Canadian Health Care System

• The lecture discusses the Canadian Health Care System.
• The lesson aims to provide historical context, compare Canada to other countries, describe the evolution of Medicare, identify the five principles of the Canada Health Act, describe current trends, explain the differences between primary, secondary, and tertiary health care delivery, describe health promotion versus disease prevention, and explain the different roles of federal, provincial, and territorial governments.

History of Health Care in Canada

• Previously, significant gaps in health care accessibility existed.
• Medical training was generally reserved for the wealthy.
• The government prioritized developing industry and infrastructure.
• Few hospitals existed, and most were military facilities in the 1800s.
• Patients directly paid doctors as they could afford.
• Infectious diseases were a major public health concern.
• Public hospital care was first implemented in Saskatchewan in 1947.
• Saskatchewan Premier Tommy Douglas led the publicly funded system.
• Tommy Douglas is considered one of Canada's most influential figures.
• By 1972, all provinces and territories had extended insurance to cover medical services outside hospitals.
• Douglas established a minimum wage.
• Douglas ensured a maximum 44-hour workweek.
• Douglas implemented a paid 2-week vacation leave
• Douglas oversaw increases in old-age pensions and mother's allowance.
• Douglas legislated medical and hospital benefits for welfare recipients at no out-of-pocket cost.

Medicare

• Medicare refers to Canada's publicly funded health care system.
• Medicare is an interlocking set of health insurance plans.
• Provincial and territorial governments fund health care services with federal assistance.
• Medicare is based on criteria in The Canada Health Act (1984).
• There are currently 13 provincial and territorial health care insurance plans.
• Medicare provides universal, comprehensive coverage for medically necessary hospital and physician services.
• Services are administered by provincial and territorial governments to Canadian residents without direct payment.
• Each province and territory is responsible for developing its policies, leading to inconsistencies.
• Services not generally covered include vision, dental, prescription drugs, ambulance, and independent living/home care.
• Individuals who do not qualify for supplementary government benefits pay for these services through payments or private insurance.

Canada Health Act (HCA)

• The Canada Health Act (HCA) is federal legislation created in 1984.
• The HCA's primary objective is to protect, promote, and restore residents' physical and mental well-being.
• The HCA facilitates reasonable access to health services without financial or other barriers.
• It specifies conditions and criteria for provincial and territorial health insurance programs to receive federal transfer payments.
• Hospital, physician, and surgical-dental services are covered.
• The HCA specifies how the system is financed, but does not dictate how care should be organized/delivered.

Principles of HCA

• The set of criteria and conditions that the provinces/territories must follow to receive their federal transfer payments:
• Public Administration requires the insurance plan to be run by a public organization that is accountable to the citizens and the government of the province or territory.
• Provincial governments determine the extent and amount of coverage of insured services.
• Management of provincial health insurance plans must be carried out by a not-for-profit authority, which can be part of government or an arm’s-length agency.
• HCA defines Comprehensiveness broadly, to include medically necessary services “for the purpose of maintaining health, preventing disease, or diagnosing or treating an injury, illness or disability."
• Universality provides that public health care insurance must be provided to all Canadians, including permanent residents.
• Program insures Canadians for all medically necessary hospital and physician care and they do not have to pay an insurance premium in order to be covered.
• Portability allows people to keep health care coverage when unemployed, changing jobs, or relocating.
• Residents moving between provinces/territories must continue to be covered by the "home" province for 3 months.
• The new province/territory of residence assumes health care coverage after the waiting period.
• Accessibility means people can receive medically necessary services regardless of income, age, health status, gender, or location.
• Accessibility means Canadians must have reasonable access to insured services without charge or paying user fees.
• Financial or other barriers to publicly funded health services are discouraged.
• Additional charges (privatization) for publicly insured services are not permitted.

Current Issues

• Changing legislation is needed to meet current Canadian societal needs.
• The system can no longer fully accommodate demands, due to rising costs of technology and drugs.
• There are worker shortages
• The aging of the baby boomer generation born between 1945-1964
• There are increasing number of Canadians that require care
• The Aging of healthcare workers
• There are long waiting lists for surgeries, diagnostics, medical procedures.
• There are Long waiting times for admission to LTC facilities
• The rising cost of care
• A lack of investment in the system by governments has had a negative impact politically
• ALL Dental services used to be covered when dentists worked in hospitals, now that they are outside of hospitals
• Services are almost entirely financed privately now
• Lobbying by other providers, including nurses has led the reviewers of the act to consider other 'practitioners' (not just doctors).
• Provinces have added midwifery services , which means that their services are also fully publicly paid for
• There are Variances in how coverage works out-of-country care
• Longer absences are dealt with, for examples students studying in another province is an issue

Current Trends

• There is reduced public funding for services, leading to privatization.
• Services that are not being funded publicly means people or their insurance companies have to pay for these services
• Those without insurance which includes part time workers, have to be considered

Ontario-Specific Current Trends

• OHIP$ was cut in June 2018, so families with sick children have to seek private coverage first and pay deductibles/co-payments
• Planned mental health funding was cut by more than $330 million in July 2018.
• Supervised consumption sites are scheduled to be closed in August 2024.

COVID 19 Pandemic

• Increased federal and provincial spending and where healthcare dollars go is a question.
• Health system workers are burned out
• There is no standardization and a shortage of PSWs in most areas
• The long term effects of this pandemic on the health system are unknown.

