Module 6 Section 2

Question 1

HEALTHCARE SYSTEMS IN HIGH -RESOURCE COUNTRIES HEALTHCARE SYSTEMS IN HIGH -RESOURCE COUNTRIES

Answer 1

• Healthcare systems in high-resource countries are often marked by their ability to provide high-quality health services to the majority of the population.
• This section focuses on Canada’s healthcare system because it is a well-known high-resource country committed to U H C. In 2017, Canada had the highest U H C index, with 89 points. However, like all healthcare systems, Canada’s system has some shortcomings. Where these shortcomings are identified, examples of how other countries provide more comprehensive or equitable health services are presented

Question 2

HEALTHCARE IN CANADA

Answer 2

• Canadians have fought to make healthcare a resource for all. All citizens qualify for health coverage for medically necessary services, regardless of their medical history, personal finances, or standard of living.
• In this non-commoditized model, funding is primarily drawn from the provincial and federal budgets, which is commonly known as a tax-funded model. Contrary to the social insurance model, in Canada’s system, healthcare is often not treated as a product or service to be bought and sold in an open market.
• While private companies in other countries, such as the United States, have a larger role in healthcare provision, Canadians have come to expect predominantly governmental organization of health services.

Question 3

Tax-funded model

Answer 3

A health funded model where more than half of the public expenditure is funded through taxes and revenues outside of payroll taxes. This can include taxes such as income tax, sales tax, tobacco taxes, etc. Although payroll tax and income tax are both deducted from one’s paycheck, payroll taxes are deductions that follow a preset contribution framework and always funding the same things, which in Canada includes Employment Insurance (E I) and Canadian Pension Plan (C P P). Meanwhile, income tax is based on federal and provincial/territorial parameters, and what the taxes fund differs from each to year. In such a system, access to publicly funded services is open to all citizens, at least in theory

Question 4

Social Insurance Model

Answer 4

Employers and employees fund health insurance in this model - those who are employed have access to “sickness funds” created by compulsory payroll dedications. In addition, private insurance plans cover every employed person, regardless of pre-existing conditions. Therequirement of employment for health insurance provides benefits and causes problems. These measures ensure that employed people will have the healthcare needed to continue working and ensure a productive workforce. Because it was not initially established to provide universal health coverage, the Social Insurance model focuses resources on those who can contribute financially.

Question 5

HOW HISTORICAL EVENTS SHAPED HEALTHCARE IN CANADA

Answer 5

Three major historical events over the past 150 years led the Canadian government to take on a critical role in healthcare policy and service provision. As a result of these events, Canadian citizens desired greater government involvement in the organization of health care policy and services.

Question 6

how four historical events shaped Canadian values towards health care

Answer 6

1. Urbanization 1870 - 1910
   The industrial revolution saw economic power shift to major cities such as Toronto and Montreal. During this period, industrial capitalism and the working class began to emerge. Suburbs and tall office towers in city centres were characteristic of this period. As a result of increased population densities and the loss of informal social networks, the provision of health and social care (common in rural communities) began to disappear. This increased both the need and demand for government-sponsored healthcare.
2. World War I 1914 - 1918
   During World War I, more than 66,000 Canadians and Newfoundlanders (then a separate Dominion) were listed in the Books of Remembrance. Another 173,000 Canadians were injured during the war, with 138,000 of those being battle casualties. To aid the wounded, the federal government established a massive system of hospitals, sanitariums, and rehabilitation centres across the country. This was part of the debt that the government owed to those who served, and it was a profound change to health care in Canada.
3. The Great Depression 1929 - 1939
   During this period of history, numerous individuals required government-funded emergency relief. Canadian hospitals found that as the number of paying patients declined, their revenues fell, forcing increased costs. In 1934, Hotel Dieu, Kingston General Hospital, and other Canadian hospitals pioneered prepaid hospital insurance plans that provided a 15-day credit in private or semi-private rooms at $2.50 per day, or 20 days in the public ward at $1.75 per day. Although this was an investment that middle- and upper-class people could make, it was usually beyond the reach of the working-class unless their unions acquired it as part of a benefits package.
4. World War II 1939 - 1945
   During World War II, many of Canada’s most talented medical and public health personnel joined the armed forces. Meanwhile, the Canadian Public Health Association continued to advocate for federal funds for full-time health units and provincial tuberculosis control programs. However, as the Canadian economy recovered through the creation of war industries, federal civil servants began to plan for the future, such as William Lyon Mackenzie King who would begin to promote social welfare policies that became the foundation of modern Canadian life.

