Historical Overview

A brief history of the social policies under focus in these blogs is necessary to understand the political underpinnings of these policies. We will start by giving a broad scope of the history of Canadian health care and how it has shaped more specific end-of-life policy. Much of the debate in the way of health care has sprung from the lack of a national approach to services. At the present time, health care and social services fall under the jurisdiction of the provincial government. The federal government is responsible for providing the necessary funding, however each province is able to determine where these resources are allocated. Subsequently this has led to a disjointed national approach to end-of-life care.

Each province and territory has established its own variety of services. Some provinces delegate partial responsibility for the administration of social and welfare services. The federal government in an agreement to share costs between provinces instated the federal Canada Assistance Plan, which ensured that social services funding was split on a 50-50 basis between the provinces. However, in 1990 the federal government imposed spending limits on the 3 richest provinces namely; Ontario, BC and Alberta. Subsequently, these provinces were forced to increase their sharing of social funding by up to 70%. Furthermore, cuts to social service funding resulted as the federal government has placed the reduction of the nation’s deficit on the forefront of the national agenda. In this way, Canada has been shifting to a more private health care as needed to deal with these severe budget cuts by all levels of government. One of the most important developments affecting social and welfare services is the general cutback in state expenditure on these services by federal and provincial governments. A number of strategies have been employed to compensate for lack of state intervention. These strategies include 1) deinstitutionalization: or the removal of people from institutions (however there should be prevention of the need for institutionalization. 2) Promoting Community Care- or emphasizing keeping the sick and elderly in their communities. 3) Transfer of responsibility from the public to the private sector (This is more pronounced in Alberta)

To address the gaps in provision of high-quality end-of-life care this group believes that a cohesive national approach to health care is necessary. Currently health insurance coverage for Canadians is financed by both provincial and federal governments. The provincial governments are responsible for designing and delivering health care but in a manner that abides by national standards that is codified in the federal Canada Health Act. In this way, health care services must be universal, accessible, publicly administrated and portable. Palliative care in hospitals is paid for by a provincial health plan, which generally covers professional care and drugs, medical supplies and equipment while the person remains in the hospital, so essentially it is designed to address acute illnesses and often overlooks the ailments of the elderly. This is a point of contention for many as 75% of all deaths in Canada occur in people over 65 years of age and 5% of these dying Canadians receive integrated and interdisciplinary palliative care. Furthermore, 1/4th of the total deaths in Canada are related to cancer; however they account for more than 90% of those receiving palliative care. These statistics indicate that the need for palliative care is concentrated for those over 65, however the actual delivery of these services is not reflecting this need.- which indicates an inherent problem in the system- if the services are not reaching the population that most urgently needs them.