These a re the very same principles used by the Canadian health  It also 
includes public adminitration,portability,
Here it is in our law as to the evidence we sure have some on 
comprehensiveness and accessibility
The Criteria

1. Public Administration (section 8)

The public administration criterion, set out in section 8 of the Canada 
Health Act, applies to provincial and territorial health care insurance 
plans. The intent of the public administration criterion is that the 
provincial and territorial health care insurance plans be administered and 
operated on a non-profit basis by a public authority, accountable to the 
provincial or territorial government for decision making on benefit levels 
and services, and whose records and accounts are publicly audited.

2. Comprehensiveness (section 9)

The comprehensiveness criterion of the Canada Health Act requires that, in 
order to be eligible for federal cash transfer payments, the health care 
insurance plan of a province or territory “must insure all insured health 
services provided by hospital, medical practitioners or dentists (i.e. 
surgical-dental services which require a hospital setting) and, where the 
law of the province so permits, similar or additional services rendered by 
other health care practitioners.”

3. Universality (section 10)

Under the universality criterion, all insured residents of a province or 
territory must be entitled to the insured health services provided by the 
provincial or territorial health care insurance plan on uniform terms and 
conditions. Provinces and territories generally require that residents 
register with the plans to establish entitlement.

Newcomers to Canada, such as landed immigrants or Canadians returning from 
other countries to live in Canada, may be subject to a waiting period by a 
province or territory, not to exceed three months, before they are entitled 
to receive insured health care services.

4. Portability (section 11)

Residents moving from one province or territory to another must continue to 
be covered for insured health care services by the "home" jurisdiction 
during any waiting period imposed by the new province or territory of 
residence. The waiting period for eligibility to a provincial or territorial 
health care insurance plan must not exceed three months. After the waiting 
period, the new province or territory of residence assumes responsibility 
for health care coverage.

Residents who are temporarily absent from their home province or territory 
or from Canada, must continue to be covered for insured health care services 
during their absence. This allows individuals to travel or be absent from 
their home province or territory, within a prescribed duration, while 
retaining their health insurance coverage.

The portability criterion does not entitle a person to seek services in 
another province, territory or country, but is intended to permit one to 
receive necessary services in relation to an urgent or emergent need when 
absent on a temporary basis, such as on business or vacation.

If insured persons are temporarily absent in another province or territory, 
the portability criterion requires that insured services be paid at the host 
province's rate. If insured persons are temporarily out of the country, 
insured services are to be paid at the home province's rate.

Prior approval by the health care insurance plan in a person’s home province 
or territory may also be required before coverage is extended for elective 
(non-emergency) services to a resident while temporarily absent from their 
province or territory.

5. Accessibility (section 12)

The intent of the accessibility criterion is to ensure that residents of a 
province or territory have reasonable access to insured hospital, medical 
and surgical-dental services on uniform terms and conditions, unprecluded or 
unimpeded, either directly or indirectly, by charges (user charges or 
extra-billing) or other means (e.g., discrimination on the basis of age, 
health status or financial circumstances). In addition, the health care 
insurance plans of the province or territory must provide:

    * reasonable compensation to physicians and dentists for all the insured 
health care services they provide; and
    * payment to hospitals to cover the cost of insured health care 
services.

Reasonable access in terms of physical availability of medically necessary 
services has been interpreted under the Canada Health Act using the "where 
and as available" rule. Thus, residents of a province or territory are 
entitled to have access on uniform terms and conditions to insured health 
care services at the setting "where" the services are provided and "as" the 
services are available in that setting.

Yves R Talbot
Professor and Director International Programs Department of Family and 
Community Medicine University of Toronto
256 Mc Caul St. suite 308
M5T 1W5
Toronto,Ontario, Canada
416-978 3763 fax 978 3912 pager 416 664 6330 [log in to unmask]