Question 7

Books of Remembrance

Answer 7

The eight Books of Remembrance housed in the Memorial Chamber in the Peace Tower of the Canadian Parliament Buildings in Ottawa are illuminated manuscript volumes recording the names of members of the Canadian Forces and Canadian Merchant Navy killed on active service in wartime, and in other conflicts.
Sanitariums: Medical facility for long-term illness, most typically associated with the treatment of
tuberculosis (T B) in the late-nineteenth and early-twentieth century before the discovery of antibiotics.

Question 8

VIDEO: THE STRUGGLE FOR UNIVERSAL HEALTHCARE IN SASKATCHEWAN

Answer 8

The implementation of universal healthcare can be a challenge. Prior to the implementation of Universal Healthcare legislation (Medicare) in 1962 in Saskatchewan, a vocal group of doctors and community members strongly opposed the new plan. Interestingly, their concerns were not driven entirely by the high cost to taxpayers, but by the belief that the new program would enable the government to dictate how doctors practiced medicine, restricting which diagnostics or treatments could be used

Question 9

U H C IN CANADA

Answer 9

Canada achieves U H C as it provides over 90% of its population with healthcare coverage which is legislated through the Canada Health Act. The Canada Health Act was adopted in 1984 and it specifies the conditions that provincial and territorial health insurance programs must comply with to receive compensation from the federal government.

Question 10

the five main principles of the Canada Health Act.

Answer 10

1. Public Administration
   Administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They must also be accountable to the province or territory, and their records and accounts are subject to audits.
2. Comprehensiveness
   Health services must be comprehensively insured. These include hospitals, physicians, and surgical dentists.
   Universality
   All insured residents must be entitled to the same level of healthcare.
3. Portability
   A resident of one province or territory can move to a different province or territory and still obtain coverage from their home province during a minimum waiting period. This also applies to residents of a province that leave the country.
4. Accessibility
   Insured persons must have reasonable access to healthcare facilities, and these facilities must be given reasonable compensation for the services they provide

Question 11

STRUCTURE OF HEALTHCARE IN CANADA

Answer 11

• In Canada, financing for medically necessary hospital and physician services comes from a tax-funded public insurance system. The government pays for most healthcare services using tax-dollars. The government acts as a single payer for medically necessary services. Services beyond medically necessary must be paid for out of pocket by the individual or through private insurance plans.
• Although the services are paid for by public funding (i.e. tax dollars), private providers carry out the services. For instance, physicians are private entities in Canada. In Canada’s system, because there is no need for marketing, no financial motive to deny claims, and no concern for profit, the system is cheaper and much simpler to navigate when compared to other countries.

Question 12

See the breakdown of healthcare spending in Canada and the United States.

Answer 12

• In 2018, approximately 70% of healthcare costs in Canada were funded publicly by the government. The remaining 30% accounted for costs paid for by individuals directly (out of pocket) or through private insurance.
• Approximately 49% of healthcare costs in the United States were funded publicly by the government. The remaining 51% accounted for costs paid for by individuals directly (out of pocket) or through private insurance.

Question 13

Medically necessary

Answer 13

Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine

Question 14

ACCESS TO HEALTHCARE IN CANADA

Answer 14

Provincial and territorial health insurance plans (known as Medicare) in Canada are required to provide insured persons coverage of insured health services. Services that are not deemed medically necessary require the individual to pay out of pocket expenses or have private insurance.

Question 15

COVERED HEALTH SERVICES

Answer 15

• Doctor’s visits
• In-patient hospital care
• Emergency room visits
• Most essential surgeries
• Psychiatrist’s visits
• Public psychologist’s visits: the psychologist is employed by the public health system (e.g. school, hospital, correctional facility)
• Public physiotherapy (provided in the hospital)

Question 16

NOT COVERED HEALTH SERVICES

Answer 16

• Private psychologist visits: the psychologist practices in the community
• Dental care
• Eye care
• Prescription drugs, unless you are living in Ontario and under 25 and over 65, or in the hospital and require these drugs
• Cosmetic surgery
• Physiotherapy, chiropractic, and many other allied health services

Question 17

Insured Health Services

Answer 17

Hospital services provided to inpatients or out-patients, if the services are medically necessary for the purpose of maintaining health, preventing disease, or diagnosing or treating an injury, illness, or disability; and medically required physician services rendered by medical practitioners.

