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
>
>
>
>-------------------------------------------------------------------
>
>
>
