HLTB16 Notes Pt 1.5 PDF

SEP 25 2024 PUBLIC HEALTH IN CANADA Keywords/Formulas Main points/Thoughts CANADA HEALTH CARE (CHA) PROVINCIAL HEALTH CARE - 1984: CHA enacted the - Canada is a decentralisation of provincial and 1867 act → standardise federal laws th...

SEP 25 2024 PUBLIC HEALTH IN CANADA Keywords/Formulas Main points/Thoughts CANADA HEALTH CARE (CHA) PROVINCIAL HEALTH CARE - 1984: CHA enacted the - Canada is a decentralisation of provincial and 1867 act → standardise federal laws that regulate health care in canada health care to other - Constitution of 1867, the provision of provinces and territories healthcare fell under provincial in canada jurisdiction and provinces administered - Provinces and territories it in different ways need to follow rules to - Place of national health care system get monies for extra have a ‘decentralised collection of healthcare help provincial and territorial insurance - Rules are set by them on plans, covering a narrow bucket of what is the standard services, which are free at the point of - controversial due to care’ broad term of medical necessity CANADA HEALTH CARE (CHA) - Backbone of healthcare - Rules and laws to enact funds for provincial in canada and federal health care - 1984: CHA enacted the 1867 act → PRINCIPLES OF 1867 ACT; standardise health care to other provinces and - Public administration territories in canada - Comprehensiveness - Provinces need to follow certain criteria - Universality to get the funds from the government - Accessibility regarding healthcare advancement - Portability - Act applies to all services deemed medically necessary for the purpose of PUBLIC ADMINISTRATION; - Maintaining health provincial or territorial health - Preventing disease insurance plan must be - Diagnosing and treating injuries administered and operated on a - Illness and disability non-profit basis by a public - Accommodations and meals authority accountable to the - Physician and nursing services provincial or territorial - Drugs and medicines government - All medical and surgical equipment and supplies COMPREHENSIVENESS; plan - CHA mission; must insure all medically - ‘Protect, promote, restore physical and necessary services provided by mental well-being of residents of hospitals, dentists working within canada and facilitate reasonable access a hospital setting, and medical to health services without financial or practitioners other barriers’ - CHA mission controversial due to UNIVERSALITY; plan must - Broad term of medical necessity entitle all insured persons to - Up to medical opinions and who is in health insurance coverage on authority to guarantee that the problem uniform terms and conditions is a necessity to necessitate funds to focus on ACCESSIBILITY; plan must CHA establishes criteria and conditions related provide all insured persons to insured health services and extended health reasonable access to medically care services that provinces and territories necessary hospital and must follow to get federal economic support physician services without under Canada Health Transfer (CHT) financial or other barriers - Federal taxation scheme to strengthen economic structure → not to carelessly PORTABILITY; plan must cover use money for small medical cases emergency services for all compared to national crisis insured persons when they are emergencies visiting another province or - Federal governments need to have territory within Canada. When measure of consistency across health moving to another care systems province/territory, all insured persons should be able to 5 PRINCIPLES OF CHA (1867) ACT; transfer their insurance to that - Public administration province or territory - Comprehensiveness - Universality FEDERAL GOVERNMENT - Accessibility RESPONSIBILITIES; - Portability - Ensure healthcare workers’ health and PUBLIC ADMINISTRATION; provincial or territorial safety health insurance plan must be administered and - Providers must operated on a non-profit basis by a public authority meet certain accountable to the provincial or territorial government standards (have credentials and COMPREHENSIVENESS; plan must insure all certifications) medically necessary services provided by hospitals, - Make rules for provinces dentists working within a hospital setting, and medical and territories to follow as practitioners a standard for their healthcare systems UNIVERSALITY; plan must entitle all insured persons - Responsible over to health insurance coverage on uniform terms and indigenous health and conditions extended peoples’ health within canada ACCESSIBILITY; plan must provide all insured - Funding restraints and persons reasonable access to medically necessary other health-related hospital and physician services without financial or contributive services other barriers HEALTHCARE FUNDING; PORTABILITY; plan must cover emergency services PRIVATE INSURANCE VS. for all insured