Question 18

QUESTION: A COMPREHENSIVE DEFINITION OF MEDICALLY NECESSARY

Answer 18

Although Canadians are publicly insured for medically necessary services, there is no explicit definition of what this term means, which leads to multiple interpretations and debate.

Question 19

Why is a comprehensive definition of the term medically necessary needed?

Answer 19

Dr. Carpenter’s Response:
Without a comprehensive definition of medically necessary services, healthcare in Canada is not equitable. Currently, there are several healthcare services for which access hinges upon individual wealth. This reduces access to services to those who cannot afford the out-of-pocket payments or private insurance payments: the people who require access to these services the most. For example, in 2010, 16% of adult Canadians skipped prescription medication and 28% did not seek required dental work because of cost concerns

Question 20

CANADA HAS A PROVINCIALLY FUNDED HEALTHCARE SYSTEM

Answer 20

• In Canada, health care services are provincially funded as set out and guided by the Canada Healthcare Act. The health care services insured under provincial and territorial governments include hospital care and primary healthcare (e.g. physicians and other health professional services).
• For example, in Ontario, citizens have the O HIP, while in British Columbia, citizens have the M S P. In this system, the Canadian federal government gives the provinces and territories money and tax transfers to help pay for the publicly funded health services through the Canada Health Transfer. To try and ensure that the wealthier and less prosperous provinces and territories have a similar level of healthcare quality, the federal government gives equalization payments to the less prosperous provinces, and territorial finance to the territories.

Question 21

OHIP

Answer 21

Ontario Health Insurance Plan

Question 22

MSP

Answer 22

Medical Services Plan

Question 23

FUNDING INDIGENOUS PEOPLES HEALTH CARE

Answer 23

• Although most healthcare is provided at a provincial or territorial level, the health care for First Nations and Inuit individuals is the responsibility of the federal government, based on the Indian Act of 1876 and Treaty 6. First Nations and Inuit individuals are insured by the federal government for health related goods and services not insured by the provincial or territorial governments (e.g., drugs, dental care, vision care, medical supplies, short term crisis mental health intervention, and medical transportation). These services as covered by Non-Insured Health Benefits.
• These services are governed by the First Nations and Inuit Health Branch (F N I H B) of the federal government. The F N I H B funds the Non-Insured Health Benefits Program (N I H B P) to insure health expenditures not covered by provincial or territorial governments.

Question 24

N I H B P Inclusion Criteria

Answer 24

• A person must be a Canadian citizen and meet one or more of the following criteria:
• Be a registered Indian according to the Indian Act
• Be an Inuk recognized by one of the Inuit Land Claim organizations
• Be an infant less than one year of age whose parent is an eligible recipient

Note that Indigenous Peoples living in remote areas and are not covered under provincial or territorial governments are still insured by the federal government.

Question 25

Treaty 6

Answer 25

The sixth out of the eleven treaties that were signed by the Canadian Crown and various First Nations between 1871 and 1877 spanning across present day Alberta and Saskatchewan. A benefit of the treaty was that a medicine chest (at the time, this was a physical chest to store medicine, while today this term has expanded to include health and wellness centres) stored at the Indian agent’s home would be made available for use by the people. Indigenous Peoples thought the treaty would adapt to accommodate changes in currency, health services, and agricultural tools; however, the treaty terms have not been adjusted, which has caused Indigenous Peoples to believe the treaty terms should be re-evaluated to better suit the needs of Indigenous People today

Question 26

Non-Insured Health Benefits

Answer 26

Health benefits for First Nations and Inuit individuals, which cover vision, dental, mental health counselling, medical supplies, medications (prescription and over-the-counter), and medical transportation. Some of the shortcomings of N I H Bs are that they do not cover the Metis population, and the list of approved drugs is constantly changing, making it difficult for users to cover their drug costs

