The Standing Senate Committee on Social Affairs, Science and Technology Interim Report on the state of health care system in Canada The Health of Canadians – The Federal Role Volume One – The Story So Far Chair The Honourable Michael J. L. Kirby Deputy Chair The Honourable Marjory LeBreton MARCH 2001 TABLE OF CONTENTS ORDER OF REFERENCE............................................................................................iii MEMBERSHIP.................................................................................................................iv FOREWORD......................................................................................................................v INTRODUCTION............................................................................................................1 CHAPTER ONE: ............................................................................................................. 5 Historical Background on Public Health Care Insurance and the Role of the Federal Government in Financing Health Care ............................................................................. 5 1.1 Federal Role in Health and Health Care..................................................................... 5 1.2 Cost-Sharing Arrangements ...................................................................................... 7 1.3 Functioning of the EPF Block Funding..................................................................... 11 1.4 The CHST.......................................................................................................... 15 1.5 Tax Points versus Cash Transfers............................................................................ 20 1.6 The Federal Contribution to Health Care .................................................................. 22 1.7 The Need for Stability in Federal Funding................................................................. 24 1.8 Accountability in the Use of Federal Health Care Dollars ............................................ 27 CHAPTER TWO: ............................................................................................................31 National Principles for Health Care and the Advent of the Canada Health Act................. 31 2.1 The Origins of the Canada Health Act................................................................... 31 2.2 Definition/Interpretation of the National Principles and their Application....................... 34 2.3 Enforcement Penalties under the Canada Health Act................................................. 37 2.4 Is the Canada Health Act Still Relevant? ............................................................... 39 2.5 Committee Commentary.......................................................................................... 40 CHAPTER THREE: ...................................................................................................... 45 Public Expectations about Health Care........................................................................... 45 3.1 Health Care is an Important Public Policy Concern ..................................................... 45 3.2 Canadians Are Concerned About Quality, Access and Universality ............................... 47 3.3 Health Care is a Priority........................................................................................ 48 3.4 Health Care is a Federal/Provincial Partnership ........................................................ 51 3.5 Support for the Principles of the Canada Health Act is High ...................................... 52 3.6 Decreasing Support for User Charges and Private Initiatives.......................................... 53 3.7 Committee Commentary.......................................................................................... 53 i CHAPTER FOUR: ......................................................................................................... 57 Trends in Health Care Expenditures............................................................................... 57 4.1 Global Trends – From 1975 to 2000 ...................................................................... 58 4.2 Public versus Private Spending................................................................................. 61 4.3 Categories of Expenditures...................................................................................... 63 4.4 International Comparisons...................................................................................... 65 4.5 Health Care is a Priority in the Provinces.................................................................. 70 4.6 Committee Commentary.......................................................................................... 71 CHAPTER FIVE: ........................................................................................................... 73 Health Status and the Concept of Population Health...................................................... 73 5.1 Health Status of Canadians.................................................................................... 73 5.2 How Does Canada Compare to Other Countries?....................................................... 77 5.3 Health Care Expenditures and Health Status............................................................ 80 5.4 The Concept of Population Health............................................................................ 81 5.5 What Makes Canadians Healthy or Unhealthy?........................................................ 87 5.6 Committee Commentary.......................................................................................... 89 CHAPTER SIX:............................................................................................................... 93 Myths and Realities......................................................................................................... 93 6.1 Myths About Rising Health Care Costs.................................................................... 93 6.2 Myths About Public Financing................................................................................ 95 6.3 Myths About the Canada Health Act .................................................................... 97 6.4 Myths About Privatization................................................................................... 102 6.5 Myths About Health Care Utilization.................................................................... 107 6.6 Myths About the Health Status of the Population..................................................... 108 6.7 Myths About the Need for Change......................................................................... 111 6.8 Myths About Health Care Providers...................................................................... 113 CONCLUSION.............................................................................................................. 117 The Next Steps............................................................................................................ 117 APPENDIX A - LIST OF WITNESSES......................................................................A-1 ii ORDER OF REFERENCE Extract from the Journals of the Senate of March 1, 2001: Resuming debate on the motion of the Honourable Senator LeBreton, seconded by the Honourable Senator Kinsella: That the Standing Senate Committee on Social Affairs, Science and Technology be authorized to examine and report upon the state of the health care system in Canada. In particular, the Committee shall be authorized to examine: (a) The fundamental principles on which Canada's publicly funded health care system is based; (b) The historical development of Canada's health care system; (c) Health care systems in foreign jurisdictions; (d) The pressures on and constraints of Canada's health care system; and (e) The role of the federal government in Canada's health care system; That the papers and evidence received and taken on the subject and the work accomplished during the Second Session of the Thirty-sixth Parliament be referred to the Committee; That the Committee submit its final report no later than June 30, 2002; and That the Committee be permitted, notwithstanding usual practices, to deposit any report with the Clerk of the Senate, if the Senate is not then sitting; and that the report be deemed to have been tabled in the Chamber. After debate, The question being put on the motion, it was adopted. ATTEST : Paul C. Bélisle Clerk of the Senate iii MEMBERSHIP Standing Senate Committee on Social Affairs, Science and Technology The Honourable Michael J. L. Kirby, Chair The Honourable Marjory LeBreton, Deputy Chair The Honourable Senators : Catherine S. Callbeck Erminie J. Cohen Joan Cook Jane Marie Cordy Joyce Fairbairn Alasdair B. Graham Janis G. Johnson Lucie Pépin Douglas Roche Brenda Robertson * Sharon Carstairs (or Fernand Robichaud) * John Lynch-Staunton (or Noel A. Kinsella) Original Members agreed to by Motion of the Senate : The Honourable Senators : Callbeck, *Carstairs (or Robichaud), Cohen, Cook, Cordy, Graham, Fairbairn, Kirby, Johnson, LeBreton, *Lynch-Staunton (or Kinsella), Pépin, Roche, Robertson Other Senators who participated in the work of the Committee during the First Session of the Thirty-Seventh Parliament and the Second Session of the Thirty-Sixth Parliament: The Honourable Senators : Atkins, Banks, Keon, Losier-Cool, Mahovlich, Meighen, Morin, Murray, Robichaud F. and Wilson * Ex Officio members iv FOREWORD anada’s publicly-funded health care