Intergovernmental Issues on Social Policy:

Health and PSENotes for Pols 321

November, 2009

Constitutional Background• Health and Education are both listed as Provincial areas of

jurisdiction in the Constitution Act, 1867. • Provinces and Territories:

– Regulation of health care providers; Provision of Universal Provincial Hospital and Medical Care Insurance Programs

– Regulation and partial support of Universities and Colleges• Federal government:

– Spending power enables federal government to contribute to provincial/territorial programs, often with conditions attached.

– Feds also directly responsible for health services to First Nations communities.

– Responsible for national research policy and programs, providing direct support to Universities, also national student financial support.

• Cities and First Nations:– Undertake some responsibilities re public health– Have an interest in effective delivery of social programs

Health Care history

• Saskatchewan pioneers hospital (1944) and medical care (1964) universal insurance programs

• Feds induce provinces & territories (with 50 % contributions or more) to have “national” hospital and medical care insurance (late 1950s, late 1960s)

• Canada Health Act, 1984 reiterates 5 principles of medicare, plus no extra billing, no private clinics

Health care …2

• 5 Principles of Medicare:– Universality of coverage (all citizens, plus)– Comprehensiveness of benefits (all medically

necessary procedures)– Equality of access (no tiers)– Portability of benefits (province to province)– Public Administration of program (no

privatization of insurance program as such)

Health Care…3

• Once “mature” programs in place, feds make funding automatic – i.e. “block grants” (1976-95: called Established Programs Financing)

• Budget cuts in 1995 reduce health care funding by one-third

• New program called “Canada Health Transfer”—gradual restoration of federal cash after 1998

• 2004 Health Care Accord: stable funds for 10 years, incentives for reform of system

Health care …4

• Costs rising rapidly, now as much as 50 percent of provincial & territorial budgets

• At best, federal funds contribute only about 25 %• Concern re aging population• Technology, including cost of drugs, is driving

the system• Pressure from some in system to increase

private options for delivery and for insurance

PSE History

• Conditional programs in 1950s: feds fund 50 % or more of costs of building university and college systems.

• 1976-1995: Funds rolled into EPF block grants (with health)

• 1995 cuts, same as health, but PSE rolled into new Canada Social Transfer program together with funds for other social services. Provinces & Territories free to spend as they see fit (i.e. more on welfare, less on PSE).

PSE…2

• Provincial/territorial funding under pressure from health care -- CST funds do not begin to meet all provincial costs

• After 1995 most provinces “deregulate” tuition, but there’s significant diversity across provinces

• Tuition now = 50% of university costs in many provinces

• Feds gradually restore cuts to CST funds, but most of $$ allocated by provinces/ territories to social services.

PSE …3

• Late 1990s…Feds concentrate on increasing funding to direct programs:– Canada Student Loan program– Millennium Scholarships– Research Granting agencies and Innovation

funds– Funds to First Nations band councils for

paying PSE costs of aboriginal students

Policy Options: Health Care

• Find more federal money

• Spend more effectively (including new federal conditions on reform)

• Revise/relax 5 principles of medicare: e.g. allow extra billing, private clinics, etc.

• New national programs: pharmacare

Policy Options: PSE

• Separate federal funds for PSE from those for social services

• Federal take-over / regulation of PSE

• Allow for more private institutions

• More emphasis on student financial support

• Income contingent loan program