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ELOM4 Ethical, Legal, and Organizational Medicine The Canadian Health Care System Toronto Notes 2019 Health Care Expenditure and Delivery in Canada
• theprojectedtotalhealthcareexpenditurein2017isexpectedtoreach$242billion,comprising11.5% of the GDP, or approximately $6,604 CDN per person
Sources of Health Care Funding
• 70%oftotalhealthexpenditurein2017camefrompublic-sectorfundingwith65%comingfromthe provincial and territorial governments, and another 5% from other parts of the public sector: federal direct government, municipal, and social security funds. 30% is from private sources including out of pocket (15%), private insurance (12%) and other (3%)
• publicsectorcoversservicesofferedoneitherafeeforservice,capitation,oralternatepaymentplanin physicians’ offices and in hospitals
• publicsectordoesnotcoverservicesprovidedbyprivatelypracticinghealthprofessionals(e.g.dentists, chiropractors, optometrists, massage therapists, osteopaths, physiotherapists, podiatrists, psychologists, private duty nurses, and naturopaths), prescription drugs, OTC drugs, personal health supplies, and use of residential care facilities
2000 28.3% 1500
1000 500
0
Drugs
14%
15.4%
11.1%
Other Professionals
6.3%
2% 2.1%
5.5%
3.7% 2.5%
• hospitalservicesinCanadaarepubliclyfundedbutdeliveredthroughprivate,not-for-profitinstitutions owned and operated by communities, religious organizations, and regional health authorities
• othercountries,suchastheUnitedStates(amixofpublicandprivatefunding,aswellasprivate for-profit and private not-for-profit delivery), and the United Kingdom (primarily public funding and delivery) have different systems of delivery
Physician Licensure and Certification
Table 2. Key Physician Certification and Licensing Bodies in Canada
5%
1.5%
2.4%
Figure 1. Total health expenditure per capita by use of funds, Canada 2017 (dollars) Adpated from: https://www.cihi.ca/sites/default/files/document/nhex2017-trends-report-en.pdf
Delivery of Health Care
Certifying Body MCC
RCPSC
CFPC Licensing Body
CPSO
Description
Certifies physicians with the LMCC. LMCC acquired by passing the MCC Qualifying Examination Parts I and II
Certifies specialists who complete an accredited residency program and pass the appropriate exam
Voluntary membership of the RCPSC is designated FRCPC or FRCSC
Certifies family physicians who complete an accredited residency program and pass the Certification Examination in Family Medicine
13 provincial medical regulatory (licensing) authorities
All postgraduate residents and all practicing physicians must hold an educational or practice license from the licensing body in the province in which they study or practice
Membership to the provincial licensing authority is mandatory Licensing authority functions include:
Provide non-transferable licensure to physicians
Maintaining ethical, legal, and competency standards and developing policies to guide doctors Investigating complaints against doctors
Disciplining doctors guilty of professional misconduct or incompetence
At times of license investiture and renewal, physicians must disclose if they have a condition (such as HIV positivity, drug addiction, or other illnesses) that may impact their ability to practice safely
Total health expenditure per captia by use of funds, Canada 2017 (dollars)
© Dani Sayeau 2019
Drugs: Prescribed Hospitals
Physicians Drugs: Non-prescribed
Dental Services Other Institutions
Public Health Health Research Other Health Spending
Other Health Professionals Vision Care Services
Administration Capital