CLAW326, Module 3 - Introduction PDF

1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Introduction Canadian medicare is not socialized medicine. The majority of healthcare services in Canada are provided by healthcare practitioners (HCPs), who work as independent professionals or employees of healthcare institutions. Physicians are no...

1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Introduction Canadian medicare is not socialized medicine. The majority of healthcare services in Canada are provided by healthcare practitioners (HCPs), who work as independent professionals or employees of healthcare institutions. Physicians are not government employees nor are they typically hospital employees. As Chapter 3 of the textbook suggests, the law’s role has, to a great degree, shaped Canada’s system of healthcare and our universal single payer scheme called medicare. The Canada Health Act (CHA), a federal statute, determines who is publicly insured and who is not, what is insured and what is not. Generally, residents of Canada are insured by their provincial/territorial plans for hospital and physician services set up as a result of the provisions of the CHA, which was assented to in 1984. Did You Know? Every province/territory has set up its own health insurance plan. If these plans meet the criteria laid out in the CHA, and more specifically set out in this module, the federal government will provide cash contributions to fund these plans. Topics and Learning Objectives Topics How the Canadian Health System Is Organized Canada Health Act The Role of Provincial/Territorial Governments Healthcare System Funding https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 1/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction The Canadian Charter of Rights and Freedoms Local Health Integration Networks Learning Objectives By the end of this module, you should be able to: Explain the federal and provincial/territorial jurisdictional breakdown and organization of the Canadian healthcare system Explain the funding system for healthcare services in Canada Discuss the current status of the use of privately funded clinics in Ontario Explain the use and role of the Charter of Rights and Freedoms in the context of healthcare delivery and regulation Explain the role of administrative tribunals in the context of healthcare delivery Discuss the role of Local Health Integration Networks in Ontario Module To-Do List Here is a list of tasks that you should complete in this module: Complete the required readings listed in this module Study Module 3 material and complete the non-graded activities it entails Readings and Websites Reading Required 1. Canada Health Act (R.S.C., 1985, c. C-6) https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 2/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction 2. Cattapan, A. (2020). Medical Necessity and the Public Funding of In Vitro Fertilization in Ontario. Political Science, 53(1), 61-77. https://doi.org/10.1017/S000842391900074X 3. Canadian Journal of Commitment to the Future of Medicare Act, 2004, S.O. 2004, c. 5 4. Erdman, Vanessa Gruben, & Erin Nelson (Eds.). Canadian Health Law and Policy, 5th ed. (Toronto, LexisNexis, 2017) Chapter 3: The Role of Law in the Rise and Fall of Canadian Medicare Chapter 4: Charter Review and Health Care Access Chapter 6: The Governance of Indigenous Health 5. Ferguson, Rob. Ford government passes law to allow more surgeries in private clinics. Toronto Star. May 8 2023. Retrieved from https://www.proquest.com/docview/2811164024/fulltext/B5B102E3FB142F9PQ/1?accountid=13631 6. Gray, Jeff. Ontario expanding private clinics while hospital PRs sit idle, health care advocates say: Advocacy group says province could do more surgeries in publicly funded institutions instead of expanding non-profit delivery. The Globe and Mail. February 6, 2023. Retrieved from https://www.proquest.com/docview/2773438032? parentSessionId=vfBtUg6LvXZCIcA23Gwkq6nI%2BUHsnJQCVz0nkMMvpSM%3D&pq-origsite=summon&accountid=13631 7. Health System Integration Update (2022). Retrieved June 2, 2023, from https://www.proquest.com/docview/2659353375/fulltext/9D353AF5C6014632PQ/1? accountid=13631 8. Here's the reality of abortion access in Canada. 9. Local Health System Integration Act, 2006, S.O. 2006, c. 4 10. Ontario Public Service Employees Union v. Central East Local Health Integration Network, 2008 CanLII 41820 (ON SCDC) 11. Tran, C. (2023, Feb 22). Some parents are leaving Ontario because of frustration with its autism program. The Canadian Press. http://ezproxy.lib.torontomu.ca/login?url=https://www.proquest.com/wire-feeds/some-parents-are-leaving-ontariobecause/docview/2779396056/se-2 https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 3/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction 12. University of Calgary, The School of Public Policy, The Challenge of Defining Medical Coverage in Canada, SPP Research Papers, Volume 6, Issue 32, October 2013, Emery and Kneebone 13. What fertility treatment coverage is offered by Canada's provinces and territories. (2022, Dec 20). The Canadian Press http://ezproxy.lib.torontomu.ca/login?url=https://www.proquest.com/wire-feeds/what-fertility-treatment-coverage-isoffered/docview/2756620984/se-2 14. Bill 60, Your Health Act, 2023. Legislative