Provincial Responsibility Research Articles

Dynamic Budgetary Consequences of the 1991 NFC Award

The National Finance Commission (NFC) award of 1991 has been acclaimed to be a historic achievement of the previous elected government. It has come after a gap of many years (due since 1979) and some abortive attempts earlier.! Meanwhile, the provinces had run into large, chronic deficits on the current account, indicating the growing inadequacy of divisible pool transfers as per the provisions of the 1974 award. Consequently, as an ad hoc provision, deficit grants and other subventions had been used increasingly to support the on-going operations of the provinces. At their peak in 1987-88, these grants were Rs 17 billion (see Table 1), equivalent to about 2 percent of the Gross Domestic Product (GDP) and financed over one-fourths of the provincial current expenditure. Also, the federal government took over the responsibility of provision of some provincial responsibilities as contained in the Concurrent List of the Constitution like SCARPS, flood control, fertiliser subsidy, universities, etc.

Health care technology in Canada (with special reference to Quebec)

In Canada, all citizens are insured for health services. Health care is a provincial responsibility. The federal role is limited to health care financing, health protection including regulation of pharmaceuticals, and environinental health. The health care system represents a balance among government direction, consumer choice, and provider autonomy. Canada has largely controlled the costs of health care by funding and management mechanisms, the most important of which is the global budget formula used to fund hospitals. This paper discusses the Canadian health care system, with particular emphasis on the province of Quebec. In 1988, the provincial government of Quebec established the first Canadian body dedicated to technology assessment. Since then, a national coordinating office and several other provincial bodies have developed. The work of these and other evaluation efforts has had a growing influence on technology management decisions, particularly those dealing with procurement of capital-intensive technologies. Expanding this influence into the realm of technology use, especially for low-cost, high-volume technologies, remains a challenge.

Anesthesia in Canada's health care system

Much has been. written about Canada's health care system as all countries wrestle with rising health costs. Few, however, have attempted to describe the influence of a system of health care on a nonprimary care specialty such as anesthesia. The purpose o f this review is to describe the Canadian system, contrast it with that of the United States, and outline the impact that Canadian Medicare has had on anesthetic practice. A centrally controlled health care system is potentially blessed with the stability (and rigidity) inherent in any program perceived by the public as being their right and privilege. Changes are slow to occur, be they changes of new technology or alterations in the form of physician reimbursement. However, such stability means that control of health care costs can be achieved without intrusion into physician-patient relationships and professional, freedom is preserved. Similarly, the acquisition. of technological support for the practice of anesthesia, necessary to ensure a high standard of public safety, has not been perceived as a problem in Canada. Anesthesia in Canada is a physician-only specialty, and nurse-administered anesthesia does not exist. It is highly dependent on the functioning of the hospitals, for widespread development of freestanding health care institutions has not occurred. Compensation is on a fee-for-service basis, although alternative compensation for certain aspects of practice exists in some jurisdictions. In general, fees are indexed to the surgical procedure at hand, with time (duration) modifiers, as well as modifiers for specific is techniques. Overhead is minimal, so although fees for a given procedure are lower than in the United States, the disparity in earned income is reduced. Unfortunately, recent initiatives to control physician use have limited the ability o f the profession to compensate completely for this North American discrepancy in fees. Since health care in Canada is a provincial responsibility, there are eleven separate plans linked only by the guiding principles of the National Health Act of 1971. Each provincial medical association is responsible for negotiating the fee schedules with the provinces on behalf of its members. Since these associations must respond to the majority of their members, it has been the perception of specialty groups such as anesthesia. that the emphasis of allocations in recent years has been on primary care fields. Anesthetists have therefore found themselves increasingly involved with the collective negotiation process as an unwanted necessity of practice. This collectivism of interests has been the most striking consequence of Canadian Medicare on anesthesia practice, as it has influenced all aspects of patient-physician interactions.

National Curriculum Research: Problems in the Metamethodology of Studies Concerned with State Policy and Local Variation

of Canada (SSHRCC) by the Canadian Society for the Study of Education (CSSE).2 This study has characteristics that make it of interest beyond the Canadian border. The Canadian study, while conducted with a reasonable degree of autonomy by the Canadian national team, was subject to the direction and guidance of the international coordinating committee. At one time, there were over 40 countries involved in the study, and approximately 25 appear to have run the course from beginning to end. There is further interest in the comparative nature of the study because of Canada's political organization that, for purposes of education, allows it to be thought of as 10 countries functioning in a rather loose confederation. This is because the Canadian constitution specifies education as a provincial responsibility with the result that, to all intents and purposes, education is a provincial matter, and there are 10 provinces. Each sets its own policy. Previous IEA studies conducted in Canada, for instance, took place only in some provinces, with provinces being treated as separate countries in the analysis. IEA mathematics defined Ontario and British Columbia as separate countries for purposes of IEA presentations and central data analysis. Similarly, the IEA classroom environment study defined Ontario and Quebec as the relevant provinces. Most university-based educational research has had a similar provincial perspective. Accordingly, an account