Question 27

FUNDING CANADIAN ARMED FORCES HEALTH CARE

Answer 27

- Individuals of the Canadian Armed Forces are not covered under the Canada Health Act for health care and thus are not funded under provincial or territorial governments. Members of the Canadian Armed Forces are covered by the National Defence Act and as such, their health care is under the responsibility and governance of the National Defence. It is the National Defence’s policy to provide similar coverage that is provided through provinces or territories that are aligned with the Canada Health Act. - In addition to this, the National Defence is required to provide additional and tailored services that meet the unique and high risk nature of the Canadian Armed Forces. This care includes comprehensive medical care, supplemental health care, occupational health care, preventive medicine, health promotion, and comprehensive dental care

Question 28

FUNDING HEALTH CARE OF INDIVIDUALS UNDER PRESSING CIRCUMSTANCES

Answer 28

- In some cases, individuals residing in Canada are not insured by provincial or territorial governments. The Interim Federal Health Program (I F H P) provides temporary and limited coverage of health care benefits for groups of people not covered under provincial or territorial insurance. This includes resettled refugees, protected persons in Canada, refugee claimants, victims of human trafficking, and detainees. - The I F H P covers refugees immediately upon arrival in Canada for basic health care (similar to the general public) but in addition, it covers supplemental health coverage, including urgent dental, eye care, prescription drugs, and allied health services such as physiotherapy. The program also covers the Immigration Medical Exam, including any diagnostic tests required. - Immigrants (who are not refugees, but choose to resettle in Canada) are not covered by the I F H P. They are required to cover all costs of their medical needs for three months, until they are eligible to apply for healthcare in the province/territory in which they reside.

Question 29

Immigration Medical Exam (I M E)

Answer 29

A medical examination required for permanent resident applicants, temporary residents, and refugees. The examination includes a physical and mental examination, a review of medical history, and laboratory and diagnostic tests. The I M E is reviewed by medical and immigration officers to decide if an individual is admissible based on their health. If an individual has a condition that is a danger to public health or safety (e.g. communicable disease like Tuberculosis), or a conditions that might cause excessive demand on health or social services, they could be deemed as inadmissible

Question 30

MYTHS OF CANADA’S HEALTHCARE SYSTEM

Answer 30

- Canada has the longest wait times for common surgeries among O E C D nations. Wait times for common surgery vary among Organization for Economic Co-operation and Development (O E C D) nations. - Doctors are leaving Canada to practice in other countries at an increasing rate. In 2019, there were 91,375 physicians in Canada, reflecting a 1.8% increase over 2018. Moving forward, you will shift your focus to other high-resource countries that appear to excel in areas where the Canadian system has shortcomings. In section 03, you will explore the healthcare systems of low-resource countries.

Question 31

FRANCE’S COMPREHENSIVE HEALTHCARE SYSTEMS

Answer 31

The healthcare system in France is largely funded by government national health insurance. Supplemental coverage may be bought from private insurers. France was ranked the best healthcare system in the world by the W H O in 2000 because of its positive health outcomes and high ratings of overall satisfaction by citizens

Question 32

What are some of the main differences between the French and Canadian U H C systems? What services are covered under the French U H C system, but are covered through private insurance in Canada?

Answer 32

Dr. Carpenter's Response: Both the Canadian and French U H C systems began to form after the World Wars, when the need for universal healthcare became apparent. The French have a national insurance plan with more than ¾ of all funding coming from taxes, specifically payroll taxes, incomes taxes, and goods taxes. Although the system is not a socialized system, same as in Canada, citizens have better access and better coverage. For instance, the National Health Insurance plan covers dentist visits, mental health related costs, and transportation related costs. In Canada, none of these services are covered by public insurance. Even though the French system is mostly funded by the public, citizens can choose to go to any specialist they wish and can select any type of cancer treatment, regardless of cost or if the treatment is experimental. Additionally, the out of pocket costs are so minimal that they do not exceed more than 50 euros a year (this includes hospital stays, drugs, etc

Question 33

WHAT IS STOPPING CANADIANS FROM SEEKING CARE FOR MENTAL HEALTH ISSUES?

Answer 33

As we start to consider areas of the Canadian healthcare system that could benefit from improvement, one major area is the funding, and delivery on mental health services. Funding for mental health care is not comprehensive in Canada

Question 34

CANADA’S TWO-TIER SYSTEM OF MENTAL HEALTH

Answer 34

- Despite a well documented increase in incidence and prevalence of mental health concerns and disorders in Canada, government spending on mental health has been measured at less than 5% of total health spending. This is staggering when compared to other O E C D countries, such as England, where roughly 13% of their total health budget is dedicated to mental health. - Due to the lack of government funding, many families are left footing the bill for mental health services. This has led people to classify the mental health system in Canada as two-tier; those who can afford the services get the care they need and want, and those who cannot, go without. Retired Canadian Senator and 2010 Order of Canada recipient Michael Kirby has been pushing governments to spend money on mental health now, to save money on treatments later.

