Are the Provinces Really Shortchanged by Federal Transfers?
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Canada Health Act Canada Health Act
CANADA HEALTH ACT CANADA HEALTH CANADA HEALTH ACT Public Administration Public Administration Accessibility Accessibility Universality Universality ANNUAL REPORT Comprehensiveness Comprehensiveness 2014–2015 Portability Portability ANNUAL 2014 REPORT 2015 Health Canada is the federal department responsible for helping the people of Canada maintain and improve their health. Health Canada is committed to improving the lives of all of Canada’s people and to making this country’s population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system. Published by authority of the Minister of Health. Canada Health Act – Annual Report 2014–2015 is available on Internet at the following address: http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/index-eng.php Également disponible en français sous le titre: Loi canadienne sur la santé – Rapport Annuel 2014-2015 This publication can be made available on request on diskette, large print, audio-cassette and braille. For further information or to obtain additional copies, please contact: Health Canada Address Locator 0900C2 Ottawa, Ontario K1A 0K9 Telephone: (613) 957-2991 Toll free: 1-866-225-0709 Fax: (613) 941-5366 © Her Majesty the Queen in Right of Canada, represented by the Minister of Health of Canada, 2015 All rights reserved. No part of this information (publication or product) may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in a retrieval system, without prior written permission of the Minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5 or [email protected] HC Pub: 150140 Cat.: H1-4E-PDF ISBN:1497-9144 ACKNOWLEDGEMENTS Health Canada would like to acknowledge the work and effort that went into producing this Annual Report. -
Canada Health Act a Barrier to Reform? Nadeem Esmail and Bacchus Barua
2018 Is the Canada Health Act a Barrier to Reform? Nadeem Esmail and Bacchus Barua 2018 • Fraser Institute Is the Canada Health Act a Barrier to Reform? by Nadeem Esmail and Bacchus Barua Contents Executive Summary / i Introduction / 1 1 The Failures of Canadian Health Policy and the Case for Reform / 2 2 How Canadian Health Policy Differs from Other Systems / 5 3 What Is the Canada Health Act? / 16 4 To What Extent Is the Canada Health Act a Barrier to Reform? / 19 5 Options for Reform / 26 Conclusion / 30 References / 33 About the Authors / 39 Acknowledgments / 40 Publishing Information / 41 Purpose, Funding, and Independence / 42 Supporting the Fraser Institute / 42 About the Fraser Institute / 43 Editorial Advisory Board / 44 Esmail and Barua • Is the Canada Health Act a Barrier to Reform? • i Executive Summary Despite spending more on health care than the majority of developed countries with universal-access health-care systems, Canada performs poorly in inter- national comparisons of the performance of health systems. Canada’s health poli- cies also differ from those of other nations with universal-access health care—in particular, those that have the developed world’s best performing universal sys- tems—in a number of ways. These include policies affecting private involvement in the insurance and delivery of core medical services, patient cost-sharing, dual practice by physicians, and activity-based funding for hospitals. Evidence of how Canada’s health-care system underperforms coupled with concerns about its fis- cal sustainability in the future suggest the need for policy reform. Canadian health-care policy, including decisions about what services will be provided under a universal scheme, how those services will be funded and remunerated, who will be permitted to deliver services, and whether those ser- vices can be partially or fully funded privately is determined exclusively by prov- incial governments in Canada. -
International Profiles of Health Care Systems