Assembly of Ontario, www.ola.org/en/legislative-business/bills/parliament43/session-1/bill-60. The Canada Health Act - Main Provisions Below we review various relevant provisions of the Canada Health Act, R.SC. 1985, c. C-6 (CHA). This federal legislation consolidated and replaced the Hospital Insurance and Diagnostic Services Act, 1957. Federal Cash Transfers (s.7) The CHA provides that federal cash transfers are conditional on the provincial/territorial health insurance plans meeting listed criteria under s.7, which are as follows: a. public administration; b. comprehensiveness; c. universality; d. portability; and e. accessibility. Provincial or territorial health insurance plans must contain or provide the following specifics to ensure federal cash transfers. https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 4/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Public Administration (s.8) The insurance plan of a province must be administered and operated on a not-for-profit basis by a public authority appointed or designed by the government of the province. This public authority must be responsible for administration and operation. It must be subject to the audit of accounts. Comprehensiveness (s.9) The healthcare insurance plan must insure all insured health services provided by hospitals, medical practitioners, or dentists, and where the law of the province so permits, similar or additional services rendered by other healthcare practitioners. Universality (s.10) The health insurance plan of a province must entitle one hundred percent of the insured persons of the province to the insured health services provided for by the plan on uniform terms and conditions. Please read the definition of who is an “insured person” in s.2 of the CHA. “Insured Health Services” (s.2) Insured health service means “hospital services, physician services and surgical-dental services provided to insured persons but does not include any health services that a person is entitled to and eligible for under any other Act of Parliament or under any Act of the legislature of a province that relates to workers’ or workmen’s compensation.” Pause and Reflect Note: This Is a Non-Graded Activity Read the University of Calgary, The School of Public Policy paper by Emery and Kneebone from October 2013. Consider the discussion therein of the meaning of “medically necessary.” Please also consider the phrase “medically required.” Are there differences in your view or not? Why or why not? https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 5/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Please post your response in the General Discussion Forum of the “Class Discussion Board.” Portability (s.11) The plan must provide that there be no waiting period in excess of three months before residents are eligible. In addition, the plan must provide payments of amounts for the cost of insured health services to insured persons while temporarily absent from the province or territory. The payment rate for services must be approved by the provincial insurance plan in which services are provided. In addition, when out of Canada the payment for services rate must be that which would have been paid by the province for similar services rendered. Accessibility (s.12) The plan must provide for insured health services on uniform terms and conditions and provide for reasonable access. The plan must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province/territory. The plan must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists; and must provide for the payment of amounts to hospitals for the cost of insured services. In reality, accessibility is not as simple as this. There is a difference in how each province/territory defines medically necessary, so what is available in one province/territory may not be available in another. Two of the biggest examples of this are abortion and reproductive health. There are many barriers to health care in Ontario. Socio economics, education, geography, gender, sexual orientation, immigration status, and culture are some of the many barriers to health care. This topic could be an entire course in and of itself. We will have a short review of two particular issues under reproductive health, abortion and fertility treatment. Although legal across Canada, abortion is not as accessible in all provinces/territories and certainly not in more rural regions. Different provinces/territories provide, through their health plans, abortion up to anywhere from 14 weeks to 23 weeks. In some provinces/territories, abortion is only covered when performed in a hospital, not in a stand alone clinic and not all areas of these provinces/territories have hospitals with abortion providers on staff. Please read the following: https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 6/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Here's the reality of abortion access in Canada. (2022). Retrieved June 2, 2023, from https://www.proquest.com/docview/2659353375/fulltext/9D353AF5C6014632PQ/1?accountid=13631 Infertility treatments, (IVF and IUI), are another instance where it becomes clear that the provinces’/territories’ ability to identify “medically necessary” and “medically required” leads to inequity of treatment options between