Standing Senate Committee on Social Affairs, Science and Technology (37th Parliament, 1st Session)

Past Session:

The Health of Canadians – The Federal Role

Interim Report

Volume One – The Story So Far

NOTES

^{Debates
of the Senate (Hansard), 2nd Session, 36th Parliament, Volume 138, Issue 23, December 16,
1999.}
^{In this report, the testimony received by
witnesses printed in the Minutes of Proceedings and Evidence of the Standing
Senate Committee on Social Affairs, Science and Technology will be hereinafter
referred to only by issue number and page number within the text.}
^{Keith Banting (9:62).}
^{Tom Kent (13:30).}
^{Payments due to the provinces under the Hospital
Insurance and Diagnostic Services Act were calculated as follows: a province’s
entitlement in a given year was equal to 25% of the average national per capita cost of
the insured services, plus 25% of the cost of the insured services per resident of that
province multiplied by the population of that province in that year. Overall, the federal
government’s contribution was equal to about 50% of the cost of insured services in
Canada, although it was more in the provinces where the per capita costs were lower than
the national average and less in the other provinces.}
^{Under the Medical Care Act, a
province’s entitlement in a given year was equal to 50% of the average national per
capita cost of insured services multiplied by the population of that province in that
year. As a result, all provinces received equal per capita transfers, although the federal
contribution as a proportion of total provincial expenditures varied from one province to
another.}
^{Hon. Marc Lalonde (15:7).}
^{Tom Kent (13:33).}
^{Hon. Marc Lalonde (15:6-7).}
^{Under EPF, the federal tax transfer was
13.5 tax points on personal income tax and one tax point on corporate income tax. The
provinces whose fiscal strength was lower than a provincial standard received equalization
payments to bring their transfer up to that standard (the provinces making up the standard
were Quebec, Ontario, Manitoba, Saskatchewan and British Columbia). As part of its
opting-out agreements, Quebec received a special abatement of 8.5 additional tax points on
personal income. Because of this additional abatement, Quebec received a relatively larger
share of its federal contribution than the other provinces in the form of transferred tax
points and a smaller share in the form of cash. In total, however, Quebec’s per
capita entitlement under EPF was exactly the same as those of other provinces.}
^{The GDP measures the value of all goods,
services and investment in a country during a defined period of time, usually a year.}
^{The initial per capita entitlement amounted
to $144.34 for hospital and medical care, $68.31 for post-secondary education and $20.00
for extended health care.}
^{Hon. Marc Lalonde (15:7).}
^Ibid.
^{The cash floor provision of the CHST was
abolished in 1999 as the amended legislation (Bill C-71) provided a level of cash transfer
over and above the $12.5 billion limit.}
^{The main reason for these discrepancies was
the funding disparity under the CAP: the provinces that used to receive a greater than
average share under the CAP continued to receive a greater than average share under the
CHST.}
^{Finance Canada, History of the Canada
Health and Social Transfer, Submission to the Standing Senate Committee on Social
Affairs, Science and Technology, 7 June 2000, p. 3.}
^{Ibid., p. 6.}
^{Provincial Premiers and Territorial
Leaders, Letter to the Prime Minister of Canada, 3 February 2000. A copy of this
letter is available on the Canadian Intergovernmental Conference Secretariat’s
Internet site at http://www.scics.gc.ca/cinfo00/85007604_e.html.
Also see the following statement: "Premiers’ Commitments to their
Citizens", 41^st Annual Premiers’ Conference, News Release, 11
August 2000 (available at http://www.scics.gc.ca/cinfo00/850080017_e.html).}
^{Provincial and Territorial Ministers of
Health, Understanding Canada’s Health Care Costs – Interim Report, June
2000, p. 10.}
^{Hon. Marc Lalonde
(15:13).}
^{Hon. Marc Lalonde (15:10-11).}
^{Keith Banting ( 9:65).}
^{Federal direct funds refer to direct health
care spending by the federal government in relation to health services for specific groups
(Aboriginals, the Armed Forces and veterans), as well as for health research, health
promotion and health protection.}
^{Tom Kent (13:34-35).}
^{Guillaume Bissonnette (17:12).}
^{Hon. Monique Bégin (16:5).}
^{Tom Kent (13:32).}
^{Hon. Claude Castonguay, Canada’s
Health Care System: An Urgent Need for Change, Brief to the Committee, pp. 3-4.}
^{Guillaume Bissonnette (17: 11).}
^{Michael Bliss
(13:37-38).}
^{Abby Hoffman (13:11).}
^{Hon. Marc Lalonde (15:11).}
^{Tom Kent (13:30).}
^{Abby Hoffman (13:25).}
^{Health Canada, History of Dispute
Resolution under the Canada Health Act, Information binder prepared for the Committee,
section 6, 9 February 2000.}
^{Hon. Marc Lalonde (15:21).}
^{Hon. Monique Bégin (16:5).}
^{Tom Kent (13:40).}
^{Chris Baker (9:31-32).}
^{Chris Baker (9:32).}
^{Chris Baker (9:32).}
^{Abby Hoffman (13:27).}
^{Graham Scott (20:13)}
^{Dr. Scott Evans (9:38).}
^{Conference Board of Canada, Canadians’
Values and Attitudes on Canada’s Health Care System: A Synthesis of Survey Results,
6 October 2000, p. 12.}
^{Ibid., pp. 31-32.}
^{Ibid., p. 2.}
^{Dr. Scott Evans (9:34-35).}