The organization of forensic services in Canada

This article describes the organization and funding of mental health services in Canada for persons accused or convicted of criminal offenses. Initially, the context in which these services are provided is briefly presented. Next, the organizational structures which exist to provide pre-trial and pre-sentence evaluations are described. In subsequent sections, mental health services for persons found incompetent to stand trial (IST) and not guilty by reason of insanity (NGRI) and for inmates of penal institutions are presented. In conclusion, some distinctive features of these structures are identified along with the principal advantages and weaknesses of each. The Canadian Context Several characteristics of the Canadian health and judicial systems are important to note at the outset, as they have major implications for the organization and funding of forensic services. Each Canadian province administers its own health and social welfare system. While each provincial system is slightly different from another, all Canadians are provided with extensive health care and social services. Taxation formula for supporting these services vary from one province to another. Adults with no children, who do not work and who are not receiving unemployment insurance, receive approximately $480 a month in welfare payments. While health is exclusively a provincial matter, the Criminal Code is a national or federal law. The administration of the justice system is a provincial responsibility, and thus differs to some extent from one province to another. This division of responsibilities and powers between the federal and provincial governments further complicates the difficult interfacing of the health and judicial systems, but it allows regional variants of the same system to emerge. The Canadian Criminal Code does not define incompetency to stand trial but generally, it is considered to be an inability to understand the court proceedings

Canadian Education And Research For Water Resources Management

ABSTRACT Responsibility for water resources is shared between the federal and provincial governments. Education is primarily a provincial responsibility, but the federal government does provide financial support to colleges and universities and is a major source of research funds for the Universities. Training for water technicians is provided at community colleges. In universities, education programs oriented to water are available in engineering, science and social science. At the undergraduate level, students are introduced to a variety of water problems, but are not able to specialize in water. Specialization normally occurs during graduate programs. Several interdisciplinary graduate programs and research centres or institutes provide alternative ways for students and faculty to address water problems. Water research attracts interest from the federal and provincial governments, the universities, and the private sector. The federal government provides nearly 75% of the funding for water research, and...

The Canadian Health Care System: An Overview

I) X 3in Canada is a provincial responsibility, the "national" e n program is really made up of lo provincial and two cseA territorial plans. The provinces enacted their programs to take advantage of the so% cost-sharing of hospital and medical care costs offered by the federal government. Although universal insurance is only 25 years old, it was first discussed in 1919. However, it was not until 1945, after the depression and the second world war, that serious legislative steps were taken. Then the federal government first proposed a national system, based on the United Kingdom model. That model was rejected by the provinces because it was interpreted as a federal incursion into their jurisdictions (1). However, because hospital facilities were insufficient and, in many instances, outdated, the federal government did make planning and construction grants to the provinces. These grants established the concept of federal-provincial cost sharing for health care services. Armed with this promise, Saskatchewan followed by three additional provinces enacted universal hospital insurance plans. They then pressed the federal government to honor its 1945 funding commitment. Federal legislation was finally proclaimed in 1958, and by 1961 all the provinces enacted plans to take advantage of federal costsharing. The next year Saskatchewan adopted a universal medical care insurance plan, and six years later the federal government completed the cycle by offering cost-sharing to the provinces for universal medical care insurance. Although cost-sharing was on a 5o-50 basis, the federal legislation was written so that the subsidies were proportionally greater than 5o% of actual costs for the poorer provinces, and less than so% for the wealthier

Lalonde and beyond: looking back at "A New Perspective on the Health of Canadians".

The Lalonde Report was published in 1974, and was the first significant government report to suggest that health care services were not the most important determinant of health. After reviewing the evidence, the report suggested that there were four "health fields"--lifestyle, environment, health care organization, human biology--and that major improvements in health would result primarily from improvements in lifestyle, environment and our knowledge of human biology. Lalonde also indicated a broad understanding of the determinants of health in subsequent speeches. While the report was greeted sympathetically at the time, it did not have all that significant an impact in Canada. It was criticised on a number of grounds, in particular that it paid too much attention to lifestyle and too little attention to environment. Furthermore, because health is a provincial responsibility in Canada, while the report was a federal report, there was no mechanism readily available to implement the recommendations of the report. The report was nonetheless widely hailed outside Canada, and similar (and often better) reports were published in Britain, the USA, Sweden and elsewhere. The report remains a highly regarded contribution to the transformation in thinking about health that has occurred in the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)