provinces/territories. No province/territory is going out of its way to cover all these costs, (which some employers are adding to their benefit packages as an incentive), and some do not offer anything through their publicly funded health care. Some say “medically required” and “medically necessary” should be what every province/territory offers and others would say each province/territory should decide for themselves what is best for its own population. But who speaks for those who require expensive care and are significantly in the minority? Who speaks for those who endure an orphan disease or, say for children on the autism spectrum and their families? There are serious questions raised all the time about accessibility. Each province/territory has a system by which its citizens are asked to contribute to the cost of health care in a way that is considered equitable, if not equal, yet the barriers are many. Please read the following: Cattapan, A. (2020). Medical Necessity and the Public Fundingof In Vitro Fertilization in Ontario. Science, 53(1), 61-77. https://doi.org/10.1017/S000842391900074X Canadian Journal of Political Tran, C. (2023, Feb 22). Some parents are leaving Ontario because of frustrations with its autism program. The Canadian Press http://ezproxy.lib.torontomu.ca/login?url=https://www.proquest.com/wire-feeds/some-parents-are-leaving-ontariobecause/docview/2779396056/se-2 What fertility treatment coverage is offered by Canada's provinces and territories. (2022, Dec 20). The Canadian Press http://ezproxy.lib.torontomu.ca/login?url=https://www.proquest.com/wire-feeds/what-fertility-treatment-coverage-isoffered/docview/2756620984/se-2 Conditions for Cash Contribution by the Federal Government (s.13) https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 7/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction The conditions are set out in s.13 of the Canada Health Act. If a province or territory breaches one of five criteria we have reviewed under s.7, the penalty is that the cash contribution to the province for a fiscal year may be reduced, by an amount deemed appropriate and commensurate with the gravity of the situation. The federal government has never penalized a province or territory. Violation, Enforcement, and Implementation of the Canada Health Act Violations of the CHA The following are examples of violations of the Canada Health Act: Refusal of Quebec to reimburse other provinces (except Ontario) at the rates of other provinces for services provided to Quebec patients Charging “facility fees” for abortion services provided by private clinics in Atlantic provinces Alberta’s refusal to provide dialysis to visitors from other provinces (which is against portability) Federal Enforcement Financial penalization of the offending province with discretion on the amount – this was NEVER exercised, despite some breaches of the CHA Only enforcement on user fees: Where facility fees were charged at clinics which provided insured physician services Policy remedy: increased transparency, the creation of the Health Council of Canada, and reporting by Canadian Institute of Health Information Implementation and Enforcement by Each Province The relatively brief CHA contrasts with the provincial frameworks for administering their plans, which are detailed, technical, and complex. Each province has a plan for the funding of physician and hospital services; delegates the administration to the provincial minister of health, government official, or agency; and defines insured services to generally include services provided by physicians and hospitals. https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 8/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction CHR - Limitations Extra-Billing and User Charges As we saw, the CHA provides that federal cash transfers to the provinces are conditional on the provincial/territorial health insurance plans meeting listed criteria under s.7. For a province/territory to qualify for a full cash contribution under the CHA, no user fees or extra-billing are permitted by medical practitioners or dentists. User charges are also not permitted. If medical practitioners extra-bill, the amount shall be deducted from the cash contribution by the federal government. Prescription Drugs The Canada Health Act covers prescription drugs if they are prescribed on a hospital in-patient basis. All provinces have programs that provide public funding for prescription drugs taken outside of hospitals, BUT funding is not based on the Canada Health Act principles of universality and comprehensiveness. Within a province/territory, publicly funded coverage is usually limited to senior citizens or social assistance recipients and is subject to copayment and deductibles. Some Ontarians are not covered for prescription drugs and they have no private insurance. Decisions about prescription drug coverages are provincial/territorial. There are interprovincial variations in prescription drug programs. For poorer Canadians, there is a differential access to drugs depending on where they live. There is also significant variation in coverage for high cost chronic diseases. What Does This All Mean? With public financing there is clearly differential access to healthcare services depending on where one