EDITED BY Elias Mossialos and Ana Djordjevic London School of Economics and Political Science MAY 2017 MAY Robin Osborn and Dana Sarnak The Commonwealth Fund International Profiles of Health Care Systems Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, Taiwan, and the United States THE COMMONWEALTH FUND is a private foundation that promotes a high performance health care system providing better access, improved quality, and greater efficiency. The Fund’s work focuses particularly on society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. MAY 2017 International Profiles of Health Care Systems Australia EDITED BY Canada Elias Mossialos and Ana Djordjevic London School of Economics and Political Science China Denmark Robin Osborn and Dana Sarnak The Commonwealth Fund England France To learn more about new publications when they become available, Germany visit the Fund’s website and register to receive email alerts. India Israel Italy Japan The Netherlands New Zealand Norway Singapore Sweden Switzerland Taiwan United States CONTENTS Table 1. Health Care System Financing and Coverage in 19 Countries . 6 Table 2. Selected Health Care System Indicators for 18 Countries . 7 Table 3. Selected Health System Performance Indicators for 17 Countries. 8 Table 4. Provider Organization and Payment in 19 Countries . -
Reforming the Canada Health Transfer
Turning Point 2014 Series A Macdonald-Laurier Institute Publication Applying the welfare reform lessons of the 1990s to healthcare today Reforming the Canada Health Transfer By Jason Clemens October 2011 Nicholson, former President, Canadian Martineau, Toronto; Maurice B. Tobin, the Board of Directors Council of Academies, Ottawa; Jacquelyn Tobin Foundation, Washington DC. Chair: Rob Wildeboer, Chairman, Martin- Thayer Scott, past President & Professor, rea International Inc., Toronto Cape Breton University, Sydney. Managing Director: Brian Lee Crowley, Research Advisory former Clifford Clark Visiting Economist at Board Finance Canada Advisory Council Lincoln Caylor Secretary: , Partner, Bennett Purdy Crawford, former CEO, Imasco, Janet Ajzenstat, Professor Emeritus of Poli- Jones, Toronto now Counsel at Osler Hoskins; Jim Din- tics, McMaster University; Brian Ferguson, Martin MacKinnon Treasurer: , CFO, Black ning, former Treasurer of Alberta; Don Professor, health care economics, University Bull Resources Inc., Halifax; Drummond, Economics Advisor to the TD of Guelph; Jack Granatstein, historian and John Beck Directors: , Chairman and CEO, Bank, Matthews Fellow in Global Policy and former head of the Canadian War Mu- Erin Aecon Construction Ltd., Toronto; Distinguished Visiting Scholar at the School seum; Patrick James, Professor, University Chutter , President and CEO, Puget Ventures of Policy Studies at Queen’s University; Brian of Southern California; Rainer Knopff, Navjeet (Bob) Dhillon Inc., Vancouver; , Flemming, international -
A Critical Study of Canada Social Transfer As an Instrument of Social Policy
International Journal of Policy Studies Vol.7, No.2, 2016 A Critical Study of Canada Social Transfer as an Instrument of Social Policy Devi Roy Jawaharlal Nehru University, India Abstract The expansion of the federal role in social policy led to the development of a Canadian welfare state. The federal government funds the majority of social programmes through the mechanisms of Canada Health Transfer (CHT) and Canada Social Transfer (CST). The CST is the federal transfer payment programme in support of education, social assistance and social services, which includes early childhood development and early learning and childcare. The CST was initially combined with the CHT in a programme called the Canada Health and Social Transfer (CHST) 1995. It was made independent from the Canada Health and Social Transfer programme on April 1, 2004, to allow for greater accountability and transparency in the social sector areas. As CHST was bifurcated into CHT and CST, the CHT is the largest major transfer and it provides funding for healthcare and supports the principles of the Canada Health Act to provinces and territories. The present paper attempts to analyse that CST is the primary federal contribution in Canada to provincial and territorial social programmes and is also an instrument of social policy. The federal transfer is an important instrument for the provinces and the territories for a social change. For the implementation of the policy, fund plays a crucial role. So from this paper tries to analyse the Canada Social Transfer as a key instrument of the social policy of 10 provinces and 3 territories. -