persons when they are visiting another PUBLIC FUNDING province or territory within Canada. When moving to - Social insurance model another province/territory, all insured persons should - Taxes be able to transfer their insurance to that province or territory HOW ARE HEALTHCARE COSTS CONTROLLED? ⇒ CHA → BASIS OF CANADIAN HEALTHCARE Limited incentives to control SYSTEM costs SUPPLY; governments in high-income countries have greater financial capacities to extend more of their services to the public DEMAND; needed to have more of an informed public so need more health consultant professionals to educate the public on matters on how to minimise disease spread REDUCING COSTS IN HEALTHCARE 1. Reduce use of services 2. Improve efficiency 3. Improve support systems DELIVERING CARE IN - Issues in canada healthcare → knowing how CANADA much federal confirmation to let provinces - Dependent on different execute necessary actions they need in terms economic structures that of public health in their areas needs demand for a - Cost-sharing agreement between particular service, or an federal and provincial governments, area has more resources Medicare, formed a bone of contention to offer what they can to for 60 years the public - Continuing issues include the federal - How to care deliberately contribution, currently around 22% and in canada leeway for provinces to decide how to - Publicly funded spend this - Distinguished - At the core, canada = CHA between funding - (all provincial-territorial healthcare sources and funding requests go to the federal delivery services government that follows the 1867 act enacted by CHA) ENSURING ACCESS TO CARE - Availability GOVERNMENT RESPONSIBILITIES WITH PUBLIC - Accessibility HEALTH - Accommodation - Primary responsibility; Regulating health care - Affordability provider’s health - Acceptability - Providers must meet certain standards (have credentials and certifications) AVAILABILITY; relation between - Regulating health professionals demand for service and their (allocation to all areas equally) supply - Regulated professional’s practice 1. Operates under provincial or ACCESSIBILITY; geographical federal legislation relationship between location of 2. Governed by a professional services and the people who corporation or regulatory need them authority (College of Physicians or an Order of Nurses). Many of ACCOMODATION; relationship these are regulatory bodies are between the manner in which provincial, variation exists the services are provided and between provinces and the constraints of people who territories need them. - There are different structures that deal with - Constraints can be provincial-territorial health matters - Physical - There are 14 healthcare systems - Social across canada (per provinces and - Time territories and federal level) → hierarchy - cultural/religious - Federal government sets standards and  principles, and assists in financing AFFORDABILITY; relationship provincial and territorial health care between cost of services and services ability of users and potential - Provinces and territories are users to pay responsible for the administration and delivery of services for most of the ACCEPTABILITY; extent to population which people who need services - Federal government is responsible over are comfortable using them indigenous community - First nations INFORMATION TECHNOLOGY - Inuit IN HEALTHCARE - Metis - Electronic medical and - RCMP health records - Canadian forces - Telemedicine - Prisoners in federal penitentiaries - Teletraining - Refugee claimants HEALTH SERVICES FOR FEDERAL GOVERNMENT RESPONSIBILITIES INDIGENOUS POPULATIONS - Social norms that influence thoughts of what constitutes health - Setting and administering national standards - Indigenous people got for health care system through → CHA isolated from access to - Providing funding support for provincial and health territorial health care services - Societal change needed - Supporting delivery for health care services to for more exposure on specific groups how indigenous people - Providing other health-related functions; deserve health as well - Disease Surveillance and prevention- - Services lack health promotion through Public Health coordination Agency of Canada and regulates drugs, - Often staffed by medical devices, food, and consumer non-indigenous people safety through Health canada - Services may not be well oriented towards the PROVINCIAL AND TERRITORIAL communities’ needs RESPONSIBILITIES - Lack cultural significant - Provincial and territories work within awareness parameters of CHA to provide health care - NAHO - disbanded due services according to the needs in the to funding cut due to lack population of representation in - Provinces; government - Plan, - Fund, OCCUPATIONAL HEALTH AND - Evaluate hospital care, SAFETY = WORKERS’ RIGHTS - Physician care - Right to know about - Allied health