The Canadian health care system: An overview

Although health care is a provincial responsibility in Canada, universal hospital insurance was fully adopted by 1961; universal medical insurance followed 10 years later. Each province enacted universal insurance after the federal government offered to pay 50% of provincial hospital and medical care costs. Hospital insurance had wide public and provider support but universal medical care insurance was opposed by organized medicine. The federal government soon realized that it had no control over total expenditures and no mechanisms for controlling costs. In 1977 it enacted Bill C-37 which limited total federal contributions and made those contributions independent of provincial health care expenditures so that increased costs had to be met by the provinces. Since private health care insurance for universal benefits is prohibited by the federal terms of reference for health insurance, the provinces must raise the money by taxes and (in some provinces) premiums. Although prohibited by the terms of reference of the universal program, some provinces have adopted hospital user fees and are allowing their physicians to bill patients in excess of provincial fee schedules. The 1980s have seen increased confrontations between the federal and provincial governmets and between the provinces and their providers. The issues are cost containment and control of the system. The provinces have two broad options. The first is more private funding through private insurance and user fees. The proposed new Canada Health Act will probably prohibit such charges. A second option involves greater control and management of the system by the provinces; this has already occured in Quebec. Greater control is vigorously opposed by physicians and hospitals. The Canadian solution to health insurance problems in the past has been moderation. Extreme moves in either direction would represent a break with tradition, but they may prove to be unavoidable.

Aspects of Medical Manpower under National Health Insurance in Canada

caGaGm ANAD A has had universal hospital insurance since 1961 S and universal medical care insurance since 1971. Medical care insurance was enacted: 1) as an inevitable consequence of universal hospital insurance, 2) because of its successfiul adoption in Saskatchewan, and 3) because the federal government accepted the recommendations of the 1964-1965 Royal Commission on Health Services (the Hall Commission) that it enact federal-provincial cost sharing for medical care insurance. In this paper we will examine the effect of universal medical care insurance on medical (and to a small extent nursing) manpower in Canada. We also will look at some of the current issues at the interface between governments and physicians. Although the analysis is national, health care in Canada is primarily a provincial responsibility and manpower policies are made at the provincial level. However, in the early days of universal medical insurance, federal contributions to the funding of medical education gave rise to a strong federal presence in medical manpower policy. Since the late 1970S, federal support of medical education and health care has decreased. With or without financial support of medical education at the federal level, medical manpower is a national resource in all of Canada except Quebec; licensure is donejointly by the nine anglophone provinces and movement of physicians among them is essentially unrestricted. In recommending universal medical care insurance in 1964-1965, the Hall Commission report made a number of assumptions (1): 1. The existing physician to population ratio of 1:857 was a minimum optimal ratio. This ratio had to be maintained or improved because of anticipated increased use due to unmet need and increased demand for services. 2. Population growth at existing rates would continue.

The Politics of Constitutional Change

One of most useful characteristics of federalism is that it makes it possible to offload some issues which produce conflict in system onto regional units, where local majorities can achieve policies never acceptable to country as a whole. The persistence of such conflict if they cannot be hived off in this way can overload system, poison its politics, and reduce it to immobility of a political stalemate. It is well known that political leaders in province of Canada attempted to overcome such avoidable conflict through device of federation with other provinces of British North America. The most troublesome conflict was schools question. In Lower Canada (which became Quebec) substantial Catholic majority was content with nothing less than a Catholic school system, an anathema to Protestant majority in Upper Canada (which became province of Ontario). The best way to resolve this divisive struggle was to make education a provincial responsibility, while at same time inserting a guarantee in constitution protecting right to separate schools to the Queen's Protestant and Roman Catholic subjects in both provinces. Similarly, historic right to preserve civil law, rather than common law, in Quebec made it essential that civil law and procedure should be a provincial concern. All federal constitutions have a certain rigidity, necessary to protect perceived interests of their component parts. Through time environment changes, demands on government alter, and later generations may find old form irksome and possibly irrelevant. How can they be changed without generating conflicts which put excessive strain on system? This is a perennial problem with federations, amplified in last hundred years by rapid changes brought about by modernization. In Canada pressure for change has reverberated through political system, colouring motives of politicians and governments, and inevitably involving courts in task of discerning and redefining original bargain in contemporary terms.