Health-Related Government Information & Statistics
HEALTH-RELATED GOVERNMENT INFORMATION & STATISTICS Useful Tips: 1. Search your local University Library catalogue. 2. Use Google Custom Searches (http://library.queensu.ca/webdoc/) 3. Consult a Librarian, and the library web site http://library.queensu.ca/webdoc/ 4. Consider contacting government agencies/departments – finding the right person can get you the information you need 5. Don’t let statistics (or even ‘survey data’) scare you off… Major Canadian Reports • Health Region Report Cards and Ranking (University of Regina) http://www.uregina.ca/admin/faculty/Lockhart/download.html • For the Public's Health: Initial Report of the Ontario Expert Panel on SARS and Infectious Disease Control http://www.health.gov.on.ca/english/public/pub/ministry_reports/walker_panel_2003/walker_panel.html • Learning from SARS - Renewal of Public Health in Canada (Naylor report) http://www.phac-aspc.gc.ca/publicat/sars-sras/naylor/index-eng.php • Building on Values: The Future of Health Care in Canada (Romanow report) http://dsp-psd.pwgsc.gc.ca/Collection/CP32-85-2002E.pdf • A Framework for Reform: Report of the Alberta Premier's Advisory Council on Health (Mazankowski report) http://www.health.alberta.ca/documents/Mazankowski-Report-2001.pdf For a more complete listing, check out the ‘publications’ list at URL: http://www.health.alberta.ca/newsroom/pub-health-care-system.html • The Health of Canadians - The Federal Role (Kirby report)… from the Canadian Senate http://www.parl.gc.ca/common/Committee_SenRep.asp?Language=E&Parl=37&Ses=1&comm_id=47 • Caring for Medicare: Sustaining a Quality System (Fyke report) Saskatchewan Commission on Medicare http://www.health.gov.sk.ca/medicare-commission-final-report • Walkerton Inquiry (water quality and water-borne diseases) http://www.walkertoninquiry.com/ 1 Health – Gov Info.doc Library of Parliament Current Issue Reviews, & Backgrounders http://www2.parl.gc.ca/Sites/LOP/VirtualLibrary/ResearchPublications-e.asp OR http://www.publications.gc.ca/ • Abortion in Canada: Twenty Years After R. -
Report of the Council of the Federation Working Group on Fiscal Arrangements
REPORT OF THE COUNCIL OF THE FEDERATION WORKING GROUP ON FISCAL ARRANGEMENTS ASSESSMENT OF THE FISCAL IMPACT OF THE CURRENT FEDERAL FISCAL PROPOSALS MAIN REPORT JULY 2012 Confidential Without Prejudice Table of Contents: Summary of Major Findings 1. Introduction 2. Major Federal Transfer Programs – Context for Analysis 2.1. Recent History of Major Federal Transfer Programs 2.2. Major Federal Transfers going into Renewal 3. Current Federal Fiscal Proposals 4. Assessment of the Impact of the Current Federal Proposals 4.1. Canada Health Transfer 4.2. Canada Social Transfer 4.3. Equalization 4.4. Territorial Formula Financing 4.5. Combined Major Transfers 4.6. Federal and Provincial-Territorial Fiscal Balances 5. Additional Information Appendices Confidential Without Prejudice Summary of Major Findings The funding parameters for major transfer programs announced by the federal government on December 19th, 2011 will improve the medium and long-term fiscal prospects for the federal government. However, the amount of federal support associated with the announcement has made the provincial/territorial fiscal situation less sustainable and will result in a declining federal share of funding for provincial/territorial health care and other social programs. To estimate the fiscal impact on provinces and territories, the Working Group on Fiscal Arrangements developed projections of major transfer entitlements based on the December 19th federal announcement and a number of alternative scenarios. See full report for details. The fiscal impacts of the December 19th announcement will be as a result of: The lower CHT growth rate beginning in 2017/18 (from 6% to nominal GDP growth); Limited protection being provided for the move to equal per capita CHT cash in 2014/15; The extension of the “caps” on the Equalization Program until at least 2018/19. -
Canadian Federal–Provincial/Territorial Funding of Universal Health Care: Fraught History, Uncertain Future