care work-related hazards - Prescription drug care in - Training and hospitals supervision - Public health; negotiate fees necessary to with health professionals protect the - Most provinces discharge their health worker’s health care obligations through regional - Right to participate in boards health and safety - Decentralizes decision-making  - Right to refuse and enhances responsiveness - Refuse = not do to community needs any dangerous - Most provinces and territories run work special programs for low-income - Refusal followed residents and seniors, covering up with out-of-hospital drug benefits, investigation to ambulance costs, and some level of determine the risk hearing, vision, and dental care involved and any - Some provinces and territories fun steps needed to community health clinics that provide a mitigate the risk range of professional services in the community LALONDE REPORT AND - Some fund extramural programmes, OTTAWA CHARTER which provide care in patients’ homes, - 1974 Lalonde Report = particularly palliative care, importance of health post-operative care, home oxygen, promotion and prevention long-term care assessment, in maintaining population rehabilitation, etc. health HOW IS PUBLIC HEALTHCARE FUNDED 2006 PUBLIC HEALTH GLOBALLY? (SOCIAL INSURANCE MODEL (NOT AGENCY OF CANADA ACT; USED IN CANADA)) NEW UPDATE! chief public 1. Social insurance model uses compulsory health officer; contributions to social insurance funds - Advocates for effective - Governments can direct how the disease prevention and premiums are levied and in what health promotion amount programmes and - If working at a corporate job- have private activities; insurance to handle any issues that employees - Provide science-based experiences health policy analysis - Premiums can be linked to a person’s and advice to the federal income, often deducted from their pay minister of health cheque - Provide leadership in - In some countries, citizens can choose promoting special health from a number of insurance providers initiatives - In other countries, choice is limited to a - Improve the quality of single national not-for-profit insurer public health practice - ex; japan, germany, france, and some other european countries PUBLIC HEALTH AGENCY OF - Equity issues occur more in USA CANADA (PHAC) 2. General taxes fund health care (ex; Canada) - PHAC mission; promote - However, in canada, only hospital and and protect the health of physician services are universally funded canadians through - Other services are funded via; leadership, partnership, - social insurance (often used for drug innovation, and action in insurance), public health - social security, - Concentrate and focus - private insurance, federal public health - out-of-pocket fees resources - Spiel; (Ironic isn’t it? We say we have universal - Enhance collaboration health care, but if we need any more between different levels specialised health care treatment, we need to of government either have long wait times (which can make - Allow faster, flexible the person suffer), or need to pay more to have  response to emergencies the health-issue addressed than fester. Makes - Improve and focus you consider if private insurance companies communication are more of a leverage in comparison to public - Allow for longer-range health accessibilities, and who really is in plans than the usual advantage of being able to have access to annual planning cycle of health when medicine’s goal is to heal people governments and do no harm (when in reality there is - Achieve greater success financial harm)) in attracting and retaining - Meanwhile, provincial workers’ compensation public health and health and safety at work programmes are professionals funded by a form of social insurance in which employers pay premiums that are graded CLINICIAN AND HEALTH according to the inherent risk of the industry SYSTEM 5 WHO’S and past safety record of the employer RESPONSIBILITIES; - Overall expenditures have been rising in 1. Health system improves canada, reaching $264.4 billion in 2019, or just the health status of over $7k per person individuals, families and - Nearly 60% goes to hospital costs, communities pharmaceuticals, and physician salaries 2. System defends the population against health threats 3. Protection against the financial consequences of ill health 4. Providing equitable access to people centred care 5. Involving people in discussions of their own health and health system CANADIAN IMPLEMENTATION - Having Ontario health - health cards - Greenshield, private insurance companies, etc. Questions - Funding of form of social insurance - Problem; Other services are funded through Index: expenditures in canada ** everything in neon blue is the PUBLIC VS. PRIVATE FUNDING OF HEALTHCARE main summarization the prof - Political/debate issue; private vs public said for each headline health-care - Finance