-
Pre-Confederation
Elizabethean Poor Law Tadition
-assumption of public responsibility
-poor laws funded by local gov't
-thinly diguised slavery
-house poor, sick, mentally sick, whores into almshouses -
First laywoman; Marie Herbert
-a laywoman is someone who is not professional
-husnand had apothecary (some sort of alternative medicind) skills -
First Nurses were male attendants
-At a sick bay at French Garrsion in port Royal -
18th Century
-Europe medicine was a collection of loose practitioners of various medical arts
-(barber-surgeons, barber apothecaries, self-taught healers, surgeons)
-division between doctors serving upper class and the masses -
Medical Profession
-barber-surgeons and surgeons apothecaries persuaded gov’t to issue an edict (an announcement of law) so.. they wanted some sort of regulation
-state regulation of the medical market place was requested of the profession -
Nuns
hospital nuns, Ursuline nuns, and Grey Nuns -
Medical Profession
-doctors warned about the evils of uderqualified and credentialization was estblished -
Legislation of New Brunswick 1786 and Nova Scotia 1763
-enacted legislation modelled on english poor law -
Medical Profession
-barber-surgeons and barber-apothecaries relegated to second class in favour of British surgeons -
Legislation in Upper Canada (Ontario) didn't include poor law/Lower Canada/Western Provinces
-opposed to taxation and local gov't power
-some public funds provided -destitute/sick
Lower Canada;
-- facilities built and operated by the church
--weely begging and donation
--primary role in health care was the church and not the state
Western Provinces
-responsibility for relief fell mainly to provincial gov'ts except where local gov'ts were organized -
Medical Profession
weak licensing procedure started in Upper Canada
-offcials decided which doctors would be licesned and which ones wouldn't
-these officials were not doctors and that's why the doctors wanted self-regulation -
Medical Profession
-first licensing board appointed in Upper Canada (ontario) -
Medical Profession
1820s
-formal medical education began and it enhanced the status of the profession -
Medical Profession
College of Physicians and Surgeons in 1839
-this was self regulation and quebec had a college established to deal with herbalists, homeopaths and eclectics(non professional alternaitives) -
Period: to
Medical Profession
Ontario:
-petitions for self regulation
-scepticism of mainstream medicine
-homeopaths and eclectics were given the right to self-regulation before main stream practitioners
-local medical societies came before provicnial colleges -
Mid 19th Century public institutions in larger centres and outdoor relief
pre-1865 almshouses served as hospitals -
Period: to
Social Minimum
Establishment of free education in Ontario, BC, Manitoba, and PEI. As well as free public libraries -
Medical Profession
-midwives officially barred from practice
-woman didn't vote and didn't have jobs outside of the home
-male medical specialisit delivered babies -
Confederation
Canada now it's own country -
Period: to
7 bills
-Seven bills introduced at federal level and none were passed due to employer pressure groups -
Social Minimum
Development of provincial health boards in ontario -
Period: to
Factories Act and Employer's Liability Act
-established saferty requirements
-limits to work hours and employment of children
-weakend legal defenses of employers -
Royal Commission
-unanimous condemnation of certain aspects of the factory system
--50 to 60 hrs/week, low pay, workplace safety, and unemployment
-rapid urbanization (people were moving from rural settings to the urban settings and the factory system was put into overdrive)
-Royal commission set out to inquire into the condition of the working people
Working conditions
-factory doors locked, physical discipline of child workers, financical penalties for slacking, industrial carnage(loss of limbs) etc -
Ames Study
-findings was that there was over crowding and the definiton of poverty line was created
-studyied ordinary working conditions within one mile of the working class district -
Lord's Day Act
-no work on sundays! YAY!! -
Government Annuities Act
-it encouraged canadians to prepare financially for retirement
-Gov't opperate annuities as a means of overcoming the inadewuacies of the private market -
Gov't Annuities Act
-
Workman's Compensation Act in Quebec
-
Rural Municipalities Act happened in saskatchewan
-allowed gov't to provide relief if not affordable -
Period: to
Early Role of Public Health
-physicians who served in WW1 saw how the british operated (public health insurance)
-debate over public health insurance -
Social service council of Canada
-churches began sponsoring surveys of urban working conditions
-reform movememnts (urban reforms) (city healthy, city efficient; especially in gov't, and city beautiful) -
European Developments
brtish gov't introduces national sickness insurance plan for wage earners
-All these schemes were set up to provide basic health care coverage for workers.. ONLY! Not their families or spouses, just them. Underlying logic was in order to keep the engines of industry going you needed to have a healthy work force. -
Robin Hood Principle and Physicians
-Health provided primarily by non-profit religious orders and municipalities
-Physicians were independent fee-for-service practitioners based on price discrimination according to ability to pay (“robin hood” principle)
-rich people pay more and poor people pay less -
Workman's Compensation Act!!!!!!!!!!!!!!!
