Canada's federal healthcare system provides coverage to all Canadian citizens through a group of socialized health insurance plans. It is publicly funded and administered on a provincial and territorial basis within the guidelines established by the Canadian federal government. Financing is provided through taxation of both personal and corporate income taxes. Additional funds from other sources, like sales tax and lottery proceeds, are also used by some provinces. The federal healthcare funds are transferred to the provinces and territories via transfer payments. As part of the economy, Canada's healthcare system had expenditures were over $100(CN) billion in 2001. Canadians individually spend about $3300 per capita on healthcare.1 All Canadians qualify and are provided preventative care and medical treatment from primary care physicians, hospitals, and additional medical services regardless of medical history, personal income, or standard of living.
The Canada Health Act is the principal federal legislation for our system; it is based on 5 main principles: (1) public administration, (2) comprehensiveness, (3) universality, (4) portability, and (5) accessbility.1 All administration of provincial health insurance must be carried out by a public authority on a nonprofit basis. The public authorities must be accountable to the province or territory, and all records/accounts are subject to audit. Comprehensiveness ensures that all necessary health services, including hospitals, physicians, and surgical dentists, are insured. Universality within the plan makes certain that all insured residents are entitled to the same level of healthcare and accessibility ensures that all insured persons have reasonable access to healthcare facilities. In addition, all physicians, hospitals, etc must be provided reasonable compensation for the services they provide. Portability within the system makes certain that a resident who moves to a different province or territory remains entitled to coverage from his or her home province during a minimum waiting period. Portability also applies to residents who leave the country.
Provincial health insurance in Canada is administered by the provinces and territories. New residents to a province or territory must apply for health coverage. A health card is issued, which provides access to care. In addition to the standard healthcare coverage as identified by the Canada Health Act, provinces provide additional services. These services may include physical therapy, dental coverage, and prescription medicines.1 Provinces are not obligated to provide services not identified in the Canada Health Act. Provincially, funding for healthcare is one-third to one-half of what is spent on social programs.
Services outside the basic standard of coverage, such as dental, vision care, and some prescriptive medicines, may be covered by private health insurance plans. These plans are made available as part of employee benefit packages or through private insurance providers. The main reason to purchase private insurance is to supplement the standard primary healthcare coverage.
The province of Ontario is the setting of the Canadian Association for Enterostomal Therapy (CAET) sponsored study reported in this issue of the Journal. The Ontario Ministry of Health and Long-Term Care is responsible for administering the healthcare system and providing health services to its population through such programs as health insurance, drug benefits, assistive devices, care of the mentally ill, long-term care, home care, community and public health, and promotion and disease prevention. It also regulates hospitals, long-term care facilities and nursing homes, psychiatric hospitals, and medical laboratories, and coordinates emergency health services.2
In 2006, the Ontario government changed the delivery of healthcare services for the province with the establishment of regional Local Health Integration Networks (LHINs) through the Local Health System Integration Act, 2006.3 The LHINs are not-for-profit corporations that work with local healthcare providers and community members to determine the health service priorities for their regions. The LHINs do not provide services directly; rather, they are responsible for integrating services in each of their specific geographic area. There are 14 LHINs across the province of Ontario; they are responsible for public and private hospitals, community care access centers (CCACs), community support service organizations; mental health and addiction agencies; community health centers; and long-term care homes. One of the main benefits of this design is that "patients will benefit from having health service decisions affecting them made by people in their community, who understand the needs of the community and the people who live there."3 LHINs have the authority to integrate local health services and programs, as agreements with providers are negotiated.
Locally, the CCACs are the point of access to community-based healthcare services.4 CCACs are funded by the provincial Ministry of Health and Long-Term Care. They serve to coordinate needed healthcare services to maintain an individual's health, independence, and quality of life. In-home healthcare services may include nursing, personal support care, physical therapy, occupational therapy, speech-language therapy, social work, nutritional counseling, and medical supplies and equipment. The CCACs purchase quality and best-priced services from local for-profit and not-for-profit service providers (such as nursing care agencies) through a request-for-proposal process. Contracts are then awarded for various periods of time. The context of this study from the standpoint of the provincial Ontario healthcare system is the contractual service relationship between a local CCAC and providers of nursing services for wound care.
References