concerns to whether or not people ** everything in light blue is kind should be allowed to pay out-of-pocket or to of important but just as context? buy private insurance for services that are also For the light blue (still good to publicly funded skim though) - Ex; reducing wait times for an operation (based on if it hurts too much to wait ** everything in red will be on the for) exam - Traditionally, 25% of health care spending in Canada is out-of-pocket or ** everything in yellow highlights from private insurance might be on exam - Private is more popular due to difference of cultural acceptance of public healthcare ** everything in black is basically - Should people pay out of pocket for certain copied from the slides so choose whichever you want to focus on healthcare services they want to access? for extra reading/understanding - Private insurance finances - Leverages administration costs - Human resources connect the 2 systems (public and private) - Pros; - Approach takes off pressure from public health system - Cons; - Limited number of qualified professionals that are able to be assigned to the private section to make sure that the public section does not collapse - Not a lot of people have the funds to access these services - Compromise may be to follow the Ontario model of funding private clinics using public money HOSPITAL FUNDING - Should hospitals be private/for-profit? - Technically not public institutions, but are private not-for-profit operated by regional health authorities - Increased mortality in for-profit hospitals, resulting in fears that attending to the ‘bottom-line’ will harm patient care - Fears that for-profit hospitals will open the door to the free market and erode the principles of the canadian health care HOW ARE HEALTHCARE COSTS CONTROLLED? - Population ageing contributing to the issues of public health - Main factors of increasing costs in healthcare section; - Increased use of healthcare - Technological advances - Pharmaceutical advances - Pharmaceutical development - Limited incentives to control costs - Physicians costs have risen due to increased number of physicians (at 15% of the total) - Proportion of overall spending goes to hospitals (currently 26.6%) has declined steadily since  the 1970s - Chronic care and Increasing costs SUPPLY AND DEMAND - Test on the aspect of - SUPPLY; governments in high-income countries have greater financial capacities to extend more of their services to the public - DEMAND; needed to have more of an informed public so need more health consultant professionals to educate the public on matters on how to minimise disease spread - Elderly canadians use family physician services - Marketing of drugs and technology to physicians and directly to consumers increases demand for newer → trade-marked ⇒ more expensive options - Net effect is that health care costs are rising faster than the national wealth as measured by the gross domestic product (Following must know for the exam + chart) REDUCING COSTS IN HEALTHCARE 1. Reduce use of services 2. Improve efficiency 3. Improve support systems REDUCE USE OF SERVICES IMPROVE EFFICIENCY IMPROVE SUPPORT SYSTEMS DELIVERING CARE IN CANADA - Dependent on different economic structures that needs demand for a particular service, or an area has more resources to offer what they can to the public - How to care deliberately in canada - Publicly funded - Distinguished between funding sources and delivery services - Ontario has many private services that are publicly funded OR publicly administered but publicly funded - Delivery may be publicly administered, or private services that are for-profit or not-for-profit (including charitable and religious organisations) - Private delivery sector includes hospital, long-term care, and community services funded by provinces - Most physicians, working in hospital or elsewhere, contract with the provincial insurance plan to deliver services as private service providers - For patients with private insurance or can pay out-of-pocket, and who want services not covered by provincial health plan → lots of professionals working outside of hospitals providing services such as - Physiotherapy - Occupational therapy - Optometry - Podiatry - Psychology 5 A’s – ENSURING ACCESS TO CARE; - Availability - Accessibility - Accommodation - Affordability - Acceptability AVAILABILITY; relation between demand for service and their supply ACCESSIBILITY; geographical relationship between location of services and the people who need them ACCOMODATION; relationship between the manner in which the services are provided and the constraints of people who need them. - Constraints can be - Physical - Social  - Time - cultural/religious AFFORDABILITY; relationship between cost of services and ability of users and potential users to pay ACCEPTABILITY; extent to which people who need services are comfortable using them