Canadian Healthcare System
Canada is world-renown for its healthcare system. Canadians typically embrace their health system as one of the most tangible characteristics of the ‘Canadian Identity’. Canadians routinely rank publically funded healthcare amongst the most valued benefits of Canadian citizenship.
Healthcare is essential. Good health is often assumed, its role in society often underestimated. In reality, the welfare and productivity of any country, the stability of world economies, depend on the health of its citizens. The consequences of poor healthcare can be devastating, and sometimes irrevocable.
Healthcare is expensive. The cost of the Canadian Healthcare system is approximately $150 Billion dollars annually, a three-fold increase in the past 25 years. This represents $100 Billion of public funding and $50 Billion of private insurance. Canadian Healthcare now accounts for approximately 10.5 percent of GDP.
Healthcare is complex. Providing healthcare is unlike any other sector of the economy. While accounting, finance, and marketing are important to healthcare, as they are to business, healthcare requires expertise in many other areas. Healthcare involves the complex interplay of not only finance, accounting, and marketing, but public and health policy, professional ethics, societal moral values, scientific evidence, and best professional practice.
To understand the Canadian health system, to administer, to shape and improve the Canadian health system requires advanced training. While undeniably a pivotal component of the Canadian landscape, the Canadian healthcare system is vastly more complex than typically understood.
Provincial Responsibility: When we speak of a Canadian program of any sort we typically refer to a program that is funded and regulated by the Federal government. The Canadian health system [‘Medicare’] is not a Federal program. Contrary to what many Canadians think, Canadian healthcare is a provincial, not a Federal responsibility. Healthcare, like education, is a provincial responsibility, regulated by provincial governments.
Public Versus Private: Although many Canadians assume they have a full ‘public health system', this is not the case. The Canadian health system is a highly complex, multi-layered system that is delivered through both private and public venues, and funded by both private and public funds. For example, the typical family physician operates a private medical service office (business), yet is funded through public funds. The government uses public funds to cover the cost of approved medical services rendered to its citizens. Additionally, there are private clinics that are solely funded from private sources. For example, private insurance companies, seeking to ensure its policy holder can regain health so as to return to work as soon as possible, may directly contract a health professional to provide health service to its policy holder, rather than access the publicly funded and publicly delivered health system. Canadian hospitals are typically not-for-profit, yet increasingly, there are for-profit, free-standing health clinics. Even when a hospital is not-for-profit, many health services are offered by private, for-profit companies such as laboratory services.
Funding: The Canadian health system is funded through a complex web of Provincial, Federal, and private sources. The Provincial government directly funds approved medical services, and the Federal government indirectly funds approved medical services. Adding to this complex mix, funding for pharmaceutical treatment, now a core aspect of medical treatment, is funded, in whole or part, through a complex funding model including public and/or private funding, depending on the type of medication, the income of the patient, and/or the access to privately held health insurance.
Access: According to the Canada Health Act (CHA), health services deemed to be ‘medically necessary’ must be provided to Canadian citizens irrespective of their ability to directly pay for such service. While an undeniably well-meaning act, the essential phrase is ‘medically necessary’. At any time the Provincial government can add or delete a medical procedure from the Medically Necessary listing. In fact, over the past decade, provincial governments have done just that, resulting in inter-provincial disparity in health services eligible for public funding.
In sum, healthcare is an essential, expensive, and complex entity. Healthcare is complex indeed. The supply of skilled health professionals is decreasing, while the demand for immediate state-of-the-art health care increases, matched only by increased expectation for accountability. No other human service demands more visionary, more resourceful leadership. No other human service offers more challenging, yet more rewarding career for a leader.