Provincial responsibilities for municipal government

Provincial responsibilities for municipal government

Canada's Social Security Review

Canada's social security system is a patchwork quilt of relatively discreet and uncoordinated programs built up over many decades. While constitutional responsibilities for income security and social services rests with the provinces, federal program initiatives were seen to be eroding the provincial responsibilities and causing confusion between federal and provincially financed programs. The Review of Social Security attempted to comprehensively evaluate the ‘system’ of programs in Canada to correct deficiencies.Financing and respective government responsibilities were also examined. The three year review did not result, in the author's opinion, in sufficient changes in the social security system ‘for the benefit of all Canadians’. The failure to adequately confront employment (unemployment) issues was one gap. Another was the failure to implement changes in income supplementation for the working poor. Tangible results included the introduction of a new Social Service Act which permits cost sharing, and increased cooperation between and among departmental officials and ministers. The Canadian experience contains lessons for the development of joint social policies between state and commonwealth governments in Australia.

PROVINCIAL RESPONSIBILITY FOR LOCAL GOVERNMENT

Canadian Public AdministrationVolume 11, Issue 1 p. 18-31 PROVINCIAL RESPONSIBILITY FOR LOCAL GOVERNMENT Murray S. Donnelly, Murray S. DonnellySearch for more papers by this author Murray S. Donnelly, Murray S. DonnellySearch for more papers by this author First published: March 1968 https://doi.org/10.1111/j.1754-7121.1968.tb00573.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume11, Issue1March 1968Pages 18-31 RelatedInformation

Education in Western Canada

PUBLIC EDUCATION in Canada is a provincial responsibility and each of the ten provinces has its own independent school system.' This, however, does not preclude similarities. In western Canada similarities predominate and differences are largely a matter of emphasis. Western Canada consists of four provinces-British Columbia and the three prairie provinces, Alberta, Saskatchewan, and Manitoba, an area larger than western and central Europe combined, but with only one-sixtieth of the population (4,807,893 in 1961). Like most parts of the world, western Canada has experienced considerable urbanization in recent years. Between 1941 and 1961 the urban population increased from 42 to 63 per cent. Urban growth has been greatest in British Columbia, with 79 per cent of the population living in cities and towns. Saskatchewan is the least urban, with only 43 per cent similarly situated. About two-thirds of the population in Manitoba and Alberta is urban. Canada's third and fourth largest metropolitan centres, Vancouver (790,165) and Winnipeg (475,989) are found in western Canada. Two of the provinces, Alberta, and British Columbia, are among the fastest growing in Canada. British Columbia's population has practically tripled since 1931; Alberta's has almost doubled.2 The recent urbanization of western Canada has been accompanied by a marked growth in industrialization and mechanization. In agriculture the shortage of farm labor has brought higher wages for farm help, which, in turn, has encouraged large-scale farming and a greater reliance on machine power. As a result, from 1951 to 1961, the agricultural labor force decreased from 39 to 33 per cent of the total labor force in western Canada.3 On the other hand, employment in industry increased substantially. During the 1939-59 period, Alberta led all of Canada with a triple increase in industrial employment. British Columbia more than doubled,

Factors Related to Educational Output Differences among the Canadian Provinces

Ninety-five years ago the passing of the British North American Act made education in Canada a provincial responsibility. Since World War II there has been increasing public concern that Canada's educational systems are failing to meet the growing demands of an industrialized and urbanized society for skilled and professional manpower. This concern is evidenced by the appointment of five provincial commissions in the last decade to report on the status of education.

War-Time Problems of Local Government

This paper is an attempt to relate briefly the impact of the Canadian war organization on local governments in Canada; most of the experience and fact are derived from the Province of Ontario although they apply in large measure to the municipalities throughout Canada. In the course of the paper some criticisms will be made, not for the sake of being critical, but in the hope that they may influence coming developments.In view of the confusion that seems to exist concerning the functions of municipal government, the division of constitutional powers in Canada is relevant and may be reviewed briefly. The British North America Act formally establishes only two divisions of government—the Dominion and the provinces. The provinces, under section 92, sub-section 8, are given exclusive power over “municipal institutions in the Province.” Certain other matters of local importance such as licences, charities, hospitals, and asylums, are also given to the provinces. These specific items along with the allocation generally of “all matters of a merely local or private nature” have been taken as indicating that the traditional social services in the first instance are a provincial responsibility although in fact they have been shared with the local government from the beginning. It is thus clear from the British North America Act that municipal institutions are under the province and are legally the creation of the province. Naturally, the experience has not been the same in all provinces and some have gone further than others in the development of local government. But one thing is clear: the provinces are familiar with the municipal governments which they have created; they have worked with them, they have argued with them, and they understand them. They appreciate that they are, to use the words of the sixteenth-century poet, “a proud and yet a wretched thing.”