During the webinar, attendees will be presented with: - An overview of the basic roles and responsibilities of federal and provincial governments within our healthcare system - A review of the key players and structures operating within the system - The differences between engaging politicians and bureaucrats when advocating within the healthcare system. Each has important and different roles to play.

1. Health Care in Canada:
Who Does What?
Ryan Clarke
Thursday, April 16, 2015

2. Overview
• About Advocacy Solutions®
• Overall Structure
• Role of the Federal Government
• Role of the Provincial/Territorial Governments
• Delivery vs. Financing
• Key Players
• Current Challenges
• Advocating to Politicians vs. Bureaucrats

3. Advocacy Solutions®
• Business committed to providing a voice to
organizations and individuals through the
development and implementation of impactful
advocacy strategies
• Three core services:
– Training and development
– Creation of strategic plans
– Implementation of strategies

4. In Canada?

5. Overall Structure
• In general, health care in Canada is publicly funded,
but privately delivered
• This means that while the vast majority of health care
services are “free” at the point of use, they are
delivered by private providers i.e. physicians
• The provinces are constitutionally responsible for the
administration and delivery of health care services
under s. 92.7 of the Constitution Act, 1867:
– The Establishment, Maintenance, and
Management of Hospitals, Asylums, Charities, and
Eleemosynary (charitable) Institutions in and for
the Province, other than Marine Hospitals

6. Federal Role
• The role of the federal government is to:
– Assist in financing provincial and territorial health care services
through fiscal transfers
– Set standards and principles upon which transfers are contingent
– Deliver health care services to specific groups
– Provide and fund other health-related functions
House of Commons

7. Canada Health Act, 1984
• The Canada Health Act (1984) is Canada’s
federal health insurance legislation
• It establishes the criteria and conditions related
to insured health care services – the national
standards – which the provinces and territories
must meet in order to receive the full federal
cash transfer contribution
• Historically, insured services are largely
restricted to care delivered in hospitals or by
physicians

8. Canada Health Act, 1984
• The Act states that "the primary objective of
Canadian health care policy is to protect, promote
and restore the physical and mental well-being of
residents of Canada and to facilitate reasonable
access to health services without financial or other
barriers”
• To do so, the Act lists a set of criteria and
conditions that the provinces and territories must
follow to receive their federal transfer payments:
public administration, comprehensiveness,
universality, portability, and accessibility
• There is also a requirement that the provinces
ensure recognition of the federal payments and
provide information to the federal government

9. Provincial/Territorial Role
• Administration of their health insurance plans
• Planning and funding of care in hospitals and other
health facilities
• Services provided by physicians and other health
professionals
• Planning and implementation of health promotion and
public health initiatives
• Negotiation of fee schedules with health professionals
Ontario legislatureBC legislature

10. Delivery vs. Financing
• Health care delivery refers to the manner in which
medical services are organized, managed and
provided
• In large measure, health care is delivered through
private providers
• The health care industry is the second largest
employer in Canada (over two million people)
• They can be divided into three types of services:
– Primary care
– Secondary care
– Additional care

11. Delivery vs. Financing
• Health care financing refers to how medical
services are paid for
• In large measure, health care is financed through
public funds, but that is evolving
• Total health care spending in Canada was
expected to reach $214.9 billion in 2014, averaging
$6,045 per person
• Financing comes from three primary sources:
– Public
– Private
– Out-of-pocket

12. Timing is Everything…

13. Key Players in Delivery
• Hospitals – representing almost 30% of total health care
expenditures
• While independently operated, all hospitals in Canada are
regulated by the provinces and territories (even the private
ones)
• Drugs – representing almost 16% of total health care
expenditures
• Includes brand and generic, those delivered inside hospitals
(publicly funded) and outside hospitals (mixed funding)
• Physician services – representing almost 15% of total health
care expenditures