^{Dr. John S. Millar (14:35).}
Dr. John S. Millar (14:35).
^{Sholom Glouberman (9:18-19).}
^{Dr. Scott Evans (9:37).}
^{CIHI, National
Health Expenditure – Trends, Ottawa, 15 December 1999 (1975-1999) and 11 December
2000 (1975-2000); and OECD, OECD Health Data, CD-ROM, Paris, 1999 and 2000.}
^{More precisely, total health care spending
grew at an average annual rate of 11.1% over the period 1975 to 1991. Then, growth fell
substantially to an average annual rate of 2.6% between 1991 and 1996. The average annual
rate of growth is expected to have risen to some 6.0% between 1996 to 2000.}
^{Abby Hoffman (13:8).}
^{Data are usually adjusted for inflation by
using a GDP implicit price index (the 1992 index equals 100).}
^{Real rates of growth averaged 3.8% between
1975 and 1991, 1.0% between 1991 and 1996 and 4.6% between 1996 and 2000.}
^{As explained in Chapter 1, the GDP measures
the value of all goods, services and investments in a country during a year.}
^{The public sector refers to the various
levels of government. Private sector spending primarily consists of direct out-of-pocket
costs by individuals and expenditures covered by third-party insurers.Expenditures
by Workers’ Compensation Boards are included in public spending on health care.}
^{Abby Hoffman (13:8).}
^{PPP is an international price index
calculated by comparing the prices of identical goods in various countries. It indicates
the rate at which one currency must be converted into another currency to be able to
purchase an equivalent basket of goods and services in other countries. Dollars adjusted
by the PPP make it possible to compare the prices of identical products in various
countries. PPP is not, therefore, simply a monetary conversion but an equivalence which
takes into consideration a real value assigned to a basket of goods and services.}
^{Conference Board of Canada, Performance
and Potential 2000-2001 – Seeking "Made in Canada" Solutions, 2000, p.
115.}
^{CIHI, Health Care in Canada – A
First Annual Report, 2000, p. 21.}
^{This review of the development of
population health approach in Canada was based on a document entitled Population Health
Initiatives provided to the Committee by Health Canada.}
^{Marc Lalonde, Minister of National Health
and Welfare, A New Perspective on the Health of Canadians – A Working Document,
Ottawa, April 1974, p. 31.}
^{Jake Epp, Minister of Health and Welfare, Achieving
Health for All: A Framework for Health Promotion, Ottawa, 1986.}
^{Federal/Provincial/Territorial Advisory
Committee on Population Health, Strategies for Population Health: Investing in the
Health of Canadians, Ottawa, 1994.}
^{Federal/Provincial/Territorial Advisory
Committee on Population Health, Intersectoral Action… Towards Population Health,
Ottawa, June 1999.}
^{Federal, Provincial and Territorial
Advisory Committee on Population Health, Toward a Healthy Future – Second Report
on the Health of Canadians, 1999.}
^{Statistics Canada,
"Health Status of Children", Health Reports, Catalogue 82-003, Winter
1999, Vol. 11, No. 3.}
^{Advisory Council on Health Infostructure, Paths
to Better Health: Final Report, Ottawa, February 1999, p. 4-1.}
^{Sholom Glouberman (9:9).}
^{Hon. Marc Lalonde (15:15).}
^{Dr. Robert McMurtry (8:17).}
^{Howard Oxley and Maitland MacFarlan, Health
Care Reform: Controlling Spending and Increasing Efficiency, Economic Department
Working Papers No. 149, OECD Paris, 1995.}
^{Dr. John S. Millar (14:49).}
^{Professor Colleen Flood, University of
Toronto (14:18-19).}
^{Guillaume Bissonnette (17:6).}
^{Frank Fedyk (13:14).}
^{Frank Fedyk (13:21).}
^{Health Canada, Canada’s Health Care
System, 1999, p. 2.}
^Ibid.
^{Hon. Monique Bégin (16:8).}
^{Dr. Fraser Mustard, Myths, Beliefs,
Values, Facts and Health Care, Brief to the Committee, p. 3.}
^{Mark Stabile (14:12).}
^{Martin Zelder (12:39).}
^{Martin Zelder (12:40).}
^{Robert Evans (12:41-42).}
^{Robert McMurtry (8:25).}
^{Dr. J. Fraser Mustard, Brief to the
Committee, 22 March 2000, p. 2.}
^{CIHI, Health Care in Canada: A First
Annual Report, p. 6.}
^{Abby Hoffman (13:10).}
^{Federal/Provincial/Territorial Advisory
Committee on Population Health, Statistical Report on the Health of Canadians,
1999, pp. 31 and 38.}
^{Colleen Flood (14:19).}
^{Dr. Robert McMurtry (8:21).}
^{First Ministers’ Meeting, Communiqué
on Health, 11 September 2000 (available at www.scics.gc.ca).}
^{Graham W. S. Scott, Brief to the Committee,
June 2000, p. 7.}
^{Dr. Mary Ellen Jeans (8:21).}
^{Dr. John S. Millar (14:5).}
^{Dr. Mary Ellen Jeans (8:21).}
^{Stem cell technology is another good
example of the potential impact health research can have on health and health care.
Recently, medical researchers in Alberta have made remarkable breakthroughs in what is
called "stem cell" technology. They have taken the healthy cells from a properly
functioning pancreas and implanted them into an insulin-dependent diabetic. Months after
the procedure, the patient still does not require insulin. Not only will this person save
the cost of insulin during his life, he will also be at a much lower risk of developing
the debilitating complications of diabetes, such as blindness and heart failure, later on.
This development would not only improve the quality of life for the individual, it could
potentially save the cost of care for the primary disease and secondary complications
associated with it.}