Health Management: The Canadian Perspective
There is one issue in Canada that tends to prevail more than any other Canadian public policy debate which is the issue of health care and health care delivery. This paper seeks to explain the various features of the Canadian health care system, the range of problems that have to be addressed in the system and the most prominent proposed ways of dealing with the problems in the industry. The Canadian health care industry was the second largest employer in the country exactly three years ago. The industry, having employed two million people, is paramount to the economic development of the country. The Canadian health care industry is unique in several ways since it has no common public plan: instead, it is characterized by regional insurance schemes also referred to as the territorial insurance plans (Greb, 2008). The functional and tasks in the industry are handled jointly by the private sector, and the government. This is done in such an approach that the public sector handles the funding whereas the private sector does the delivery of the actual services. Further to the sharing of the responsibilities and duties, the federal administration and the regional governments handle the medical services at different levels. Canada does not have a single national arrangement, but regional insurance arrangements.
The Principal Feature of the Canadian Health Care
The Canadian healthcare is characterized by a merge of private and public engrossment. The public sector is the key financer of the citizen’s health concerns as it finances the provision of health care services. Even, so the private sector remains the key provider of the health care services (Drummond et al., 2005). This model is however not consistent in the health care sector as the Canadian government at times exercise considerable authority over the provision of health care services by the private sector while the private sector at times play a role in the financing of the health care delivery. The outstanding features or elements of the health care system of the country are as follows:
Health care professionals:
Vital in the health care delivery are the professionals who give the medical services to the Canadians. Majorly, when we talk of health care professionals in Canada, we are referring to the doctors, general physicians, specialized medics and the nurses. These health care professionals are approximately two million in number and make up the second largest group of professionals in Canada. The health care professionals in the nation can be labeled according to the kind of services they offer (Drummond et al. 2005). The health care services in Canada can be categorized into three. The first category is the primary or the basic services. These are the medical services offered by the family physicians.
The primary care services serve as the basis of the Canadian health care system. It represents the first point where the Canadians come in contact with the health care services. These services are largely provided an independent group of doctors or family doctors, telephone health information lines or community health clinics. The family doctors give attention to the members of the particular family and get paid accordingly. The primary health services are as well offered through the telephone where the patients or the clients call the medical experts for medical advice and guidance (Duncan et al., 2005). Primary health care practitioners offer referral services. They direct the patients that need extra care to higher levels of the system. These all indicate that the primary care services provide two crucial functions: the direct provision of first contact services such as treatment and prevention of common injuries and diseases, and basic emergency services. The other function is the coordination of the patients’ movements to other levels of care, for example the referrals to hospital admissions and medical specialists.
The secondary services are those services offered by medical institutions such as hospitals and dispensaries. It includes a wide range of special medical services which are not provided by the community health clinics and family doctors such as diagnostic testing, emergency care, prescription therapy, counseling, rehabilitation services and palliative care for persons who are almost dying. Other services include the administration of drugs and general therapy, handling of emergency cases such as accidents casualties and victims of violence (Gratzer, 2002). Such health facilities as well handle such services as guidance and counseling. These services are offered to various groups according to their unique needs. They handle such people as drug addicts that are on their way to reformation, HIV/AIDS victims that need medical, psychological as well as nutritional support and orphaned children that need to grow and lead a normal life. Other specialized medical services are as well handled at the secondary level. Specialized services include such complicated procedures as dialysis and major surgical operations especially the ones involving transplants of various body parts. These services are predominantly offered through home care and specialized medical services.
The third category is the additional care services. Such services include specialized medical attention that is not offered by the provincial care insurance schemes (Gratzer, 2002). These include such services as prescription of the medicines, dental care, and optic attention, independent living for persons with disabilities and seniors, and medical appliances and equipment. These are not handled by general physicians but rather by those doctors that have specialized further. A general physician is a doctor who studies medicine at an undergraduate level. A specialist on the other hand is one that has, in addition to the basic undergraduate studies, specialized in the treatment of some particular parts of the body. For, instance, an optician is a doctor who specializes in the treatment, as well as the study of the human eye. It is worth noting that the additional care services may vary considerably from province and region to another.
Federalism:
This is the second feature of the Canadian health care system. By federalism in health care we mean that the regional governments have the mandate to make decisions relating to the administration of health care (Raphael, 2004). This is because as a federation the political authority and power is divided between and among various levels of government. They can actually pass laws governing the administration of health care. Essentially health care in Canada falls under the docket of the regional administrations but is guided by some guideline put in place by the federal government. The provincial governments have to stick to these guiding principles to be eligible for funding from the federal government. Even so, the regional governments have autonomy when it comes to the creation of public policy. The healthcare is therefore not a rational idea but rather a collage of policies. The federal government also plays a crucial role in health care. It enjoys the authority and power in some functional areas of health care which include policing drug safety and food and Aboriginal healthcare. It also exerts its control over the health care system through its constitutional spending powers as it is permitted to spend resources in the area of health care either through fiscal transfers directly to individuals and groups or to the provinces.