Question 35

Michael Kirby on Mental Health Spending

Answer 35

“Seventy percent of adults live with mental illness that started under the age of 20. Now you’re talking big bucks: social assistance programs, supportive housing and in many cases, the cost of incarceration in jail, which is very expensive. Treating these problems early in the long run would save governments a huge amount of money.”

Question 36

AUSTRALIA’S MENTAL HEALTH COVERAGE

Answer 36

Australia’s universal health coverage, known as medicare, is publicly funded and administered by the federal government. Over the last 3 decades Australian governments have worked together, via the National Mental Health Strategy, to develop mental health programs and services to better coordinate services and address the mental health needs of Australians. There is a division of roles and responsibilities in Australia’s mental health system, with services being delivered and/or funded by the Australian Government, state and territory governments, and the private sector.

Question 37

what is covered in either sector of Australia’s mental health system

Answer 37

PUBLIC SECTOR State and territory governments fund and deliver public sector mental health services that provide care for people experiencing mental illness. These include: specialized mental health care delivered in public acute and psychiatric hospital settings, state and territory specialized community mental health care services, state and territory specialized residential mental health care services, non-specialized hospital services (such as emergency departments and non-specialised admitted units), and accommodation and social housing programs. PRIVATE SECTOR Private sector services include admitted patient care in a private psychiatric hospital and private services provided by psychiatrists, psychologists, and other allied health professionals. Private health insurers fund treatment costs in private hospitals, public hospitals, and out of hospital services provided by health professionals

Question 38

Compare and contrast two main areas of Canada’s and Australia’s mental health coverage.

Answer 38

Dr. Carpenter's Response: - In Canada, only a small subset of our mental health services are covered under medicare. These includes visits to the family doctor or a psychiatrist through a referral. However, visits to registered psychologists or social workers are often covered through private insurance plans, or out of pocket. Even if citizens have private insurance, there is usually a yearly maximum that can be used towards sessions with a licensed mental health expert. - Although Australia’s mental health services are not completely publicly funded, in contrast to Canada, a lot more services and options are government funded. Government funded services includes mental health services in acute or psychiatric hospitals, community mental health services, residential mental health services, outpatient psychiatric hospital services (e.g. in the E R), and social housing programs. Private insurance covers private services provided by psychiatrists, psychologists, and other mental healthcare professionals. - As you can appreciate, both countries have a two-tier public-private model for mental health services, but in Australia the publicly covered services are much more extensive and comprehensive.

Question 39

INTERACTION: S D G PER CAPITA ACROSS THE GLOBE

Answer 39

- Recall the myth about Canada having the longest wait times among O E C D countries for surgery from earlier in this section. Although consistently on par with other countries with regard to surgery, Canada struggles with providing access to family doctors. - In Canada, there is a low practicing doctor per capita ratio, especially when compared to other O E C D countries. For example, for every 1000 people, Canada has 2.8 doctors while countries like Australia, France, and Switzerland have 3.8, 3.4, and 4.3, respectively. These lower numbers can make it a challenge for Canadians to retain and access a family doctor

Question 40

CANADIANS EXPERIENCE LONG WAIT TIMES FOR PRIMARY CARE

Answer 40

- If you are fortunate enough to have a family physician, this does not guarantee that you will have reliable access to primary care. In a 2016 report that compared 11 O E C D countries, Canada ranked last in the percentage of people who are able to book a same- or next-day appointment with their family physician. - What are Canadians forced to do when they do not have reasonable access to their family doctors? For many people, the only options are emergency departments or walk-in clinics. In response to this problem, Ontario made changes to encourage and support family physicians to have timely/same-day appointments. One of the most drastic examples of this encouragement is that family physicians are now penalized if their rostered patients seek care in a walk-in clinic

Question 41

The Commonwealth Fund

Answer 41

The Commonwealth Fund is a private U. S. foundation whose stated purpose is to "promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable and the elderly”.