-First peice of social insurance
-designed to provide benefits, medical care, and rehab services to people who suffered workplace injuries or contracted occupational diseases -
WORLD WAR 1
-there was a rise of the political left due to growing social unrest -
Federal department of health care
-
Winnipeg general strike
-one of the most influential in canadian history
-it was the platform for future labour reforms -
Dominion elections act
-Domininon elections act
-granted universal suffrage to men and women in federal elections
-Except natives -
Mother's Pension Act in BC
-provided support for single mom's and their children -
Minimum wage legislation and Old Age Pension and Family Allowances
-
B.C. Plan
-mother's pension act in 1920 paased, but not health insurance
-legislation for health insurance was passed but failed to be IMPLEMENTED
-had coverage for medical, hospital, and dental for all lower income wage earners -
Canadian Council on Child and Family
-reviewed mother's pension act
-and then felt it was better to punish the dad's and mothers would give up their children
-and led to a cut back in services -
Great Depression
-one quarter of population unemployed
-relief was considered a local responsibility
-federal support came in the form of annual emergencice appropriations -
Impact of Depression and War
-seven month doctor’s work- action strike in Winnipeg -
Impact of Depression and War
-canadian medical association (CMA) policy statement : public health insurance, free for service payment , and contributory plans (it is a plan in which empolyers and employees both make contributions) -
Unemployement Insurance Act
-gov't benefit payments during the period of unemployment
-failed to progress becuase it was 'beyond the powers' -
Beveridge Report -- WW2 GOING ON 1935-1945
Keynesian Economics
and Beveridge report
-- the report was that public assitanve could be emliminated through comprehensive social security
-Universal health service, universal children’s allowance, comprehensve social insurance to address life interruptions; and maternatty and funeral grants -
Municipal Medical and Hospital Services Act in Saskatchewan
-
Unemployment Insurance Act Created
-
Enter the Federal Gov't
-Rowell-Sirois Commission (1940)
--toured the counry and reported on the economic basis of confederation and the distribution of legislative powers between provinces and federal gov't
-The Commission recommended that the federal government take over control of unemployment insurance and pensions. It also recommended the creation of equalization payments and large transfers of money from the federal government to the province each year. -
WORLD WAR 2
-Committee on post war reconstruction -
Enter the Federal Gov't
Committee of 7
-doctors directly involved in national legislation of health care
-supported physician preference for method of payment; pension plan; full medical control; plan administered by independent commission -
Heagerty Committee
-formal Cabinet Advisory Committee on Health Insurance-national health insurance plan (through the provicnial level)
-Original idea is that everyone would have to register with a physician and it would be geographically dispersed -
Marsh Report
-National Employment and ivestment program to maintain full employment
-social insurance protection federally adminstered to protet workers from income interruption
-comprehensive health insuracne and universal family allowances
-nested health care as part of the social safety net
-financed by both levels of gov’t -
CASSIDY REPORT ON SOCIAL SECURITY
-called for a comprehensive social security system including a standard of living floor, unemployment, disbaility, illness, death, training and placement -
Cooperative Commonwealth Association in Saskatchewan
-became official opposition in
-canada's first socialist party -
Special Committee
-premium scale was adjusted
-shifted cost to indidividuals to bring gov't cost down
CMA changes:
-doctors dropped the requirement that they have total control -
Green Book Proposal and Federal Proposal for national health insurance
-McKenzie King (prime minsiter and liberal) threat from the left and costs