INFORMATION TECHNOLOGY IN HEALTHCARE - Electronic medical and health records - Telemedicine - Teletraining ELECTRONIC MEDICAL AND HEALTH RECORDS - Interoperability to store and share the data to make the transfer/access of health record easy and quick - Better for disease prevalence and respondents - Major concern; ensuring confidentiality - Data leaks and compatibility of using electronic transfers in the available systems - Solution; develop compatibility between system in building networks - If well-designed, can provide useful information for evaluating practice performance TELEMEDICINE - Video conferencing for medical care - Trials of telesearching - Reduce wait-times TELETRAINING - Web-based health training (for clinicians) - Podcasts, videocasts, and interactive training programmes are all available HEALTH SERVICES FOR INDIGENOUS POPULATIONS - Social norms that influence thoughts of what constitutes health - Indigenous people got isolated from access to health - Societal change needed for more exposure on how indigenous people deserve health as well - Services lack coordination - Often staffed by non-indigenous people - Services may not be well oriented towards the communities’ needs - Lack cultural significant awareness - Traditional indigenous teachings highlight the importance of maintaining and restoring balance among the physical, mental,  emotional, and spiritual aspects of health through social and environmental sensitivity - These teachings were discounted by arriving europeans who brought with them a way of life that threatened the lives and health of indigenous peoples - Infectious diseases arriving with the immigrants had a devastating impact because indigenous peoples had no immunity to them - Through colonisation, european way of life became more common while indigenous peoples where forcibly excluded and disconnected from traditional ways of living - As a result, indigenous health deteriorated compared to that of the dominant society - The health gap between many First Nations, Inuit and Metis communities and the rest of Canada broadened → indigenous health should remain as significant as ever - Health services along cannot significantly reduce the health gap between Indigenous people and other Canadians - Reducing gap requires - Attention to employment opportunities - Income - Education - Social and physical environment - Housing and sanitary infrastructures - Restoration of traditional lands - Governance and culture - Furthermore, despite much greater service need among indigenous peoples, their health services lack coordination - Although the federal government retains responsibility for providing care for a number of first nations communities, the services are increasingly delivered by provinces, territories, and by band councils on reserves and in Indigenous communities - The services may not be well oriented towards the communities’ needs - Tend to be staffed by non-Indigenous people and, until recently, the First Nations communities had little say in the planning services - There are no specific services for First Nations people living off-reserve - Mainstream institutions and professionals who serve Indigenous people living off-reserve rarely have the resources or training to provide culturally safe care NAHO (NATIONAL ABORIGINAL HEALTH ORGANISATION) - Funding cut made it disband - Lack of representation in the government to push for the funding of this organisation to be considered - 2000 NAHO funded by Health Canada; ‘Aboriginal-designed and -controlled body committed to influencing and advancing the health and well-being of Aboriginal Peoples by carrying out knowledge-based strategies.’ - In the same year, the Institute of Aboriginal People’s Health was established as one of the Canadian Institutes of Health Research (CIHR) to support research and build research capacity in Indigenous peoples’ health - Nonetheless, the political nature of health service provision and wide variety of issues to be addressed continue to create barriers to health for First Nations, Inuit and Metis Peoples and will likely do so for sometime - NAHO closed in 2012 OCCUPATIONAL HEALTH AND SAFETY - Ensuring health working environments - Health introspective of occupation - Certain workforces are subjected to federal legislation (ie. Canada Labour Code) - Despite differences among provinces, certain functions are common 1. Government regulators who protect worker health and safety and prevent illness and injury through enforcement of occupational health laws 2. Workers’ compensation boards that help workers who have been injured or made ill due to work. Compensation covers lost earnings, out-of-pocket health care costs and non-financial losses (such as pain and suffering due to an illness/injury), and other expenses - Other agencies that play a role in occupational health and safety include unions, industry