Due to the complex nature of the various policy problems in Canada
There is no clear-cut answer as to whether provincial or federal actors are better suited to deal with the various aspects of each problem. In many cases, the federal government is needed in conjunction with provincial governments to implement effective policies. This paper will navigate through two different aspects of the Canadian health care system, financing, and administration, arguing that the provincial and federal governments need to reach their optimal levels in financing the industry, and administration in the sector needs coordination from both parties. Despite achieving various goals in the field, both the federal and provincial governments still have more to contribute to the sector regarding financing and administration.
Health Care Financing in Canada
Just like in many countries across the globe, the health care industry in Canada is funded by both the public and private entities, with the former being the dominant contributor. For instance, 70% of health care financing in Canada comes from the public sector, with the remaining being contributed by the private department (Stevenson, 2017). The public sector contribution is both from the federal and provincial governments. Governments at these levels both utilize taxation as a key contributor to the funds needed for the provision of health to the people. However, the provinces also rely on finances channeled from the federal authorities to boost their health care budget. Despite the well-structured financing plan in the health industry, the challenge of high costs of healthcare has been a major problem in Canada (Stevenson, 2017). As of 2017, it was estimated that a Canadian family of four members paid $12,057 for health (Sutherland, 2011). On the other hand, an individual Canadian paid $4,596 which is close to a 100% increase when compared to the data available for the period of the previous 20 years (Sutherland, 2011).
The constitutional division of powers between the federal and provincial authorities
Has slightly helped in solving the problem of high costs of health care in Canada. First, the fact that the governments at both levels make contributions is one solution to the challenge. The Federal authority supports the provinces by making contributions through the Canadian Health and Social Transfer (CHST). For example, the provinces received $35 billion in the 2002-2003 through the CHST. It is worth noting that the contribution just followed an extra $23 billion that the federal government had invested in the health care system in the year 2000. In 2015, the federal government projected that its expenditure in the health section in 2016 would be 11.1% of the country’s GDP. The hospitals got the largest share, 29.5%, followed by buying of drugs at 16%. Eleven percent of Canada’s GDP in 2016 was roughly $228.1 billion, showing the federal government’s will to channel more funds to health departments (Coyte & McKeever, 2016).
The provincial governments also largely contribute to the financing of the country’s health. For instance, most local authorities acquire additional funds from taxes and lottery profits to finance health care systems. In most provinces across the country, 38% of the fiscal year budget is allocated to healthcare (Sutherland, Crump, Repin, & Hellsten, 2013). Some provinces such as Alberta and Ontario also charge the people premiums to help in supplement the programs in the medical field. However, some activists have rallied against such premiums arguing that they are not supported by the Canada Health Act, thus making them unconstitutional.
Administration of the Health Care Sector in Canada
Canada is one of the countries in the world that have governance at different levels. When some nations have the national and the state governments, Canada has the federal and the provincial governments. The constitutional division of power has made it possible for authorities at both levels to make contributions towards different sectors. For instance, the medical field is diversely managed by the authorities at both the local and national level in Canada. The split of power has helped the country in tackling various challenges in the sector such as financial constraints and reliability. However, the challenges are not completed solved yet (Porter, 2015). Therefore, there is a need for reviewing the current coordination of the two governance levels. It is recommendable that running of programs in the sector be handed over to the provincial governments while the federal authority is left to oversee the operations and also finance the programs.
One reason why the running of programs should be left for the provincial administration is the fact that the local managements tend to know the varied needs of the people in a more detailed way than the national leaders. The provincial administrators frequently meet the people in their areas of jurisdiction thus making it easier for them to know the demands of the locals. It is crucial to note that the needs of people vary with the environment and culture. Similarly, the health needs of individuals are usually influenced by the environment and cultural aspects. Therefore, the local authorities can easily understand the demands of the people living in the areas since they mostly live in the same neighborhood with similar cultural backgrounds.
Secondly, running of programs in the health sector should be done by the provincial governments to enhance the reachability of the various services and products to every Canadian. The federal government has the capacity and financial strength of making sure public resources reach nearly all citizens. However, the efficiency of the process is not guaranteed when the national authority seeks to play this role. For instance, federal officers rarely reach out to everyone at every corner of all the provinces when making medical campaigns. However, the provincial officers can easily mobilize their teams and make sure they reach every corner of the province. Such efficiency is crucial in making sure healthcare services are enjoyed by all Canadians in different parts of the country.
