Overview of Canadian Medicare PDF

Overview of Canadian Medicare Key Features of Canadian Medicare -​ Canadian Medicare is a decentralized, universal, and publicly funded healthcare system that ensures access to medical services for all Canadians. -​ The system is designed to provide comprehensive health services withou...

Overview of Canadian Medicare Key Features of Canadian Medicare -​ Canadian Medicare is a decentralized, universal, and publicly funded healthcare system that ensures access to medical services for all Canadians. -​ The system is designed to provide comprehensive health services without direct charges at the point of care, promoting equity in health access. It is governed by the Canada Health Act of 1984, which sets out national principles for the healthcare system, including universality, accessibility, and portability. Historical Context of Medicare in Canada -​ The first medical plan was implemented in Saskatchewan in 1947, marking the beginning of publicly funded healthcare in Canada. -​ By 1961, all provinces and territories had established health insurance plans, leading to the national framework we see today. -​ In 1966 the Medical Model was introduced -​ The Canada Health Act was introduced in 1984, solidifying the principles of Medicare and ensuring federal funding for provincial health services. Structure of Healthcare Services Levels of Care in the Canadian Healthcare System -​ Primary Care: The first point of contact for patients, focusing on health promotion, disease prevention, and management of chronic conditions. Services include family physicians, nurse practitioners, and community health centers. -​ Secondary Care: Provided by specialists upon referral from primary care providers, including services like medical imaging and acute care in community hospitals. -​ Tertiary Care: Specialized care for complex health issues, often requiring advanced medical technology and facilities, such as cancer treatment and cardiac surgery. -​ Quaternary Care: An even higher level of specialized care, often involving rare and complex conditions, typically found in major academic health centers. Health Equity and Access Issues - Health equity refers to the absence of unfair and preventable differences in health outcomes among different population groups. - Indigenous populations face significant health disparities due to systemic racism, historical neglect, and lack of access to culturally safe healthcare services. - The government has been urged to implement the Truth and Reconciliation Commission's calls to action, particularly regarding Indigenous health rights and access. Challenges and Reforms in Canadian Healthcare Current Issues in Healthcare Delivery -​ Increasing privatization of healthcare services, including Public-Private Partnerships (P3s) and for-profit clinics, raises concerns about equity and access. -​ Long wait times for primary, specialist, and emergency care are prevalent, leading to patient dissatisfaction and potential health risks. -​ Out-of-pocket expenses for services not covered by Medicare remain a significant barrier for many Canadians. Recent Developments and Future Directions -​ The introduction of the Canada Dental Benefit aims to address inequalities in access to dental care, which is often privatized and fee-for-service. -​ The Pharmacare Act (C-64) introduced in February 2024 seeks to establish a national pharmacare program, starting with diabetes medications and contraceptives, to ensure equitable access to necessary medications. -​ Ongoing discussions about healthcare reform focus on improving primary care investment, reducing administrative burdens, and enhancing social services to support overall health. Overview of Canadian Health Care System Privatization and Financing -​ The Canadian health care system has increasingly moved towards privatization, with services being financed through a fee-for-service model, which can create barriers to access for lower-income individuals. -​ This model often leads to disparities in health care access and quality, as those with more financial resources can afford better services. -​ The need for a federal role in establishing national dental care standards is emphasized to ensure equitable access to dental services across Canada. -​ Including dental care as a medically necessary service is proposed to integrate it into the broader health care framework, ensuring comprehensive care for all Canadians. Pharmacare Initiatives  -​ The C-64 Pharmacare Act was introduced in February 2024, marking a significant step towards universal pharmacare in Canada. -​ The first phase of this initiative focuses on providing universal access to diabetes medications and contraceptives, addressing critical health needs. ​ The act aims to reduce the financial burden of prescription drugs on Canadians, promoting better health outcomes and equity in health care access. Barriers to Health Care Program Implementation Political and Economic Influences -​ Neoliberal political ideologies often prioritize market solutions over government intervention, hindering the expansion of public health programs. -​ The power of the corporate sector can influence health policy decisions, often prioritizing profit over public health needs. -​ Tax cuts at both provincial and federal levels can limit the funding available for health care programs, exacerbating existing gaps in coverage. vA lack of political will among government leaders can stall the implementation of necessary health reforms. Health Promotion Challenges -​ Health promotion is defined by the Ottawa Charter as enabling individuals to increase control over their health, yet systemic barriers often impede this process. -​ The interaction between health care and social determinants of health, such as living and working conditions, significantly affects health outcomes. -​ Marginalized populations face greater health risks due to socio-economic factors, leading to higher incidences of chronic diseases. Health Promotion Strategies Five Action Areas for Health Promotion 1.​ Reorienting Health Care Services: The health sector must shift focus from solely clinical services to include health promotion and prevention strategies, respecting cultural needs. 2.​ Developing Personal Skills: Providing education and resources empowers individuals to make informed health choices and improve their life skills. 3.