Understanding Canadian Medicare

• The Canadian health care system is publicly funded and best described as an interlocking set of health insurance plans.
• Responsibilities for the health care system are shared between the federal government and the 10 provincial and 3 territorial governments.
• Medicare provides universal, comprehensive coverage for medically necessary hospital and physician services at no additional cost to the client.
• These services are administered and delivered by provincial and territorial governments.

Principles of Medicare

• Provincial and territorial medicare plans must meet five criteria to receive full federal funding.
• These criteria are comprehensiveness, universality, portability, accessibility, and public administration, as outlined in the Canada Health Act.
• Comprehensiveness: The insurance plan must cover all medically necessary services, including drugs, supplies, and diagnostic tests in hospitals, as well as necessary services outside of hospitals.
• Universality: Every permanent resident of a province or territory is entitled to receive insured health care services on similar terms and conditions.
• Portability: People retain health care coverage even when unemployed, changing jobs, relocating within Canada, or traveling abroad, ensuring they inform their province/territory when moving.
• Accessibility: Medically necessary services are accessible regardless of income, age, health status, gender, or geographical location, prohibiting additional charges for publicly insured services.
• Public Administration: The insurance plan must be administered by a public authority on a nonprofit basis, accountable to citizens and the government of the province or territory.

Federal Role in Health Care

• Administering the Canada Health Act.
• Providing provincial funding.
• Providing direct delivery of health care services to specific groups such as First Nations people living on reserves
• Developing policies and programs (approving drugs, assessing health risks).
• Transferring tax money to the provinces and territories to share the cost of medically necessary health care services.
• Prohibiting extra billing
• Ensuring equal quality and type of care across all provinces and territories.

Indigenous Health Care

• The Canadian government recognizes the challenges in delivering equitable health care to Indigenous peoples due to factors like geography, language barriers, and socioeconomic status.
• Indigenous health practices have often been overlooked in favor of non-Indigenous medically focused practices.
• Traditional healing incorporates Indigenous healing and wellness through ceremonies, plant/animal-based medicines, energetic therapies, or physical/hands-on techniques.

Health Canada's Role in Indigenous Health Care

• 1945: Health services for Indigenous populations were transferred from the Department of Indian Affairs to Health Canada.
• 1962: Health Canada started providing direct health services to First Nations people on reserves and to the Inuit in the North.
• 1974: Government policy acknowledged that Health Canada would ensure the availability of health services to Indigenous people.
• Mid-1980s: Work began to give First Nations, Métis, and Inuit communities more control over their own health services.
• 1998: The Canadian government published Gathering Strength: Canada's Aboriginal Action Plan, emphasizing diabetes and tuberculosis initiatives, the Aboriginal Healing Foundation, and a healing strategy.
• 2000: The Medical Services Branch was renamed the First Nations and Inuit Health Branch.

Primary Health Care Delivery

• Primary health care delivery is the first point of contact people have with the health care system.
• It could be through a doctor, nurse, or another health care provider, or through phone- or computer-based services.
• It aims primarily at health promotion, early diagnosis of disease or disability, and disease prevention.

Secondary Health Care Delivery

• It is an intermediate level of health care that includes diagnosis and treatment in a hospital with specialized equipment and facilities.
• Secondary health care delivery includes assessment, diagnosis, treatment, and preventive services for complex medical issues, typically provided by specialist physicians.

Tertiary Health Care Delivery

• It represents the specialized, highly technical level of health care in large research and teaching hospitals.
• A new specialized section of tertiary health care delivery is called quaternary care, which includes experimental medicines or surgical procedures.

Home Care

• It provides health care and support services to people in their place of residence.
• Home care enables clients to remain in their own homes by providing personal care services, home support services, professional services, and/or support for instrumental activities of daily living (IADLs).
• All provinces and territories offer client assessment, case coordination, nursing services, and support services for eligible clients.
• Funding for home care falls under provincial funding policies

Provincial/Territorial Role in Health Care

• Each province and territory develops and administers its own health care insurance plan.
• Provincial and territorial governments finance and plan health care services, following the principles outlined in the Canada Health Act.
• They decide on the location and organization of health care facilities, the number of health care providers needed, and the allocation of funds for health services.

Home Care Governance

• Each jurisdiction has ministries/departments responsible for home care services, monitoring services, and deciding on budgets, policies, and standards of care.
• Assesses client needs/eligibility, coordinates/monitors home care services, provides information/referrals to long-term care, and offers placement services in assisted-living/extended care facilities.

Health Care Challenges

• Worker shortages in rural areas
• An aging population
• A growing number of Canadians requiring care
• Long waiting lists
• Rising costs of care

Supplementary Services

• These benefits often include prescription drugs, dental care, vision care, medical equipment and appliances, independent-living assistance, and the services of other health care providers such as chiropractors.
• Additional health insurance is referred to as benefits.

Health Care Trends

• A trend toward providing alternative care in clinics, health care centers, and through home care.
• Medical advances have led to day surgery on an outpatient basis.
• Post-acute services and hospital-alternative services are now more frequently provided in the home and community.

Alternative Health Practices

• Alternative health practices are treatments not taught or practiced in traditional medical communities, offering therapies that differ from standard medical practice.
• They may include therapies such as massage or herbal medicine.
• Alternative health practices have gained widespread acceptance and are covered under some provincial/territorial plans.

Health Promotion and Disease Prevention

• Health promotion refers to strategies that improve or maintain health and independence.
• Disease prevention refers to strategies that prevent the occurrence of disease or injury.
• Some sectors of government and industry have policies to promote health and prevent illness.

Health and Support Worker Responsibilities

• Support workers provide nonmedical care and services to help prevent major health problems.
• Common examples include helping clients maintain hygiene, change position, and perform range-of-motion exercises to prevent complications like pressure ulcers and pneumonia.