FEDERALISM AND THE POLITICS OF HEALTH CARE POLICY IN CANADA - PowerPoint PPT Presentation

About This Presentation
Title:

FEDERALISM AND THE POLITICS OF HEALTH CARE POLICY IN CANADA

Description:

Title: PowerPoint Presentation Author: Gerry Boychuk Last modified by: Debora Vannijnatten Created Date: 9/7/2000 9:29:16 PM Document presentation format – PowerPoint PPT presentation

Number of Views:307
Avg rating:3.0/5.0
Slides: 47
Provided by: GerryB3
Category:

less

Transcript and Presenter's Notes

Title: FEDERALISM AND THE POLITICS OF HEALTH CARE POLICY IN CANADA


1
(No Transcript)
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
FEDERALISM AND THE POLITICS OF HEALTH CARE POLICY
IN CANADA
  • Gerard W. Boychuk
  • Department of Political Science
  • University of Waterloo
  • Political Science 321
  • March 6th, 2007

6
Federalism and Health Care
  • constitutional division of powers provides
    different orders of government with different
    policy tools

7
Health Care and the Constitutional Division of
Powers
  • provincial jurisdiction
  • S.92 (7) The Establishment, Maintenance, and
    Management of Hospitalsin and for the Province
  • exceptions
  • gives provinces the power to legislate in regard
    to health care

8
Health Care and the Constitutional Division of
Powers
  • federal policy tools
  • the federal spending power
  • the power of the federal Parliament to make
    payments to people or institutions or governments
    for purposes on which it Parliament does not
    necessarily have the power to legislate.
  • not explicit in the Constitution Act, 1867
  • formally recognized (and limited) in the Social
    Union Framework Agreement, 1999

9
The Federal Role The Canada Health Act, 1984
(CHA)
  • Canada Health Transfer (CHT)
  • block-funding transfer from the federal
    government to the provinces
  • Canada Health Act (CHA)
  • the five principles
  • universality, comprehensiveness, accessibility,
    portability, public administration
  • universal availability of public health insurance
    (on uniform terms and conditions) for all
    medically necessary hospital and physician
    services
  • without financial barriers to access
  • no extra-billing on insured services
  • no user/facility fees on insured services
  • penalties
  • non-discretionary penalties for
    extra-billing/user fees
  • discretionary penalties for other violations of
    five principles
  • no province has ever been penalized for violation
    of the five principles
  • non-requirements
  • no legal prohibitions on private provision of
    services
  • no legal prohibitions on private insurance

10
Federalism and Health Care
  • constitutional division of powers provides
    different orders of government with different
    policy tools
  • the operational division of powers in health care
    is determined politically

11
The Politics of the CHA
  • Theres nothing that says you have to stay in
    the Canada Health Act. Premier Ralph Klein, June
    2004
  • sowhy do provinces abide by the CHA?
  • provinces need the money?
  • CHT (cash) equals roughly
  • 6.5 of total provincial revenue
  • 36 of total federal transfers to provinces

12
Ipsos-Reid, CFNU, January 2006.
13
Ipsos-Reid, CFNU, January 2006.
14
The Politics of the CHA
  • Theres nothing that says you have to stay in
    the Canada Health Act. Premier Ralph Klein, June
    2004
  • sowhy do provinces abide by the CHA?

15
The Politics of the CHA
  • Theres nothing that says you have to stay in
    the Canada Health Act. Premier Ralph Klein, June
    2004
  • sowhy do provinces abide by the CHA?
  • the CHA is politically popular

16
The Politics of the CHA
  • Theres nothing that says you have to stay in
    the Canada Health Act. Premier Ralph Klein, June
    2004
  • sowhy do provinces abide by the CHA?
  • the CHA is politically popular
  • the CHA is enforced politically

17
The Politics of the CHA
  • Theres nothing that says you have to stay in
    the Canada Health Act. Premier Ralph Klein, June
    2004
  • sowhy do provinces abide by the CHA?
  • the CHA is politically popular
  • the CHA is enforced politically
  • provincial violations of the CHA tend to be
    politically unpopular

18
Federalism and Health Care
  • constitutional division of powers provides
    different orders of government with different
    policy tools
  • the operational division of powers in health care
    is determined politically
  • the politics of federal-provincial interaction in
    health care occur in a broader political context