​ Strengthening Community Action: Effective health promotion requires community involvement in decision-making and strategy implementation, fostering ownership and empowerment.  4.​ Creating Supportive Environments: A socioecological approach emphasizes the importance of healthy environments in promoting well-being. 5.​ Building Healthy Public Policy: Coordinated health policies that include legislation and fiscal measures are essential for fostering equity and improving health outcomes. Community-Based and Public Policy Approaches -​ Community-based approaches focus on building networks among individuals to empower them in managing their health determinants. -​ Public policy initiatives are crucial for creating conditions that promote health through regulations and legislation, addressing systemic issues. -​ The welfare state plays a role in mitigating class conflict and addressing social needs that the capitalist system fails to meet. The Political Economy of Health Understanding Political Economy -​ A materialist perspective highlights the relationship between politics and economics, emphasizing how societal structures contribute to health inequalities. -​ The ideological commitments of both state and non-state actors significantly shape public policy outcomes, affecting health care access and quality. -​ The welfare state is viewed as a mechanism to address social needs and mitigate the adverse effects of capitalism on health and well-being. The Interconnection of Politics and Economics Fundamental Relationships -​ Politics and economics are intertwined, influencing societal structures and outcomes. ​ The organization of production and distribution of resources shapes institutions and public policies. -​ Ideological commitments of both state and non-state actors significantly affect policy outcomes. Inequality and Societal Structures -​ Societal structures can lead to systemic inequalities, impacting various demographics differently. -​ Historical context: The evolution of welfare states has been influenced by economic disparities and political ideologies.  -​ Case studies: Examination of different countries' welfare systems reveals varying levels of inequality. Esping-Andersen’s Welfare State Regimes -​ Introduces a political economy perspective to analyze welfare states. -​ Identifies three main typologies: Liberal, Conservative, and Social Democratic, each with distinct characteristics. -​ Economic impacts on distribution and poverty levels vary significantly across these regimes. Forces Leading to the Decline of the Welfare State -​ Weakened national identities and their implications for social cohesion. -​ The impact of deregulation and internationalization on local economies. -​ Political compromises that have shifted focus away from welfare provisions. Welfare State Typologies and Their Implications Dichotomous Typology ​ Residual welfare states provide minimal support, often leaving vulnerable populations unprotected. ​ Institutional welfare states offer comprehensive support, including pensions, healthcare, and housing. ​ Example: The U.S. vs. Scandinavian countries in terms of welfare provisions. Esping-Andersen Typology -​ Liberal welfare states (e.g., UK, USA) emphasize market solutions and minimal state intervention. -​ Conservative welfare states (e.g., Germany, France) maintain traditional family structures and social insurance. -​ Social Democratic welfare states (e.g., Sweden, Norway) prioritize universal welfare and egalitarianism. Future of the Welfare State -​ Engaged citizenry is crucial for sustaining welfare systems; involvement should extend beyond elections. -​ Proportional representation can enhance redistribution efforts and social equity. -​ The role of grassroots movements in advocating for welfare reforms. Primary Care and Health Care Reform in Canada Importance of Primary Care Clinics (PCCs) -​ PCCs are essential for equitable health care provision, especially during crises like the pandemic. -​ They collaborate with community partners to address health disparities. -​ The role of interprofessional teams in enhancing patient care and outcomes. Current Models of Primary Care -​ Fee-for-service (FFS) is the dominant model, but it has limitations such as focusing on curative care. -​ Capitation models offer funding based on patient enrollment, promoting preventive care. -​ Challenges include maintaining service quality and accessibility for patients. Indigenous Health Care Services -​ Indigenous health care is often fragmented, focusing on acute care rather than holistic approaches. -​ The federal government has a responsibility to deliver health services to Indigenous populations. -​ Recommendations from the TRC emphasize the need for culturally competent care and sustainable funding. Health Care Legislation and Policy Development The Canada Health Act -​ Establishes principles for health care delivery: universality, accessibility, comprehensiveness, portability, and public administration. -​ Critiques: The Act has been criticized for focusing on treatment over prevention and health promotion. -​ Gaps exist in coverage for certain services, such as dental and eye care. Key Reports and Recommendations -​ The Mazankowski Report advocates for private funding and delivery of health services, including Medical Savings Accounts. -​ The Kirby Report raises concerns about the effectiveness of devolving responsibilities to regional health authorities.  -​ Both reports highlight the need for a strong federal role in health care funding and policy. Barriers to Policy Development -​ Federal-provincial relations can complicate health care reform efforts. -​ Political feasibility and public opinion play significant roles in shaping health policy. -​ The influence of political ideology on health care priorities and funding allocations. Practice Questions What are 2 major reports on healthcare reform -​ Mazankowski report -​ Kirby report What are 5 key areas of reform -​ Equitable drug insurance – e.g. Pharmacare -​ Primary care -​ Community care: treat patients in the community -​ Social Determinants -​ Quality: “Safe and prompt” What are the components of the kirby report? 1. independent health care 2. Public vs. private Administration of delivery health care services 3. Cost efficiency and medical savings account 4. Health care guarantee 5. Primary health care reform 6. devaluation of regional health authorities 7. service-based funding