The Canadian Health Care System

Provincial Delivery of Health Care

Learner Guide

In this unit, you will learn about the structure and functions of the health care system in
Ontario. You will learn about the different ways health care is delivered and why those
difference exist. You will learn about public and private health care, hospitals, clinics,
trends, and issues.

In order to prepare for the classroom session, you will visit the website of the Ontario
health care system to discover how the provincial health care services are organized
and delivered. Due to the variations in the way is delivered in different provinces, you will
be asked to do some research on your own in order to begin to build your understanding
of how things “work” in your province. You are encouraged to explore and discover. To
begin, you may wish to review the readings and notes from the Unit: The Role of Federal
Government in Health Care.

At the end of this session, you will be able to answer the following questions:
 Who provides what types of health care in your province?
 Who pays the costs of providing health care in your province?
 What factors contribute to the costs of providing health care?
 How is this different from your experience as a health care professional or as a
patient?
 What do you need to know or do differently to be a successful health care
professional in your province or territory?

Preparation
 Read the session materials, write down any questions you have, and bring your
questions to class.
 Visit the website for your provincial health care system. Answer the questions. Be
prepared to discuss in class how health care in your province is organized and
delivered.

Key Concepts

 Provincial health care systems

 Provincial health care responsibilities

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

The Role of the Provinces and Territories in Canadian Health Care

In the Unit: The Role of Federal Government in Health Care, you learned that the
administration and delivery of health care services are the responsibility of each province
and territory. The provinces and territories pay for these services with assistance in the
form of transfer payments from the federal government. Provincial governments also
contribute funds, derived from provincial taxation, to administer and deliver health care.
Perhaps you are beginning to realize why Canadians, as taxpayers, feel entitled to the
best care possible!

Research Task #1
Visit the following website and find the link to your provincial and territorial ministry of
health: http://www.health.gov.on.ca/en/

Be sure to bookmark this site!

Take a tour of the website of Ontario’s Ministry of Health and Long-Term Care
(www.health.gov.on.ca). As you explore, find answers to the following questions:

 Who is the provincial minister of health in your province?

 What are some current issues related to health care in your province?

 What are some health care facilities and resources in your community?

 What different kinds of health care are available to patients in your province?

 Can you find this information easily?

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

Research Task #2
Below you will find some additional links. Use them to explore some of the current issues
in health care and the services available across Canada.

Tools for health professionals

http://www.health.gov.bc.ca/professional-regulation/

Family health teams

http://www.health.gov.on.ca/en/pro/programs/fht/

Pandemic influenza
http://www.health.alberta.ca/health-info/pandemic-influenza.html

How is Health Care Delivered?

We have read about how the provision of health care in Canada is evolving so that more
health care is being offered in community settings. What does that mean? Many people
go to their local hospital to receive health care, but increasingly government and health
experts are focusing on how health care can be delivered within the community.

It is helpful to think of two different sectors in health care: the institutional sector and
community sector. A challenge for our health care system is integrating these two
sectors to that they work efficiently together to provide Canadians with the health care
they need.

Institutional Sector
This sector includes:
 Hospitals (community and regional)
 Mental health centres
 Rehabilitation centres
 Extended care facilities
 Veterans’ hospitals (you will recall that health care services for veterans are
federally funded but are delivered provincially)

Community Sector
This sector includes:
 Family practice offices
 Walk-in clinics
 Ambulatory centres

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

 Community health centres

 Home health care agencies
 Adult daycare centres
 Comprehensive school health services (school nurses)
 Support groups
 Community and volunteer agencies (e.g., the United Way)
 Palliative care/ hospices

Health Service Delivery Models

Consider the variety of health services delivery models listed below:

Acute Care
Acute care is for individuals requiring hospitalization and the expertise and equipment
available in a hospital. We hear a lot about hospital beds. How many beds are enough?
Can there be too many? How can effective planning be achieved, based on the needs
and resources of the community?

Continuing Care, Long-term Care, and Home Care

These services provide care for people who need ongoing care outside the hospital,
either on a long-term or short-term basis. For example, a patient recently discharged
from hospital following knee-replacement surgery may need physiotherapy. A person
with a chronic illness or a very elderly person may need to live a long-term care facility to
receive daily care.

Emergency Health Care

Emergency services include paramedic staff and the emergency response team. You
may wish to research whether paramedics are regulated.

Public Health and Health Promotion

Public health and health promotion focus on improving and enhancing the health of all
Canadians. Examples include programs that promote the use of condoms for safe sex or
programs such as safe injection sites for intravenous drug users. Another example is
immunization clinics.