>From: "Oliver,AJ" <[log in to unmask]>
>Reply-To: "Oliver,AJ" <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: Quick question (or rather, 2 quick questions)
>Date: Fri, 19 Nov 2004 19:31:03 -0000
>
>Barbara et al.
>
>Equal access for equal need is, I think, implied from the rules of 
universality, comprehensiveness, and (almost) free care at the point of use, 
which I thought were the three procedural rules that underpin public sector 
health care in many countries.
>
>If enough people want to violate these procedural rules vis-a-vis 
curative health care, then fine. But they should at least be aware, and 
explicitly acknowledge, that their policy proposals are (potentially) 
violating these rules.
>
>
>-----Original Message-----
>From: Barbara Starfield [mailto:[log in to unmask]]
>Sent: 19 November 2004 19:15
>To: [log in to unmask]
>Subject: Re: Quick question (or rather, 2 quick questions)
>
>
>
>Thanks Adam, for the summary.
>
>
>
>I think that your premise i.e. that horizontal equity ought to be the 
criterion, is not a reasonable basis from which to start, because it 
pre-determines the range of responses. That is, countries can achieve 
horizontal equity of access and be very far from working toward equity in 
health. Perhaps that is why 6 people thought that their country had achieved 
equity.  The literature is very consistent in showing that, in many places, 
equity of access to primary care is equitable; no country that I know of has 
achieved equity in access to specialist care, even indicated specialist 
care.
>
>
>
>Starting from an alternative premise that equity in health is 'the 
absence of systematic and potentially remediable differences in one or more 
aspects of health across population groups defined geographically, 
demographically or socially"  ( www.iseqh.org 
<http://www.iseqh.org/> ) it seems clear that it is vertical equity 
that  should concern us i.e. greater resources for greater needs. These 
resources can be both health services as well as other public health (and 
social) interventions. There is not much of an ethical problem, I think, 
with public health efforts, since they are mainly directed at ensuring 
healthy environments. (A healthy environment for an upper class person is 
the same as for underclass people. )  That is, the need for HEALTH (as 
distinguished from the need to prevent ill health from becoming worse) is 
the same across social groups.
>
>
>
>As far as I can tell, the major value decision is the extent to which 
improvements in the health of the non-poor should take  precedence over 
reducing inequities in health. That is, should remediable differences be 
remedied before the more advantaged are made still more advantaged?
>
>
>
>Barbara
>
>
>
>*******************************************************
>
>Barbara Starfield, MD, MPH
>
>University Distinguished Professor
>
>Johns Hopkins University & Medical Institutions
>
>624 North Broadway, Room 452
>
>Baltimore, Maryland 21205
>
>Phone 410-955-3737
>
>Fax 410-614-9046
>
>[log in to unmask]
>
>*******************************************************
>
>-----Original Message-----
>From: The Health Equity Network (HEN) 
[mailto:[log in to unmask]] On Behalf Of Oliver,AJ
>Sent: Friday, November 19, 2004 12:26 PM
>To: [log in to unmask]
>Subject: Quick question (or rather, 2 quick questions)
>
>
>
>Hi
>
>
>
>I sent the following questions (and subsequent response) to the European 
Health Policy Group (EHPG). It follows up on a debate that I tried but 
failed to create on the HEN list a few months back, but I thought that some 
of you might be interested in the answers from the very small number of EHPG 
members who responded. It's to do with my view that the principle of 
non-discrimination is slowly (and somewhat covertly) being eroded in public 
health care systems.
>
>
>
>Best,
>
>Adam
>
>-------------------------------------------------------------------------------------------------------------
>
>
>
>
>
>I'm just curious about list members' views on the following two 
questions. Don't worry - I won't use your answers in any research of course 
- it's just to give me an idea about what others' think:
>
>
>
>1. Do you think, in your country, that the health of the relatively 
wealthy is unjustifiably better than the health of the relatively poor?
>
>
>
>2. If your answer to question 1. is 'yes', do you think that curative 
public sector health care is an appropriate 'mechanism' by which to try to 
narrow these inequalities (which would mean that, when allocating curative 
health care to equally sick people, you would give more priority to those 
who are relatively poor - e.g. if two people needed a life saving or life 
extending operation, it would mean that you think that the person's income 
should be a relevant consideration when deciding whose life to save or 
extend)?
>
>
>
>Best,
>
>
>
>Adam
>
>--------------------------------------------------------------
>
>Hello
>
>
>
>To those who responded, many thanks. The reason I asked is that there 
now seems to be a general view that income inequalities in health are 
unacceptably wide in many countries. This is, of course, debatable, as it 
depends on one's ethics, but I'm willing to accept the argument that this is 
the case.
>
>
>
>As a consequence, many are beginning to argue that health outcomes ought 
to be 'equity-weighted', so that, in effect, a unit of health gain for the 
relatively poor has more weight than a unit of health gain for the 
relatively rich. However, most public health care systems, as I can gather 
(and certainly the UK NHS) were founded on the basis of universality (or 
non-discrimination, as Sen would say). Given this, it seems inappropriate to 
me to prioritise the poor over the rich (all other things being equal), 
particularly in 'curative' health care (where people are already sick), as 
it would violate the principle of non-discrimination (which essentially 
would create a very different health care system). Discrimination in 
(perhaps) preventive health care, or other areas of social and fiscal policy 
(i.e. over people who are not yet sick; over the determinants of health) is 
of course a different matter.
>
>
>
>And there's the rub. Public health care systems were never meant to 
correct for the fundamental injustices in socio-economic systems. And, in my 
view, we should therefore be very careful when considering the arguments of 
those who would say we should prioritise the poor for curative health care. 
When people are asked if the distribution of health outcomes is unjust, they 
are very rarely asked if curative health care is an appropriate mechanism by 
which to address the 'injustice'. I suspect that many people who would say 
yes to the former question would say no to the latter.
>
>
>
>Of those of you who answered may questions, 6 of you didn't think the 
distribution of health in your country was unjust, 4 thought it was and 
would use curative health care to address it, and 8 thought it was but 
wouldn't use curative health care to address it. So it appears I'm not alone 
after all.
>
>
>
>Best,
>
>
>
>Adam
>
>
>
>-------------------------------------------------------------------
>
>
>