14. Other Key Players
• Canadian Institute of Health Information
– mandate is to lead the development and maintenance of
comprehensive and integrated health information that enables
sound policy and effective health system management that
improve health and health care in Canada
• Canadian Institutes of Health Research
– mission is to create new scientific knowledge and to enable its
translation into improved health, more effective health services
and products, and a strengthened Canadian health care system
• Canadian Agency for Drugs and Technologies in Health
– provides decision-makers with the evidence, analysis, advice, and
recommendations they require to make informed decisions in
health care

15. Other Key Players
• Mental Health Commission of Canada
– a catalyst for improving the mental health system and changing
the attitudes and behaviours of Canadians around mental health
issues
• Canadian Partnership Against Cancer
– an independent organization funded by the federal government to
accelerate action on cancer control for all Canadians
• Canada Health Infoway
– jointly invests with every province and territory to accelerate the
development and adoption of health information and
communications technology projects in Canada

16. Other Key Players
• Health Council of Canada
– The Health Council of Canada's role is to let Canadians and their
governments know how progress towards the vision laid out in the
health accords is coming along, to better enable decision-making
at all levels
• Canadian Patient Safety Institute
– provides a coordinating and leadership role across health sectors
and systems, promotes leading practices and raises awareness
with stakeholders, patients and the general public about patient
safety
• Provincial Health Quality Councils
– report directly to the public on the quality, safety and performance
of health services and the health system in given provinces

17. Other Key Players
• Regional/Local Health Authorities
– provide the delivery of operational public health care
services by geographic region
• Patient/Advocacy Groups
• Patients/Caregivers
• The Public

18. Current Challenges
• On September 16, 2004, the Canadian government
announced $41 billion over the next 10 years of new
federal funding in support of the action plan on health
• That Health Accord expired in 2014 and the federal
government did not negotiate funding leading up to last
year - just measurement, accountability and best
practices
• The funding is set – an increase of six percent in the first
three years, and a minimum of three percent in the
remaining seven years

19. Current Challenges
• On September 16, 2004, the Canadian government
announced $41 billion over the next 10 years of new
federal funding in support of the action plan on health
• That Health Accord expired in 2014 and the federal
government did not negotiate funding leading up to last
year - just measurement, accountability and best
practices
• The funding is set – an increase of six percent in the first
three years, and a minimum of three percent in the
remaining seven years
• In 2013, health care accounted for about 38% of
provincial/territorial government spending: BC 43%, AB
38%, SK 37%, MB 44%, ON 41%, PQ 30%, NS 46%,
NB 40%, PEI 38%, NL 37%

20. Federal/Provincial
Government Structure
Minister:
– Political staffers
– Serve at the pleasure
of the Crown
– Sole purpose is to
serve their Minister
and their political
interests
– Transitory positions
Deputy Minister:
– Hierarchical structure
below
– People under DM do
not serve at the
pleasure of the
Crown
– Sole purpose is to
serve the public in an
impartial manner
– Permanent positions

21. Advocating to Politicians
• Ensure that your key messages are clear, compelling concise
and consistent – with one ‘ask’
• Assume they know nothing about your issue
• Find out everything you can about that person and their
potential link to your issue
• Where possible, link your issue to their stated political
objectives or public policies i.e. Families First
• Bring your issue down to the riding/personal level
• Position your issue within the context of the election cycle
• Position your issue as a political ‘win’
• Selectively engage the opposition to leverage the gov’t
• Keep them informed of your engagement with the bureaucrats
• Be prepared to be assertive/aggressive if necessary

22. Advocating to Bureaucrats
• Ensure that your key messages are clear, compelling concise
and consistent – with one ‘ask’
• Find out everything you can about that person, including past
roles, career track, etc.
• Where possible, link your issue to gov’t programs and
initiatives i.e. disease strategy
• Have people who can speak to the technical or clinical aspects
of your issue
• Know where you are in the election cycle
• Keep them informed of your engagement with the politicians
• NEVER blindside a bureaucrat

23. Advocacy Solutions®
Contact Information:
Ryan Clarke, LL.B.
t. 905.891.0311
f. 905.891.0366
ryan@advocacysolutions.ca
www.advocacysolutions.ca