing birthing areas which contain their own suite, often with a hot tub (which is good for relieving pain without medication). These births often cost much less than the traditional manner of birth but are close to hospital facilities in case the need emerges. There have been occasional problems but overall the system has worked quite effectively. In an irony, the hospital best suited for these types of births in Ottawa was closed and turned into a health facility due to later budget cuts under a new government. The building is still used and still part of the Ottawa Hospital; its birth facilities, which had a high rating of approval among those using them can generally no longer be used.

3.4 Privatization

In recent years some on the political right-wing have called for an increased role for the private sector in the delivery of hospital medicare services. Currently, privately owned and operated hospitals that allow patients to pay out-of-pocket for services cannot obtain public funding in Canada, as they contravene the "equal accessibility" tenets of the Canada Health Act. Canada has the most public hospital system in the world: 98% of all Canadian hospital care is paid for by the state, while no other country covers more than 80%.

Many political scientists believe that removing the "equal accessibility" clause could be political suicide. Some have suggested relaxation of the rules of the Act to allow such facilities to open and operate in tandem with the publicly funded system. It is argued that this would lessen the burden on the publicly funded system as many well-off citizens would simply choose to pay out-of-pocket or through private insurers for services rather than rely on the public system. However, such proposals have been met with a large degree of public hostility. As a compromise, some provincial governments have experimented with the concept of " public-private partnerships" (P3 Projects) or the contracting out of health services to private providers, whose services are paid for out of the public purse.

In a P3 project situation, a private company is granted licence to build a hospital, or other facility, and to manage maintenance and infrastructure services upon its completion. However, all health services in the facility continue to be paid for and administered solely by the public system. Advocates for P3 projects in Canada often cite the successful implementation of such facilities in the National Health Service (NHS) of the United Kingdom. A significant report by the UK National Audit Committee released in early 2003 reported much success with the P3 system. In the Canadian province of Ontario, the government signed deals for the construction of several P3 facilities, including one for the William Osler Hospital in Brampton and the Royal Ottawa Hospital. However, the defeat of the Progressive Conservative government of Ernie Eves in Ontario on October 2, 2003 placed the status of these projects in jeopardy, as the newly elected Liberal premier, Dalton McGuinty, had campaigned against the use of P3 hospitals.

Due to the decentralized nature of the Canadian federation, the degree of privatization varies from province to province.

3.5 Barriers to foreign trained practitioners

One of the main issues regarding medicare is the resistance offered by the Canadian health system to foreign trained doctors called IMGs (international medical graduates). This is the opposite of what is happening in the US which is absorbing doctors from all over the world. In practice, little has been done to solve this issue all across Canada.

4 Canadian health care in comparison

Despite the high costs of providing health care in Canada's hinterland and the high wages necessary to compete with wages in the United States, Canada spends no more than the G7 average on health care as a percent of its GDP. Most health statistics in Canada are about average for the G7, and vastly better than the world average.

Country	Life expectancy	Infant mortality rate	Per capita expenditure on health (USD)	Healthcare costs as a percent of GDP	% of government revenue spent on health	% of health costs paid by government	% of health costs paid by private sector
Australia	80.0	5.6	1,741	9.2	16.8	67.9	32.1
Canada	79.3	5.6	2,163	9.5	16.2	70.8	29.2
France	79.3	5.7	2,109	9.6	13.7	76.0	24.0
Germany	78.2	5.2	2,412	10.8	16.6	74.9	25.1
Japan	81.4	4.1	2,627	8.0	16.4	77.9	22.1
UK	77.5	5.9	1,835	7.6	15.4	82.2	17.8
USA	77.0	6.4	4,887	13.9	17.6	44.4	55.6

Source: WHO, note that these figures include all areas of health care including dentistry, optometry, and drugs.

See also: Canadian and American health care systems compared

See also:

• OHIP

5 External link

• 2001 report comparing Canadian health care to that of other nations

Canada Healthcare

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