Mental Health Services

People of all ages may need mental health services, and these are distributed across
the country.

Pharmacies
The drug distribution system relies on pharmacies, where pharmacists provide public
education and individualized counselling to patients about appropriate medication use.

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

Addiction Services
Resources are available to assist those with addictions, for example to alcohol, drugs, or
gambling.

Cancer Care
Many provinces have multi-faceted programs that coordinate services for cancer
patients.

Dental Care
Not all provincial health care systems cover the cost of dental care. Use the Internet
resources provided above to find out if dental care is covered in your province. In
province where dental care is paid for by Medicare, insurance for dental care can be
purchased by consumers from private insurance companies. Some employers purchase
this insurance for their employees.

Research Task #3

Visit Ontario’s Ministry of Health and Long-Term Care website. Find links to some of the
health care institutions and community services in your city/province.

Does your city/province have a regional cancer centre? Addiction services? Palliative
care centres? A regional mental health centre? Health care centres especially for
children or for women? What are the names of these institutions? Where are they
located? Write down what you learn here:

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

Private Health Care

The Canada Health Care Act does not allow health providers to offer medically
necessary services privately. However, there are many types of healthcare services that
are not insured by provincial Medicare plans. Examples of health care services that are
not insured or only partially insured (depending on the province) include: laser eye
surgery, midwifery services, optometry, massage therapy, echopractic care,
physiotherapy and podiatry. Independent practitioners are permitted to offer these
services and charge a fee for them. Many employers offer extended private health care
insurance that covers these and other health services. So you can see that we do have
some limited private health care in Canada, outside of the public Medicare system.

In addition, some private clinics offering specialized health services have operated for
many years within the regulated health care system. For example, the Shouldice Clinic,
in Toronto, Ontario, is a private clinic offering hernia surgery that has been operating
successfully for 54 years. Specialized clinics offering cataract surgery and hip and knee
replacements have opened recently in some provinces. Typically, these clinics are
operated privately; they bill Medicare for the medically necessary services they provide
an extra-bill their patients for additional services not covered by Medicare.

Health care entrepreneurs are beginning to provide new types of health care not offered
by the public system. For example, the Copeman Healthcare Centre in Vancouver
focuses on providing “medically supervised programs of therapeutic lifestyle change.”
The clinic’s focus on prevention means they can operate outside the Medicare system.
Patients typically pay a set amount (about $3, 500 a year per person) to receive
unlimited services related to fitness and diet assessment, diagnostic services, etc. Staff
include dietitians, psychologists, doctors, nurses, and physiotherapists.

Here is how the clinic is described in its website:

Copeman Healthcare Centres offer relaxed and comfortable

environment, and contain in-house diagnostic and screening
laboratories, educational rooms, and modern fitness assessment and
rehabilitation facilities. Each reception area includes an entertainment
centre, refreshment bar, wireless internet access, and personal
computer workstations. (www.copemanhealthcare.com)

Health entrepreneurs are betting that Canadians are willing to pay for these deluxe
services!

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.
Learner Guide: Provincial Delivery of Health Care

Research Task #4
Search the internet and see if you can find any private health care facilities in your
province. Write down what you learn here:

Health Care Consumers

Canadians, as taxpayers and consumers of health care, are playing a more significant
role in the development of health care than ever before. They want to see what they are
getting for their tax dollars. They have become more knowledgeable and more assertive,
and they are no longer willing to accept the old saying “doctor knows best.” Canadians
are prepared to ask their healthcare providers questions and to equip themselves with
knowledge about their healthcare needs through the internet and the mass media
(television, newspapers, magazines, and radio). Canadians consumers of health care
expect to be part of all discussions related to their care, and they want to work in
collaboration with their healthcare providers.

Our health care system is evolving. Five defining characteristics of the new healthcare
workplace have been identified as follows (Pruitt & Epping-Jordan, 2005):
 Patient-centered care
 Partnering
 An emphasis on quality improvement and safety
 The use of information and communication technology
 A public health perspective

Are you ready for this exciting challenge?

References
Pruitt, S. & Epping-Jordan, J. (2005) Preparing the 21st century global healthcare
workforce. British Medical Journal, 330:637-639 (19 March).

Orientation to the Canadian Health Care System, Culture and Context is licensed to
HealthForceOntario Marketing and Recruitment Agency.
Modification, copying or redistribution of any of the course materials is strictly forbidden.