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Strangulation or Rationalization

Over a decade ago, hospital s in Canada began experiencing acute financial restraints. The hospital expenditure experienced a sharp decline and this has eroded the confidence of the general public on the capability of the Canadian hospitals to provide medical services with efficiency. One major cause attributed to this decline was the persistent inflation that locked the Canadian economy in early 90s. The Canadian government then set up commissions to make major inquiries into the matter and make appropriate recommendations. Most hospitals were of the feeling that they could only benefit from considerable rationalization. It was found that most hospitals offer a combination of rehabilitation, acute and extended care to patients (Cardiff, 2002).

The average bed supply was standing at four for every one thousand people. Canada has about 750 acute care hospitals. While this number is not enough to meet the ever growing number of patients in Canada, the medical supply is quite efficient. The renovation of the Canadian medical sector has had a lot to do not only with the establishment of the physical infrastructure but also the medical fraternity as a whole. This has seen the Canadian government making surgical surgery in policies governing provision of medical services to the general public. Claims that the health sector is inefficient have now been proved wrong. The only concern now is the escalation of medical costs far beyond the reach of many people especially those with terminal illnesses.

Provincial governments have expressed their interests in financing construction of more hospitals and also in permitting private health care providers to establish medical units within their respective areas of jurisdiction. This move will go a long away in supplementing the provision of medical services in Canada. The government has also expressed willingness to subsidize the operations of pharmaceutical firms in an attempt to make their products cost effective.   

Lost Opportunity

Canada's fiscal arrangement that allows federal governments to participate in the Medicare programme is not likely to achieve its objectives, though well intended. The arrangement has not been effective with regard to the coordination between the federal governments and the central government and also in the delegation of duties. A new model for the provision of Medicare services is required and this will have to engage the federal governments more firmly. In this new move the federal governments will be expected to gain increased stability and security in health care grants from the central government.

A report by the Kirby Committee identified some key rationale for implementing an effective policy foe Medicare financing in Canada. According to the report, there is need for coherence in the adoption of principles governing Medicare financing. Also, all extra revenues that may be required to sustain Medicare programmes should be raised chiefly by the respective federal governments. Further, the report recommends that the federal governments should be more involved in monitoring the progress made so as to ensure that revenues and grants provided to the provinces are used effectively and accountably (Cardiff, 2002).

Nevertheless the prospect of federal governments assuming an active role in the health care sector raises the issue of decentralization of health care services and the independence of provincial Medicare authorities. The Canadian Medicare programme is a harmonized consortium of several provincial systems that work independently under the umbrella of one supervisory body. The provincial authorities have an absolute independence and discretion in the provision of their services. The federal involvement in the health care is only limited to provision of grants. Federal participation in the health care calls for efficient allocation of resources to respective provincial units.

It also touches on cost-benefit analysis to ascertain how efficient the involvement is and also determination of incentives to the health care sector that can help improve it. Provincial governments faced with financial constraints are more likely to undertake reforms that are of far reaching effect and this may give rise to interprovincial differences and misunderstanding, a matter that will eventually weaken the autonomy of provincial governments in the provision of health care services.  

Health of nations

Provision of effective Medicare services is essential to both the rich and the poor. The Medicare needs of people are diverse and boundless in the face of the modern world. In most of the rich countries government financed Medicare programmes only benefit the old and poor folk as the employed and their families are left to seek private medical insurance from their employers. This scheme has not been effective in meeting the needs of people and in Canada, only twenty per cent of her citizens have confidence it the country's Medicare scheme. Public expenditure on health care is nearly ten percent of gross domestic product in rich countries. Nevertheless there is strong evidence that a sound health care programme pays off as seen in rapid improvements in health and long lives. All those countries that have invested heavily in public health care programmes are rated among those with the highest life expectancy (Cardiff, 2002).

Medicare costs have increasingly soared in many countries shudder save for the resilience of power producers in the Medicare market. Most hospitals blame the increasing Medicare costs on shortage of labour and also new regulatory requirements with regard to provision of health care services. Growth in pharmaceutical spending has consistently grown faster in rich countries than it has in less developed countries.

There is actually an urgent need to change the policies governing the structure of Medicare markets so as to cap the rising health care costs. While developed countries have many means of financing health care programmes, the poor ones are left with no remedy. For the rich countries, they can finance their health care programmes through taxation, imposing compulsory contributions from employers and workers as is the case in Germany and France and also through contributions from private voluntary insurance, which is the case in America and some other countries.

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