resides. There is different provincial capacity, circumstances, availability of resources (Human Health Risk (HHR) and otherwise). This has resulted in some Canadians being left more exposed to risks and burdens than others. Delivery of healthcare has evolved beyond the publicly funded hospital and physician services. Today, one’s ability to pay and private insurance plans provided through employment have made for a much more complex array of entitlements and benefits than originally envisioned when medicare was initially conceived. The Role of Provincial/Territorial Governments https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 9/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Constitution Act, 1867 This legislation gives the provinces the exclusive authority to make and administer laws for the “establishment, maintenance, and management of hospitals, asylums, charities and eleemosynary institutions” (s.92(7)). The general provincial power to make laws on “property and civil rights” (s.92(13)) has been interpreted by the courts to include professional services and buying and selling of goods and services. The provinces have authority to regulate professional activities, including doctors, nurses, dentists, physiotherapists, lawyers, accountants, and engineers. Indigenous Health In short, the federal government is responsible for delivering healthcare to Indigenous communities. Please ensure you read Chapter 6 of your textbook for more information. The Role of Provincial/Territorial Governments Provincial and territorial governments are responsible for setting up their healthcare plans. In Ontario it is called the Ontario Health Insurance Plan (OHIP). The provincial and territorial governments are also responsible for regulating the quality of healthcare services, even if they are not funded (for example, dental services). They are also responsible for the legislation around self-regulation of the healthcare professions and institutional regulation of hospitals, long term care facilities, private clinics, etc. Further, they are responsible for establishing the general healthcare system objectives, including monitoring and evaluating of system success, ensuring coordination and continuity between different parts of the system, and ensuring reasonable access to healthcare services either through public funding or other means. Bill 60 - Your Health Act 2023 Bill 60, also known as Your Health Act 2023, received Royal Assent May 18, 2023. The stated purpose of this act is to make some services more accessible and to shorten wait times by allowing private clinics to provide certain services. There was a time in Ontario when privately funded health care was allowed. As a patient, you could pay your doctor an annual amount to know that if you called in the morning not feeling well they would drop everything, and everyone in their waiting room, and see you immediately. As a patient you could pay to jump the line for surgery. We had a two tiered system of health care, those who could afford to https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 10/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction pay got faster, better care. But in 1984 with the unanimous passing of the federal Canada Health Act, all provinces and territories had to abolish extra-billing in order to receive transfer payments from the federal government. From that point on doctors could only bill those things covered by the provincial/territorial schedule. This change is not intended to be a return to extra billing. According to this plan, patients will not be asked to pay anything out of pocket, simply the owners of these clinics are making their facilities available for OHIP covered procedures and accepting OHIP as payment. There is a great deal of controversy over this move and as this change is so new there is no literature to support either side so I simply provide some articles for you to read to inform yourselves and we will watch the outcome together. For information on where things stand on private funding in health care in Canada you can have a look at the case Dr. Brian Day has been fighting in British Columbia. Search "Cambie Surgeries Corporation v British Columbia". Acceptance of privately funded health care would mean Canada would have a two tiered health care system. Those who could afford to pay for their care may have access to different facilities and shorter wait times. Some say it should be allowed, that it would remove cost and strain from the public system, others say that it would strip resources from an already exhausted public system. The debate continues. Listed below are two recent articles on the changes to the use of private clinics in Ontario and some more information about the legislation. Depending on your current or future position, this topic may hold more relevance or interest to you. In order to answer questions on tests, the exam or discussion posts make sure you read the articles. The specifics of the legislation is something you can look at. Gray, Jeff. Ontario expanding private clinics while hospital PRs sit idle, health care advocates say: Advocacy group says province could do more surgeries in publicly funded institutions instead of expanding non-profit delivery. The Globe and Mail. February 6, 2023. Retrieved