Health care delivery and financing
Health care delivery and financing the delivery of health care refers to the process of organizing, administration, and actual provision of health care services (Drummond et al., 2005). The public sector and the private sector play very different roles in the financing and the delivering of medical services. This as mentioned earlier is left in the power of the private sector following the inadequacies of the public sector. Certainly, the public sector has various inefficiencies that make the quality of health care poor. The financing of health services is two-fold. One type of such payment is the one borne by the individual in totality. This is referred as the out-of-pocket financing. This is done when the patient is not covered or wants to avoid the bureaucratic procedures of having to wait for the insurance plan to materialize (Raphael, 2004). It entails the patient directly covering his/her costs associated with the medical service that they are provided with. This can be as result of the patient obtaining medical services which are not covered by the health care insurance plan of an individual or the absence of a health insurance. The second type of financing is the cost-sharing where the individual and the insurance scheme pay the bill in a certain ratio. This is common when patients pay a fixed amount to the insurance plan they obtain before the payment of any benefit can take place. The patient can also pay a small fee to the medical service provider when they have received the medical service which is known as user fees.
Health care financing can also be made possible through the use of health insurance. Health insurance is a means by which people pool the risk of incurring medical expenses. This involves them participating in a collective fund that will eventually cover their health care costs. The health insurance plan can be organized in various forms which has a basic distinction in the presence of the private insurance schemes and the public insurance schemes (Morgan, 2008). The public health insurance schemes cover the community as a whole which is controlled and imposed by a government unit. The private health insurance schemes, contrarily, are schemes which are administered and controlled by private entities or non-governmental entities. This private insurance scheme only covers a small portion of the overall population.
Public insurance schemes are also distinguishable by the manner in which they are funded. Funding may happen through the use of insurance premiums, which require individuals to contribute by paying standard premiums into the public insurance fund so that they can receive its benefits at a later date when they need it. This usually referred to as social security funding (Morgan, 2008). The other approach which is used is the taxation plan which requires the government to fund the insurance scheme through the taxes which are paid in the residents and citizens. These public insurance schemes can also be funded through the mixed approach by the general taxation and the paying in of premiums.
The private insurance schemes normally get their funding through premiums which may be contributed as an individual through the employers or one’s pocket. Furthermore, these private schemes can be either for-profit or non-profit. The non-profit schemes entails the private insurer seeking the collection of premiums and other fees which are necessary in the covering of costs which are to be incurred by the insurance fund, which involve the payment of administration costs and benefits (Greb, 2008). The private for-profit schemes entail the private insurer operating the insurance fund as a business which seeks to generate a profit which will be above the cover costs.
The problems that need to be addressed in the Canadian health care
Just like many health care programs in most of the western nations, the Canadian health care has many pitfalls. Such setbacks have made the health care industry inefficient. These problems often hinder the delivery of medical services to the people of Canada. With the presence of such problem that health care delivery system can never be efficient and effective. These problems have a direct effect on the health status of the people of Canada and need to be addressed. The problems that need to be addressed in the Canadian healthcare include:
Lack of adequate medical personnel:
The problem of inadequate staff in the medical facilities is the reason for the long waits that patients have to endure before they get medical attention. There have been reported cases where patients have to wait on the queue for three months before they can be attended by the hospital attendants (Gratzer, 2002). People have had to book appointments three months earlier so as to avoid unforeseen disturbance. This has resulted in the deaths of many. Health of other several people often worsen during the periods of waiting which leads to the incurring of numerous costs when the final treatment is offered. If not checked upon the persistence of this problem will lead to the deterioration of the general health of the people of Canada.
The imbalances of the healthcare patchwork:
As stated earlier, the healthcare policy is not uniform as public policy changes from one province to another; hence, it implies that the Canadian citizens are not served with the same degree of attention. Some receive better healthcare than other people in different regions. However, the federal government has put in place the policies that each province need to fulfill so that they can receive adequate funds for the upgrading of their health facilities. This is an indication that if every province complies with these policies, there will be a uniform health care system in Canada.
Partial autonomy:
The autonomy given to the province in as far as policy making is concerned is not total or full autonomy (Fierbeck, 2001). The leaders in the provinces are limited in their decision making power. They are restricted by some federal provisions compliance with which is that basis for allocation of funds. With such restriction from the federal government it hinders the provision of quality health care services in some of the provinces.
Proposed solution
Improvement in the public sector healthcare:
The public healthcare policy should not be taken to pieces. Instead, it should be enhanced because if the healthcare is left entirely in the mandate of the private sector, it will be very costly to the common citizens (Fierlbeck, 2001). The major strength of this proposal is that it will yield maximum benefit to the public. The key weakness is that it does not offer an immediate solution.
Training and employing of more specialists:
It is proposed that the government should facilitate the opening and running of many training centers that will ensure more medical personnel are available. This will reduce the agony of long waits that the citizens have to endure to get medical attention (Duncan et al. 2005). This proposal is weak in the sense that it requires too much time to take effect. It is strong in the sense that it provides a long term solution. With the presence of qualified professionals in the health care delivery field it will lead to the effective and efficient operation of the health care system.
Prevention of illness:
Research has it that the persistent diseases account for sixty percent of the medical costs incurred in the country. Through immunization and health campaigns, the chronic diseases can be reduced a great deal. This will cut down on the cost incurred on health care. The money so salvaged can be put into other constructive uses.
Improvement in delivery of health care:
The way in which the care is managed, organized, and administered can be improved through teamwork among doctors (Duncan et al., 2005). If doctors come together and stop the act of practicing as individuals, healthcare will be better delivered. The foremost weakness of this solution is that practicability is not easy since doctors have already established private practice.
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