Finally leaving the role of managing health programs to the provincial authorities is important in enhancing accountability in the industry. When specific people are left in charge it becomes easy to hold people accountable for every action taken in the sector. The provincial governments can delegate different duties to various local authorities to make it easier for people to access medical services (Leeson, 2004). The delegation of duties is critical for accountability. The key areas that need accountability are financing and billing. Fraudulent activities are common when it comes to matters relating to funds. It will be easy for the public and governments to account for the money used in the health sector if there are specific parties left in charge. Similarly, negligence can be tackled effectively if the provincial authorities are openly made responsible for administration in the industry. In this case, nobody would get away with negligence since there will be authorities monitoring activities closely.
Challenges of Jurisdiction in Canada’s Health Care Sector
The federal and provincial governments are given powers by the Constitution of Canada to handle different aspects of the healthcare sector in the country. The fact that these are different authorities with powers granted by the constitution, issues of jurisdiction come in when talking about the sharing of power and resources. For instance, the fiscal government is obligated by the constitution to channel funds to the health care industry. The national government is supposed to finance the country’s health care sector directly or through the provincial authorities. On the other hand, the provincial governments are given constitutional powers that allow them to administer their health insurance plans, plan and fund care provision in medical facilities under their jurisdictions, implement health initiatives, and to negotiate fees to be offered to medical professionals.
One core challenge faced by these two levels of government regarding healthcare provision is with regard to financing. The National Medical Care Insurance Act of 1968 has it that the federal government shall cater for 50% of the cost of health insurance plans for the provinces. However, in 1984, the Canada Health Act was introduced thus disqualifying the direct payment of bills for the patients (Jackman, 2000). The new act came along with five principles that were to be followed for the federal authorities to cooperate with the local governments regarding the allocation of funds. The seventh section of the Canada Health Act outlines these five principles which include: universality, public administration, accessibility, portability, and comprehensiveness. However, there is a concern on whether the act gives the federal officers the power to question the quality of medical services, or it just majors on funding. For instance, the Canada Health Act does not obligate the provinces to comply with the five principles, thus giving room for poor performance in this sector. The only penalty that the regional governments stand to face is withholding of funds (Flood, Lahey, & Thomas, 2017).
Other than the Canada Health Act, the funding of national health promotions and research undertakings connected to the medical field is under the jurisdiction of the federal government of Canada. Such initiatives include those under the Canadian Institute for Health Information and the National AIDS Strategy. The national government has the power to plan, implement, and fund these programs without interference from the provincial representatives. Mostly financing of these initiatives is usually from deductions collected under Income Tax Act of Canada.
Conclusion
The division of power in Canada has impacted on the country’s health care system in both the short and long terms. For instance, the constitutional power-sharing has seen the national government maintain its obligation of catering for 50% of health insurance costs in the provinces. The initiative had a long-term effect of lowering the cost of health in the country. However, comparatively, health in Canada is still expensive than in other countries that are at par with Canada economically. The administration of health care in Canada has also been affected by the constitutional division of power. The personnel tasked with delivering medical attention to the people are managed from a local perspective. Therefore, it becomes easy for citizens to reach out to the respective authorities regarding issues relating to health. However, challenges relating to the constitutional division of power across the various levels of governance are eminent in Canada’s case. The provincial authorities believe that the federal should just fund them without probing their activities. On the other hand, the national government is keen on adhering to the Canada Health Act that gives the power of withholding allocation of funds to a province that does not follow the five health principles.
References
Coyte, P. C., " McKeever, P. (2016). Home care in Canada: Passing the buck. Canadian Journal of Nursing Research Archive, 33(2).
Flood, C. M., Lahey, W., " Thomas, B. (2017). Federalism and Health Care in Canada: A Troubled Romance?
Jackman, M. (2000). Constitutional jurisdiction over health in Canada. Health LJ, 8, 95.
Leeson, H. (2004). Constitutional jurisdiction over health and health care services in Canada. The governance of health care in Canada. The Romanow Papers, 3, 50-82.
Porter, J. (2015). The vertical mosaic: An analysis of social class and power in Canada. University of Toronto Press.
Stevenson, J. (2017). Canadians' health-care costs have skyrocketed: Study. Retrieved on November 14, 2018 from https://torontosun.com/2017/08/01/canadians-health-care-costs- have-skyrocketed-study/wcm/495190a8-ff3e-4016-aea2-43c61b4e6d3d
Sutherland, J. M. (2011). Hospital payment policy in Canada: options for the future. Ottawa: Canadian Health Services Research Foundation.
Sutherland, J., Crump, R., Repin, N., " Hellsten, E. (2013). Paying for hospital services: A hard look at the options.