from https://www.proquest.com/docview/2773438032? parentSessionId=vfBtUg6LvXZCIcA23Gwkq6nI%2BUHsnJQCVz0nkMMvpSM%3D&pq-origsite=summon&accountid=13631 “Your Health Act, 2023.” Legislative Assembly of Ontario, www.ola.org/en/legislative-business/bills/parliament-43/session-1/bill60. Ferguson, Rob. Ford government passes law to allow more surgeries in private clinics. Toronto Star. May 8 2023. Retrieved from https://www.proquest.com/docview/2811164024/fulltext/B5B102E3FB142F9PQ/1?accountid=13631 Commitment to Future of Medicare Act The Commitment to the Future of Medicare Act, 2004, S.O. 2004, c. 5 is an Ontario legislation, which confirms a commitment to the principles of the Canada Health Act. It also establishes the Ontario Quality Health Council (OQHC). https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 11/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction The functions of the OQHC are to report to Ontarians on access to publicly funded healthcare services, HHR, consumer and population health, health system outcomes, and to support continuous quality improvement. The OQHC delivers an annual report on the state of the health system in Ontario. This Ontario legislation ended direct billing of patients by physicians. Physicians cannot bill OHIP for more than the regulated amount for the insured service, nor can they bill patients directly for related extra charges. The Act also provides for government negotiations with the Ontario Medical Association, the Ontario Dental Association, and the Ontario Association of Optometrists, as representatives to negotiate and set fees for insured services to insured persons. The Act is intended to improve publicly funded healthcare in the province. The Act also strengthened the prohibition of “two-tier” medicine by closing loopholes that allowed “queue jumping” and extra-billing. Healthcare System Funding Access to healthcare is often shifted to third-party healthcare insurance, which can be public or private. Fee for service compensation can be viewed as creating an incentive for physicians to provide more rather than less units of their services in order to increase their incomes. Hospitals and physician services are financed by the public sector, while drugs (for the most part) and other healthcare professionals are financed by the private sector (dental care and vision care). Expenditures for healthcare services have a striking age pattern of distribution from the beginning of life and for the aging population. Total health spending in Canada is estimated at $331 billion for 2022, or $8,563 per Canadian. This represents 12.2% of Canada’s gross domestic product (GDP) in 2022, following a high of 13.8% in 2020. Total health expenditure in Canada is expected to rise by 0.8% in 2022, following high growth of 13.2% in 2020 and 7.6% in 2021. Prior to the pandemic, from 2015 to 2019, growth in health spending averaged 4% per year. Hospitals (24.34%), Physicians (13.60%) and Drugs (13.58%) continue to account for the largest shares of health dollars (more than half of total health spending) in 2022. Spending related to the COVID-19 pandemic continued in 2022. COVID-19 Response Funding makes up 4.4% of total health spending, compared with 9.9% in 2021. Federal, provincial and territorial governments (combined) spent $770 per person in 2020 for health-specific funding to deal with COVID-19. Pandemic response funding is projected to decline to $376 per person in 2022. https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 12/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Total health expenditure per person vary across the country with the highest being Alberta and Newfoundland and Labrador and the lowest per person being British Columbia and Ontario. Source: Canadian Institute for Health Information (Health Spending and National Health Expenditure Trends, 1975 to 2019 ). Pause and Reflect Note: This Is a Non-Graded Activity What do you think are the causes of these variances and what impact will this distribution have on the provision of healthcare across the provinces? Please post your response in the General Discussion Forum of the “Class Discussion Board.” As an Aside – How Do the Provinces Manage Physician Compensation? There are negotiations that take place between the provincial government and the provincial medical association. In Ontario, the medical association is the Ontario Medical Association (OMA). Each province enters into an agreement with the medical practitioners and dentists of the province. The agreement deals with compensation for insured health services between the province and provincial medical associations that represent practising medical practitioners or dentists in the province. These two bodies often provide an expanding list of services covered under medicare; new services and/or ways of providing service are added to a tariff. However, some de-listing of services (e.g. stomach stapling, wart removal, vasectomies, and circumcision) often also takes place. Inter-provincial negotiations lead to variations in services across the provinces. Role of Administrative Tribunals In Ontario, the provincial government has set up an administrative justice/tribunal system, consisting of several tribunals in order to manage medical necessity. For example, in Ontario