Question 42

ACCESS TO PRIMARY CARE IN GERMANY

Answer 42

As you might have noticed throughout this section, Germany has consistently ranked as one of the better O E C D healthcare systems. Germany has mandatory private insurance (funded through taxation and insurance premiums) to enable the provision of universal health coverage. Although Germany spends less on its healthcare system than Canada, it has a higher doctor to population ratio (4.3 vs. 2.8)

Question 43

What does Germany do well in their healthcare system that Canada could adopt to decrease wait times for primary care?

Answer 43

Dr. Carpenter's Response: Calculations of wait times based on O E C D Health Indicators (2011) suggest that greater access to family doctors, as experienced in Germany, could decrease wait times for Canadians in need of health services

Question 44

HOME AND COMMUNITY CARE IN CANADA

Answer 44

For the most part, provincial and territorial governments in Canada are responsible for overseeing home and community care in their respective jurisdictions. Although publicly funded home and community services are available for Canadians who meet eligibility requirements, many Canadians do not receive the amount of care they need or any care at all.

Question 45

Compare home and community care.

Answer 45

HOME CARE - In-home nurse care and therapy - Homemaking (such as cleaning) - Personal support services - Other related services COMMUNITY CARE - Non-clinical supports - Meals (either through food boxes, or community offered events) - Transportation (reduced fares) - Supported living (reduced and subsidized housing costs) - Home help (such as yard work, general maintenance) - Other assistance

Question 46

CANADA’S AGING POPULATION AND HOME CARE

Answer 46

As Canada’s population continues to grow and age, there is an increasing need for quality, publicly funded home care services for the elderly. In 2012, almost one in seven Canadians was a senior (aged 65+); by 2030, that number will jump to nearly one in four. This change in demographics presents challenges for the Government of Canada to ensure both the well-being of seniors and Canada's future prosperit

Question 47

THE AFFORDABLE CARE ACT: THE U S A’S MOVEMENT TOWARDS U H C

Answer 47

- The remainder of this section will explore the healthcare system of the United States of America (U SA). Although the U S A is not currently considered a country that provides U H C, it is important to note that the Affordable Care Act (A C A; also known as Obamacare) is a healthcare reform law that expands and improves access to healthcare in the U S. - The A C A aims to provide universal healthcare by mandating that all Americans have healthcare insurance. In order to provide healthcare insurance at an affordable rate, the A C A introduced subsidies to existing insurance packages, as well as expanding the eligibility of Medicaid

Question 48

PROS AND CONS OF THE AFFORDABLE CARE ACT

Answer 48

PROS - Slows the rise of care costs as preventative services are covered. - Covers 10 essential health benefits which include: preventative and wellness visits, maternity and newborn care, mental/behavioural health treatment, medical equipment, lab tests, pediatric care, prescription drugs, outpatient care, emergency room services, and hospitalization. - Coverage for pre-existing conditions. - Children can stay on their parent’s health insurance plans. CONS - Raised the income tax rate. - The A C A taxed those who didn’t purchase insurance, until 2019, when this fine was eliminated. - People chose to pay the fine rather than pay for coverage. - Businesses with 50 plus full-time employees need to offer health insurance, and to avoid doing so some have cut employee hours, negatively impacting employee income

Question 49

MEDICARE AND MEDICAID IN THE U S A

Answer 49

There is a disproportionate amount of people with low socioeconomic status who do not have health insurance in the U S A, which makes healthcare unaffordable for them

Question 50

SUMMARY OF HEALTHCARE IN CANADA

Answer 50

Throughout this section you explored many aspects of the Canadian healthcare system. Although it is hard to understand the complexity in which bills are passed, and care is delivered in just a few slides, you may have developed ideas as to what are some of the strengths and weaknesses of the Canadian healthcare system.

Question 51

healthcare in Canada - strengths and weaknesses

Answer 51

STRENGTHS 1. Provides access to medically necessary healthcare services through taxation. 2. Provides relatively high-quality healthcare. 3. The healthcare system is fiscally conservative. WEAKNESSES 1. Inequitable access to healthcare services not deemed medically necessary. 2. Limited eligibility for home care. 3. Does not provide comprehensive services that promote holistic health (mental health services/community physiotherapy (and other allied services)). 4. Low doctor to population ratio results in the overuse of emergency room care. 5. Inequalities in rates of diseases and poor health outcomes in Indigenous populations. 6. Does not cover prescription drugs.