ANALYSIS Canadian federal–provincial/territorial funding of universal health care: fraught history, uncertain future C. David Naylor MD DPhil, Andrew Boozary MD MPP, Owen Adams PhD n Cite as: CMAJ 2020 November 9;192:E1408-12. doi: 10.1503/cmaj.200143 s the coronavirus disease 2019 (COVID-19) epidemic con- tinues in Canada and financial pressures mount on all KEY POINTS levels of government, the federal–provincial/territorial • Federal–provincial and territorial cost-sharing arrangements cost-sharingA framework for universal publicly financed coverage that support publicly financed health services in Canada have of physician and hospital services — commonly referred to as evolved over the course of more than 60 years and remain Medicare — has once again become a point of contention. In contentious today. September 2020, just days before a federal Speech from the • The fraught history of cost-sharing illustrates why the federal and Throne, Canada’s provincial and territorial premiers called for provincial and territorial governments have divergent views on a fair deal to support Canada’s health care systems. the federal government to become “a full funding partner” in health care spending, raising its contribution to provincial and • Examination of the benchmarks used historically for cost sharing shows that there is a ~$20 billion variance in the level of territorial health spending from 22% to 35%, an increase of current federal support depending on whether credit is given $28 billion per annum.1 Yet, to the expressed disappointment of for tax points transferred in 1977, and on a cash-only basis, the premiers,2 the Throne Speech offered no increases in federal discrepancies against benchmarks range from ~$15 billion in funding for health. -
Restoring Fiscal Balance in Canada
fp_e•GOOD 4/30/06 8:48 PM Page 1 fp_e•GOOD 4/30/06 8:48 PM Page 2 © Her Majesty the Queen in Right of Canada (2006) All rights reserved All requests for permission to reproduce this document or any part thereof shall be addressed to Public Works and Government Services Canada. Available from the Distribution Centre Department of Finance Canada Room P-135, West Tower 300 Laurier Avenue West Ottawa, Ontario K1A 0G5 Tel: 613 995-2855 Fax: 613 996-0518 and from participating bookstores. Also on the Internet at www.fin.gc.ca Cette publication est aussi disponible en français. Cat. No.: F1-23/2006-4E ISBN 0-662-43313-0 fp_e•GOOD 4/30/06 8:48 PM Page 3 Table of Contents 1. Introduction . 5 2. Concerns Over Transparency in Federal Fiscal Planning . 11 3. Concerns Over Blurred Accountability Due to Reduced Clarity in Roles and Responsibilities . 17 4. Concerns Over Predictable, Long-Term Funding for Fiscal Arrangements . 25 5. Concerns Over a Competitive and Efficient Economic Union . 45 6. The Government’s Approach . 53 7. Moving Ahead . 75 Annexes 1. A Brief History of the Fiscal Relations Debate in Canada . 83 2. Recent Evolution of Fiscal Balance in Canada . 101 3. Major Transfers . 123 fp_e•GOOD 4/30/06 8:48 PM Page 5 1 INTRODUCTION fp_e•GOOD 4/30/06 8:48 PM Page 7 Introduction “This new government will take a new approach. It is committed to building a better federation in which governments come together to help Canadians realize their potential. -
030821 Canada's Health Care System — Reform Delayed
The new england journal of medicine health policy report Canada’s Health Care System — Reform Delayed Allan S. Detsky, M.D., Ph.D., and C. David Naylor, M.D., D.Phil. The foundation of Canada’s government-funded constitutional contradiction, health insurance system was laid in 1957, when the structural gridlock federal government passed legislation providing financial incentives for the provincial governments Canada’s constitution puts the authority for taxation to establish universal hospital insurance. There- largely in the federal sphere but the management of after, major reforms in the health insurance system health care systems under provincial jurisdiction. have occurred three times. In 1968, insurance for The inevitable byproduct of this division of powers physician services was added. In 1977, the federal is recurrent squabbling among levels of government government altered its cost-sharing arrangement about health care. Because the federal government with the provinces, abandoning its previous com- has very limited powers to promulgate legislation or mitment to pay approximately 50 percent of