we have the Ontario Health Services Appeal and Review Board, which sets out on its website: https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 13/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction “The Health Services Appeal and Review Board (HSARB) is established by the Ministry of Health and Long-Term Care Appeal and Review Boards Act, 1998 to conduct appeals and reviews under twelve different health care statutes. The proceedings under each of the statutes range from oral appeals to written reviews. The decisions being appealed to or reviewed by the Board include: Decisions of the Ontario Health Insurance Plan (“OHIP”) under the Health Insurance Act respecting eligibility for OHIP coverage and payment for services; Health Insurance Act Information Sheet Decisions of approved agencies under the Home Care and Community Services Act, 1994 regarding eligibility for and amount of community services; Orders of the Medical Officer of Health or public health inspectors under the Health Protection and Promotion Act; Orders and decisions of the Director under the Long Term Care Homes Act, 2007; Decisions of the Director under the Independent Health Facilities Act with respect to licensing of independent health facilities.” Variations of this type of administrative tribunal exist in other provinces (QB, AB, BC). For example, HSARB is mandated to hear appeals when health insurance administrators do not fund out-of-country treatment when that treatment is not available in Canada. Medicare and the Court System The law does not provide Canadians with options for ensuring accountability from government. The only limited “safety-valve” protection enabling the review of personal access difficulties to decision makers is the role administrative tribunals play. The public has little opportunity to decide what physician and hospital services are covered by universal health insurance, and more broadly, what should be covered as “medically necessary.” The Canadian Charter of Rights and Freedoms The Canadian Charter of Rights and Freedoms (the Charter) was enacted as part of Canada’s Constitution in 1982 and protects various rights and freedoms against unjustified government intrusion. The Charter applies only to government. The most often argued provisions are the section 7 rights to life, liberty, and personal security, and section 15(1) equality rights. In addition, the Charter, in section 1, guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society. The challenge under section 1 is to balance the rights of individuals with the competing interests of society as expressed through government action. The Charter is used to challenge various aspects of healthcare delivery and regulation in Canada. As you have seen https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 14/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction in Module 2, the Charter is relevant in a range of health law areas, including reproduction, mental health, public health, and end of life. It is used to challenge laws or government powers that impact individual rights and freedoms, such as mental health and public health laws that authorize involuntary treatment of patients. See the health law cases of Eldridge v. British Columbia, Auton v. British Columbia, and Chaoulli v. Attorney General (Quebec), reviewed in Module 2, which considered sections 1, 7, and 15 of the Charter. Below is the language of sections 1, 7, and 15(1) of the Charter: “1. The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.” “7. Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.” “15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.” Home and Community Care Support Introduction The Local Health System Integration Act, 2006, S.0. 2006, C.4 is Ontario legislation. Section 2 declares the purpose of this Act: “to provide for an integrated health system to improve the health of Ontarians through better access to high quality health services, coordinated care in local health systems and across the province and effective and efficient management of the health system at the local level by local health integration networks.” The legislation created Local Health Integration Networks (LHINs). It affirms the commitment to principles of public administration as provided under the Canada Health Act and the Commitment to the Future of Medicare Act, 2004. It provides for a commitment to the delivery of public health services by not-for-profit organizations. As well, the statute acknowledges that a community’s health needs and priorities are best developed by the community, healthcare providers, and the people they serve. The legislation excludes certain groups from the definition of health service providers and therefore from control by the LHIN. On April 1, 2021, the health system planning and funding functions from the Local Health Integration Networks (LHINs) transferred into Ontario Health, which became a super agency made up of the LHINs and six health agencies. LHINs are now https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 15/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction operating under a new business name, Home and Community Care Support Services, to reflect a focused service delivery mandate to deliver patient care. The process is slow and you will find