-organized labour and CCF membership x2
National Health Insurance
-health insurance (50/50 between citizens and gov't)
-FAILED; due to federal and provincial disputes in revenue sharing -
First Provinical hospital insurance in saskatchewan
-became the national modeal and public health insurance developed in all the provinces -
Post WW2
-old age security act doesn't include quebec
-$40 a month for people over 70 came from the gov't -
Period: to
Growth of Selected Non-Profit Medical Care Plans
-less than a quarter of the population covered by these plans -
Post WW2
-unemployment assistance act
-federal sharing of costs was 50% -
Hospital Insurance and Diagnostic Act passed
-
CAP
CAP was the basis for cost sharing of a range of services and programs including: health services, children services, social assistance, disability allowances, old age assistance, services for the elderly, and institutional care -
National Medical Insurance Act
-50-50 cost shared based on national per capita costs
-benefits: comprehensive coverage of all medically necessary services
-universality, portability, public administered, comprehensiveness -
Medical Care Act passed
-federal gov't passed act
-according to which federal gov't would contribute to provincial medical-care insurance plans provided that such plans met the central federal goal of ensuring universal coverage to provincial residents for a comprehensive range of general practitioner and specialist services, available to all regardless of age or condition or ability to pay, and upon uniform terms and conditions -
Universal Medicare introduced
-
Period: to
Reform of Unemployment Insurance Plan
-broaden current insurance plan
-introduce principles of GAI
-gov't wanted to make UI universal and increased benefits
-widening of elligibility also to include child birth and sickness -
Movements towards Guarantted Annual Income
External Forces:
oil crises (1973 and 1979)
slowed economic growth
increased size of labour force
- Internal Forces
impact of technological change (changes in employment patterns
emergence of working poor
focus on poverty -
Period: to
The Social Security Review
Working paper on social security
employment (near-universal income for employment)
social insurance(contributory as first line of defense)
income supplementation (top-up of basic employment and social insurance) for unemployables
employment and social services -
Saskatchewan establishes the family income plan
However there is no income supplementation plan introduced for the working poor (beyond family allowance) and and no Guaranteed annual income introduced -
"This is the End" Established Pograms Financing Act
-response to economic downturn, rising world oil prices and growing fed/prov friction
transfers (13.5 points)
-effectively ended the 50/50 cost shared arrangement between the federal/provincial/territorial governments for the delivery for health services and post-secondary education, previously spelled out through the Revenue Transfer Act (1972). The new transfers were a combination of cash and tax points, tied to the rate of population growth and growth in the Gross Domestic Product (GDP). -
Federal Child Tax Credit
However there is no income supplementation plan introduced for the working poor (beyond family allowance) and and no Guaranteed annual income introduced -
Quebec Income Supplement program
However there is no income supplementation plan introduced for the working poor (beyond family allowance) and and no Guaranteed annual income introduced -
Manitoba Income Support Program
However there is no income supplementation plan introduced for the working poor (beyond family allowance) and and no Guaranteed annual income introduced -
Canada Health Act
- federal gov't ensures that provinces and terriotries meet certain requirements such as: -free and universal access through publicly ensured health care
-
Federal Gov't imposed a 5% ceiiling on the annual growth rate of CAP
CAP ( canada's assistance plan)
-in ontario, alberta, and bc -
Nationla Child Benefit
-federal gov't announced &600 million in '97 budget
-provinces have used the funding for different initiatives
-feds add an additional $425 million in 1999