associations, occupational health researchers, law firms, and association that provide education and training to workers and workplaces, such as canadian centre for occupational health and safety - Some workplaces have their own occupational health services, staffed by health care professionals (including physicians, nurses, case managers, ergonomists and others) - Larger workplace = complex structures and services HEALTH AND SAFETY AT WORK - Authorities responsible for providing services also vary by province or territory - Employees in most industries are covered by provincial legislation, and the types of industry covered vary slightly by province or territory - Certain industries that cross provincial and national boundaries are covered under federal legislation - Some employees, such as domestic workers in private households, are generally not covered - In spite provincial differences, all Canadian workers have certain rights and duties - Workers’ Rights; - Right to know about work-related hazards - Training and supervision necessary to protect the worker’s health - Right to participate in health and safety - Right to refuse - Refuse = not do any dangerous work - Refusal followed up with investigation to determine the risk involved and any steps needed to mitigate the risk WORKER’S COMPENSATION: PLEASE REVIEW THE MEREDITH PRINCIPLES - Meredith Principles; ensure that employers fund the compensation system and share the liability for injured workers. In return, injured workers receive benefits while they recover, but cannot sue their employers. LALONDE REPORT AND OTTAWA CHARTER - 1974 Lalonde Report = importance of health  promotion and prevention in maintaining population health - 1974 Lalonde report; need to look beyond care of the sick in order to improve the health of the population, arguing that the health care system should include action on environment, lifestyles, and health care organisations, as well as biology - In 1986, at first international conference of health promotion being held in Ottawa, Jake Epp, Minister for Health and Welfare, presented “Achieving Health for All: A Framework for Health Promotion” - Set out the direction for health promotion in Canada, as reflected in the Ottawa Charter for Health Promotion - Canada should attempt to reduce inequities - Increasing prevention effort - Enhance people’s capacity to cope - Suggests that these could be achieved by fostering public participation, strengthening community health services, and coordinating public health policy DIFFERENCES IN PUBLIC HEALTH SERVICES ACROSS PROVINCES - Although most provinces structure their public health system in regional or provincial health authorities, Ontario relies on local public health units to deliver services - Similarly, BC, ON, QC have developed provincial Public Health organisations to provide technical and scientific public health expertise (BC-CDC in BC, Public health ontario in ON, ad INSPQ in QC) SOME BIG EVENTS THAT LED TO PUBLIC HEALTH CHANGE IN THE NEW MILLENIUM ⇒ man-made and natural disasters increased awareness of the need for public health services and disaster planning around the world - 2000; E. coli outbreak killed seven people in Walkerton, ON, and affected thousands of others - 2001; ~6,000 people in North Battleford, SK, contracted cryptosporidiosis because of problems with the water supply - 9/11 attacks in NY and several terrorist attacks in Europe and Asia occurred + severe weather conditions were causing death and injury around the world  - 2002-2003; SARS reaches near pandemic levels causing over 8,000 cases in 16 countries - 44 Canadians died, mostly in Toronto - Experts in public health were warning of an impending influenza pandemic - Events demonstrated the weakness of our public health infrastructure 2006 PUBLIC HEALTH AGENCY OF CANADA ACT - Established a chief public health officer for canada that; - Advocates for effective disease prevention and health promotion programmes and activities; - Provide science-based health policy analysis and advice to the federal minister of health - Provide leadership in promoting special health initiatives - Improve the quality of public health practice PUBLIC HEALTH AGENCY OF CANADA (PHAC) - PHAC mission; promote and protect the health of canadians through leadership, partnership, innovation, and action in public health - Concentrate and focus federal public health resources - Enhance collaboration between different levels of government - Allow faster, flexible response to emergencies - Improve and focus communication - Allow for longer-range plans than the usual annual planning cycle of governments - Achieve greater success in attracting and retaining public health professionals PUBLIC HEALTH LAW IN CANADA - Government has duty to protect the health and well-being of the population by providing public health services - Government has authority to set