some still using the term LHINs and the legislation refers to Local Health Integration Networks, The Ontario government has said the LHINs will eventually be eliminated entirely, but for now, five CEOs will remain on to oversee different regions until the merger is complete. Exclusions Health services providers ARE NOT: a member of the College of Chiropodists; a member of the Royal College of Dental Surgeons; a member of the College of Physicians and Surgeons; or a member of the College of Optometrists. Section 5 – Objects of a LHIN The objects of a local health integration network are to plan, fund, and integrate the local health system to achieve the purpose of this Act. Powers By section 6, a LHIN has the capacity, rights, and powers of a natural person for carrying out its objects. A LHIN receives revenue to “further objects,” although it has limited powers, for example regarding the purchasing of a property. LHIN Board Meetings The LHIN has a board of directors consisting of nine members appointed by the Lieutenant Governor in Council, a Chair, and Vice Chair. Board members are appointed for three-year terms, remunerated, and reimbursed for expenses. Meetings are open to the public. There is an annual report made to the Minister. Each LHIN shall provide the Ontario Health Quality Council with information about the local health system that it requests. https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 16/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Planning and Community Engagement Section 14 requires the Minister to develop a provincial strategic plan. Section 15 requires the development of an Integrated Health Services Plan. Funding and Accountability By s.18, the Minister and each LHIN shall enter into an accountability agreement to include: performance goals and objectives; performance standards, targets, and measures; requirements for the network to report on performance; funding at the discretion of the Minister; and adjustment, efficiencies, and savings. Pause and Reflect Note: This Is a Non-Graded Activity The Ontario government has recently passed amendments to legislation that made changes to the LHIN’s system in Ontario: the Patients First Act, 2016.(Google "The Patients First Act 2016") See if you can find the Act and post a brief summary of what this amending Act provides for in the General Discussion Forum of the “Class Discussion Board.” Also, please read the following case which sets out a good summary of the LHIN system: Ontario Public Service Employees Union v. Central East Local Health Integration Network, 2008 CanLII 41820 (ON SCDC). Summary As you will recall, healthcare is a divided area of jurisdiction constitutionally, although much of it is provincially/territorially controlled. https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 17/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction In order for the federal government to try and put in place a universal health insurance program across the country, it legislated the Canada Health Act (CHA). This Act provides the criteria for federal funding of the provincial/territorial insurance plans, which match the federal formula set out in the CHA for federal funding. In Ontario, there are a number of pieces of provincial legislation as noted in this module. This has led to differences in the provincial/territorial plans instituted across the country. The Charter has been used by individuals in an attempt to expand through the courts the health services made available to individuals, at times successfully (e.g. Eldridge) and at times unsuccessfully (e.g. Auton). References Acts Canada Health Act (R.S.C., 1985, c. C-6) Canadian Charter of Rights and Freedoms Commitment to the Future of Medicare Act, 2004, S.O. 2004, c. 5 Constitution Act, 1867 Local Health System Integration Act, 2006, S.O. 2006, c. 4 Bill 60, Your Health Act, 2023 Case Law Auton v. British Columbia Chaoulli v. Attorney General (Quebec) Eldridge v. British Columbia Ontario Public Service Employees Union v. Central East Local Health Integration Network, 2008 CanLII 41820 (ON SCDC) Other https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 18/19 1/21/24, 1:12 AM CLAW326, Module 3 - Introduction Canadian Institute for Health Information (Health Spending and National Health Expenditure Trends, 1975 to 2018) Cattapan, A. (2020). Medical Necessity and the Public Fundingof In Vitro Fertilization in Ontario. Science, 53(1), 61-77. Canadian Journal of Political Commission on the Future of Health Care in Canada [the “Romanow Commission”]. (2002). Medically Necessary: What is it, and who decides? Ottawa: Canadian Health Services Research Foundation. Joanna Erdman, Vanessa Gruben, & Erin Nelson (Eds.). Canadian Health Law and Policy, 5th ed. (Toronto, LexisNexis, 2017) Chapter 3: The Role of Law in the Rise and Fall of Canadian Medicare Chapter 4: Charter Review and Health Care Access Chapter 6: The Governance of Indigenous Health Tran, C. (2023, Feb 22). Some parents are leaving Ontario because of frustrations with its autism program. The Canadian Press. What fertility treatment coverage is offered by Canada's provinces and territories. (2022, Dec 20). The Canadian Press https://de.torontomu.ca/de_courses/templates/m/?c=6A8018B3A00B69C008601B8BECAE392B&m=3&p=180534 19/19