Private Health Care

• Private health care is anything beyond what the public system will pay for.
• Ambulance rides and most cosmetic procedures are generally not covered
• The Shouldice Hospital in Toronto was opened in 1945, it opened before Canadians were covered by universal health care.
• Privately-run clinics offer CT scans and MRI services.
• B.C.'s first private emergency clinic opened in Vancouver in December 2006.

Federal Government Role in Medicare

• The federal government funds Medicare as per the CHA.
• The federal government administers CHA.
• The federal government provides direct health care services to specific groups.
• policy and programs that promote health and prevent disease
• The federal government transfers tax money to provinces/territories
• The federal government Prohibits service providers from billing extra charges

Provincial and Territorial Roles in Medicare

• Provincial and territorial governments finance and plan their health care services, following the five basic principles outlined in the Canada Health Act.
• Decide where hospitals and long-term care facilities will be located and organized
• Decide how many physicians, nurses, and other service providers will be needed.
• Decide on how much money to spend on health care services
• Provincial and territorial health insurance plans pay for hospital and physician costs.

Indigenous Health Care Practices and Universal Health Care

• Challenges involving geography, lack of organization, language/cultural barriers, and SES have resulted in universal health care access only slowly becoming available to Indigenous people
• Indigenous health practices have been overlooked in favour of non-Indigenous medically focused practices
• Indigenous health and wellness is based on a holistic model of health
• There is a focus on the balance and interrelationships of the physical, mental, emotional, and spiritual aspects of a being
• Traditional healing uses ceremonies; plant, animal, or mineral-based medicines; energetic therapies; or physical/hands-on techniques
• A move to more culturally sensitive and inclusive care must be done

Current Canadian Approach to Health Care

• Primary Health Care delivery model
• Secondary Health Care delivery model
• Tertiary Health Care delivery model

Primary Health Care Delivery

• Primary health care delivery is the first point of contact that most people have with health care sysm
• It usually takes place in community
• There are a wide range of services focusing on health promotion and early diagnosis and disease prevention

Secondary Health Care Delivery Model

• Assessment, diagnosis, treatment and preventative services
• Is generally provided by MD, NPs and specialists

Tertiary Health Care Delivery

• Is Specialized and highly technical
• Usually takes place in research or teaching hospitals
• Includes Units like ICU (Intensive care)
• Requires advanced diagnostic and treatment support
• The most costly level of health care delivery- why?. Examples?

Home Care

• Patients are sent home sooner to save money and partly from technological advances
• The are sent home to reduce rates of infection
• Home care increases spending so In order to meet this, governments have gradually increased spending on home care for patients in there homes
• As a result PSWs are needed more and more in both public and private agencies

Home Care Clients

• Home care clients can be older persons
• They may be from families with children
• They may be individuals living with mental, physical, or developmental disabilities
• It may be individual with short-term and long-term medical conditions
• It can be individuals in the recovery, rehabilitative, or final stages of a life-ending disease

Home Care Funding

• The Canada Health Act does not say what services must be provided
• Each province and territory defines and funds its own home care system
• Services offered and how they are provided vary across Canada
• All provinces and territories offer a client assessment
• They offer Case coordination and management
• They offer nursing services
• They offers support services for eligible clients

PSW Duties in Home Care

• PSWs Provide assistance to families who need help with a new baby
• They enable people with disabilities to get up in the morning and get ready for school or work
• They help people adjust to a disability or recover from an illness
• They enable people who are dying to remain at home rather than be admitted to a hospital
• They enable people to remain in their homes, so they can be as healthy as possible and remain independent for as long as possible

Categories of Services Offered

• PSWs provide personal care services (ADLs)
• They provide home care services
• They may provide professional services
• They may provide ADLs services.

Health Promotion and Disease Prevention

• Traditionally, healthcare was to diagnose, treat and cure illness
• Now -Approach is to promote health and prevent diseases
• Preventing illness and injury (keeping people healthy) is cheaper

Health Promotion

• The Process of empowering people to increase control over their health by increasing healthy behaviors

• Addresses behavioral risk factors

Health Promotion Examples

• Canada Food Guide
• Oral Health Programs
• Summer and Winter Active programs
• Maternal care (vitamins, prenatal check ups)
• Anti bullying initiatives
• Tobacco cessation
• Workshops/training on conflict resolution
• Implementing tobacco policies – smoke-free buildings and playgrounds

Disease Prevention

• Programs may also focus on keeping people healthy
• This may include prevention strategies to reduce the risk of developing chronic diseases and other morbidities

Disease Prevention: Examples

• Cancer prevention programs
• Diabetes

Social Determinants of Health

• There are 14 social determinants of health
• Each of these have strong effects upon the health of Canadians. Effects are actually much stronger than the ones associated with behaviours such as diet, physical activity, and even tobacco and excessive alcohol use.

Social Determinants of Health list

• Aboriginal status
• Gender
• Disability
• Housing
• Early life
• Income and income distribution
• Education
• Race
• Employment and working conditions
• Social exclusion
• Food insecurity
• Social safety net
• Health services

Conclusion

• Canada’s publicly funded health care system needs an overhaul
• Medicare is the name of our national system
• There are 5 principles in the CHA
• Health care delivery is divided into primary, secondary and tertiary care
• Current trends in health care continue to change especially with the pandemic