standards of health and safety ⇒ power to constrain individuals who may pose a risk to the public’s health - Ensure compliance with these standards - Exercise restraint in the use of this power; only acted on the basis of clear criteria and respect due process CLINICIAN AND HEALTH SYSTEM 5 WHO’S RESPONSIBILITIES; 1. Health system improves the health status of individuals, families and communities 2. System defends the population against health threats 3. Protection against the financial consequences of ill health 4. Providing equitable access to people centred care 5. Involving people in discussions of their own health and health system - Although an individual physician is a very small part of the system as a whole, collectively physician play a huge role in ensuring that these objectives are attained HEALTH SYSTEM IMPROVES THE HEALTH STATUS OF INDIVIDUALS, FAMILIES, AND COMMUNITIES - Physicians maintain high standard of care by keeping up to date on best practices in health promotion and treatment and prevention of illness - Ensuring that the care provided meets the need of patients, families and communities - Collaborate with other professionals to provide the appropriate care at the appropriate moment in the appropriate setting SYSTEM DEFENDS THE POPULATION AGAINST HEALTH THREATS - Physicians identify threats by participating in surveillance systems that identify threats early, for instance the notifiable disease system - Contribute to limiting the impact of threats, for instance by providing prophylaxis to contacts of infectious disease - Prevent adverse effects of care - by judicious prescribing (antibiotics only when indicated) - by introducing and adhering to system that prevent error (marking the area on which to operate while the patient is still awake and able to confirm) - by respecting guidelines for infection control - By ensuring that communication with patients, families, and other professionals is clear and understood - Physicians advocate for people with adverse health determinants PROTECTION AGAINST FINANCIAL CONSEQUENCES OF ILL HEALTH  - Physicians tailor their advice to the patient’s financial resources and situation - They realise workers may lose wages by taking the time to attend medical appointments and practical considerations such as transport and child care can make appointments costly - They advocate for people whose ill health has resulted in inability to get work or keep working, full-time or at all - Collaborate with professionals who can help people get all the benefits at which they are entitled and identify work-related illnesses and encourage the patients to claim benefits PROVIDING EQUITABLE ACCESS TO PEOPLE CENTRED CARE - Physicians ensure that those most in need of healthcare have the access they need - May be clinic hours suit people who are constrained by long working hours or availability of child care - Physicians practise in areas where vulnerable populations are found and make sure that people without transport or with disabilities can get to the clinic - If clinic serves an immigrant population, the physician arranges for interpretation services - Physicians and clinic staff are open to cultural differences - Outreach systems may be necessary to ensure that preventative services are used INVOLVING PEOPLE IN DISCUSSIONS OF THEIR OWN HEALTH AND THE HEALTH SYSTEM - Physicians make sure that patients understand their condition and risks and benefits of management options - Knowing which referral services best respond to their patients’ needs - Put patient goals first when developing a management plan - Look for patients’ opinions on the services they and their collaborators provide Summary - Provincial health care - Canada health act (CHA) - Principles of act - Basis of canadian healthcare system - Government responsibilities - Federal - provincial/territorial - Social insurance model - Canadian implementation - Public vs. private funding of healthcare - Healthcare costs control - Supply and demand * - Reducing costs - Delivering care = insurance systems and the prioritisation of funds - Ensuring access to care (5 A’s) 1. Availability 2. Accessibility 3. Accommodation 4. Affordability 5. Acceptability - Information technology in healthcare - Electronic medical and health records - Telemedicine - Teletraining - Health services for indigenous populations - NAHO - Occupational health and safety - Meredith principles - Lalonde report and ottawa charter** - First to mention health promotion and prevention for population health - PHAC - Clinician and health system responsibilities; Health system improves the health status of individuals, families and communities System defends the population against health threats Protection against the financial consequences of ill health Providing equitable access to people centred care Involving people in discussions of their own health and health system