19
Federal Involvement in Health Care
  • nation-building
  • origins of the CHA
  • Quebec referendum, 1980
  • Canada-US free trade debate, 1988
  • continuing context
  • 1995 Quebec referendum

20
Federal Involvement in Health Care
  • globalization has constrained national govts
    more than sub-national govts
  • what does the federal government do in a
    globalized world?
  • trade policy, industrial policy and regional
    development policy, monetary policy, fiscal
    policy
  • what do the provincial governments do in a
    globalized world?
  • education
  • post-secondary education
  • health care

21
Federal Involvement in Health Care
  • vertical fiscal (im)balance
  • definition
  • federal government has excess revenues (relative
    to its responsibilities) and provincial
    governments have insufficient revenues (relative
    to their responsibilities)

22
Source Canada Institutes for Health Information,
Statistics Canada
23
Federal Involvement in Health Care
  • vertical fiscal (im)balance
  • definition
  • federal government has excess revenues (relative
    to its responsibilities) and provincial
    governments have insufficient revenues (relative
    to their responsibilities)
  • effects
  • e.g. federal government is strongly positioned to
    powerfully exercise the federal spending power
  • excess federal revenues
  • provincial demands for federal government to
    share excess revenues

24
Federal Involvement in Health Care
  • constitutional politics
  • formerly the preoccupation of federal-provincial
    relations
  • shift in 1993
  • demise of Meech Lake Accord (1988) and
    Charlottetown Accord (1992)
  • shift to emphasis on functional federalism (and
    away from constitutional discussions)
  • result health care replaced constitutional
    discussions as the central focus of
    federal-provincial relations
  • less evident since 2004

25
Federal Involvement in Health Care
  • context for a renewed federal role in health care
  • health care policy has become a defining
    characteristic of Canadian identity
  • globalization has weakened federal raison detre
  • federal govt has more financial resources than
    it knows what to do with
  • continuing vacuum in federal-provincial relations

26
Federal Involvement in Health Care
  • federal proposals for reinvigorated federal role
    (1995-20??)
  • federal elections 1997, 2000, 2004
  • federal proposals
  • national pharmacare program
  • national homecare program
  • national wait times guarantee

27
Support for 5 Harper Priorities
Source IPSOS-Reid, November 26, 2006
28
Federalism and Health Care
  • constitutional division of powers provides
    different orders of government with different
    policy tools
  • the operational division of powers in health care
    is determined politically
  • the politics of federal-provincial interaction in
    health care occur in a broader political context
  • federal-provincial interaction has important
    impacts on the dynamics driving the politics of
    health care

29
Effects of Federalism on Health Care
  • health as a watertight jurisdictional
    compartment vs. federal-provincial
    interpenetration?
  • dynamics resulting from interpenetration
  • intergovernmental competition has driven
    expansion of public health insurance
  • interpenetration has undermined transparency and
    accountability
  • blame avoidance

30
Effects of Federalism on Health Care
  • different jurisdictional arrangements
  • watertight federal jurisdiction
  • access to public health care would be more
    nationally uniform
  • in the absence of provincial experimentation, may
    be less developed
  • watertight provincial jurisdiction
  • citizen rights to public health care less uniform
  • esp. if dependent on fiscal capacity of the
    provinces (e.g. no federal transfers/equalization)
  • more experimentation
  • likely would be more highly varied range of
    models of public/private interaction

31
Federalism and Health Care Main Messages
  • constitutional division of powers provides
    different orders of government with different
    policy tools
  • the operational division of powers in health care
    is determined politically
  • the politics of federal-provincial interaction in
    health care occur in a broader political context
  • federal-provincial interaction in health has
    important impacts on the dynamics driving the
    politics of health care

32
(No Transcript)
33
(No Transcript)
34
Source Canada Institutes for Health Information,
Statistics Canada
35
Source Canada Institutes for Health Information,
Statistics Canada
36
Source Canada Institutes for Health Information,
Statistics Canada
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
Pollara, Health Care in Canada Survey, 2005.
42
Ipsos-Reid, CFNU, January 2006.
43
Ipsos-Reid, CFNU, January 2006.
44
Ipsos-Reid, CMA, June 2006.
45
(No Transcript)
46
Support for Chaoulli Decision
Source IPSOS-Reid, August XX, 2005
Write a Comment
User Comments (0)
About PowerShow.com