pro- regulations that control provincial health services, vincial health care costs. Instead, cash transfers it can lead only by persuading the provinces to ac- were cut at the same time as some federal tax rates cept conditions on funds that it transfers to them. were reduced, leaving provinces the option of fund- If the provinces fail to comply with the conditions ing health care from additional taxes. The result was set by the federal government, the only recourse is an immediate reduction in the federal contribution to impose financial penalties by withholding por- to health care and greater interprovincial variation tions of the transfer payments. -
Paying for Canada
Paying for Canada by Sherri Torjman January 2014 Paying for Canada by Sherri Torjman January 2014 Copyright © 2014 by The Caledon Institute of Social Policy ISBN 1-55382-614-0 Published by: Caledon Institute of Social Policy 1354 Wellington Street West, 3rd Floor Ottawa, ON K1Y 3C3 CANADA Tel./Fax: (613) 729-3340 E-mail: [email protected] Website: www.caledoninst.org Twitter: @CaledonINST Table of Contents The expenditure side of the equation 1 Transfers to Canadians and to governments 1 Table 1 2 Three major fiscal transfers 4 a. Canada Health Transfer 5 b. Canada Social Transfer 7 c. Equalization 8 Conclusion 10 References 11 The expenditure side of the equation Discussions about financing in Canada often focus on the revenue side of the equation. Federal revenues derive primarily from various sources of taxation including income tax, sales tax, payroll taxes (also known as payroll contributions) and corporate tax. The levels and mix of these taxes always seem to spark spirited conversations within and outside government. Both the volume and rhetoric heat up as elections draw near. This report does not deal with the revenue side of the ledger. It is not about how money comes into the government and how Ottawa uses the personal income tax system to deliver income benefits – the latter a crucial subject about which Caledon has written in previous reports. We have argued for a progressive income tax system, the removal or refundability of ‘boutique’ tax credits that favour the well-off and restoration of the two-percentage point cut in the Goods and Services Tax (GST) [Battle and Torjman 2011; Battle, Torjman and Mendelson 2011]. -
Federalism and Health Care in Canada: a Troubled Romance?
Schulich School of Law, Dalhousie University Schulich Law Scholars Research Papers, Working Papers, Conference Papers Faculty Scholarship 6-1-2017 Federalism and Health Care in Canada: A Troubled Romance? University of Ottawa Law RPS Submitter University of Ottawa - Common Law Section, [email protected] Colleen M. M. Flood University of Ottawa - Common Law Section, [email protected] Bryan P. Thomas University of Toronto - Faculty of Law, [email protected] William Lahey Dalhousie University, [email protected] Follow this and additional works at: https://digitalcommons.schulichlaw.dal.ca/working_papers Recommended Citation RPS Submitter, University of Ottawa Law; Flood, Colleen M. M.; Thomas, Bryan P.; and Lahey, William, "Federalism and Health Care in Canada: A Troubled Romance?" (2017). Research Papers, Working Papers, Conference Papers. 17. https://digitalcommons.schulichlaw.dal.ca/working_papers/17 This Working Paper is brought to you for free and open access by the Faculty Scholarship at Schulich Law Scholars. It has been accepted for inclusion in Research Papers, Working Papers, Conference Papers by an authorized administrator of Schulich Law Scholars. For more information, please contact [email protected]. Federalism and Health Care in Canada: A Troubled Romance? Colleen Flood, William Lahey & Bryan Thomas∗ Forthcoming in The Oxford Handbook of the Canadian Constitution, 2017 DRAFT VERSION – NOT FOR CITATION 1. Introduction Canada’s efforts to offer a modern health care system to its people are shaped, complicated, and in many ways hindered, by interpretations of federal/provincial divisions of power laid out in the Constitution Act, 1867 (the 1867 Act). Given its vintage, the 1867 Act has relatively little to say directly with respect to the health sector, which has since Confederation evolved into an enormously important area of the economy and of government activity.