PPN 101 Lecture 10 Canadian Healthcare Delivery System PDF

Week 10: The Canadian Healthcare Delivery System November 12, 2024 History of the Canadian Health Care System: Pre-1867 Care was provided by families, churches, local communities Health problems like poor sanitation, infectious diseases were apparen...

Week 10: The Canadian Healthcare Delivery System November 12, 2024 History of the Canadian Health Care System: Pre-1867 Care was provided by families, churches, local communities Health problems like poor sanitation, infectious diseases were apparent during this time 1867 Canada became its own country and separated after the passing of British North American Act The federal/provincial government were set up and were granted certain powers (4 provinces) The provinces had the responsibility of health, education and social services of citizens Federal government was responsible for healthcare for Indigenous people, Canadian forces, veterans, and pharmaceutical safety Late 19-20th century (a difficult time period) The industrial revolution led to urbanization that caused more issues in living conditions, and sanitization= increasing disease Healthcare had to be paid for people, individuals who could not afford it were dependent on charity In 1916, the federal government gave municipalities the ability to use tax dollars to pay for physicians (Municipality Act) Most healthcare before World War 2 was privately delivered and funded (the nurse would visit and treat you at the comfort of your own home) In 1930, the great depression a happened and the ability to pay for healthcare became even more challenging for people in Canada Important events of 1940s and 50s First universal social programs became an idea in Canada Began in Saskatchewan, then in British columbia and Alberta After the war, economic growth and stability with positive effects on determinants of health for the population Immunization programs started Tommy Douglas Founder of medicare Initiated changes in provincially funded system that led the way for all provinces and federal government to legislate Believed all people regardless of income they should receive the same levels of healthcare resources Evolution of Medicare 1961- provinces and territories provided coverage for inpatient hospital care 1972- all provincial and territorial insurance plans extended coverage to include medical services provided outside of hospitals  Canadas began to have free access to hospital and medicare Costs were shared between federal & provincial/territorial government until 1977 1977- federal government began block transfer to funds, each province will get a set amount of funds to use for healthcare that resulted in provinces responding with extra billing and user fees Safety Net Refers to programs that help vulnerable people from poverty and hardship Examples of programs that contribute to supporting Canadians are Ontario works, Ontario disability and Canada pension plan A key component of Canada’s social safety net is Medicare that provided access to hospitals/physician services Canada Health Act Federal government created the Canada Health Act in 1984 in response to extra billing that was becoming a threat to university and access to medical insurance program Based on five principles 1. Public administration 2. Comprehensiveness 3. Universality 4. Portability 5. Accessibility Principles of Canada Health Act: Brief Overview Public administration: government administers publicly run healthcare program in a province or territorial Comprehensiveness: province has to provide care to all people; everything is covered in hospital or doctors office (care provided at doctors office) Universality: all residents of Ontario is entitled to be insured by OHIP Portability: residents are entitled to a certain level of coverage when they move to another province/territory Accessibility: everyone has reasonable access to services ➔ Not additional charges for uninsured service ex: physiotherapist under a hospital ➔ No discrimination based on age, health, status Questions (on menti) 1. I live in Ontario but wa able to get care in a BC hospital when I broke my leg while skiing Ans: Portability 2. All residents of Ontario are entitled to OHIP coverage Ans: Universality 3. While I am hospitalized all costs for medications and physiotherapy are covered by OHIP Ans: Comprehensiveness Roles of federal and provincial/territorial governments Healthcare is administered by provinces/territorial with federal oversight Some provinces cover home care; others don't (provincial government administers care) The federal government Responsibilities Administer nation principles/standards through Canada Health Act They provide money transfer to provinces so provinces can use that money for healthcare Health services to veterans, Indigenous Canadians, people living on reserves, military personnel,inmates of federal penitentiaries, RCMP Involved in health protection, drug regulation, food regulation, and disease prevention Provinces/territorial governments Responsibilities Develop/administer health health insurance plans Plan, fund and organize care in hospitals and other healthcare facilities Reimburse healthcare providers and hospitals Long term care and rehabilitation services Manage some aspects of prescription care and public health Determines what services each province will cover Canada Transfer Largest transfer of money from federal government to provinces and territories Funding for healthcare and support principles of Canadian Health Act About ¼ of the money the federal government spends goes to healthcare and will continue to increase Canada Social Transfer Money the federal government provides for other types of services. Some examples are post secondary education child development, child care, and social assistance Equalization (Additional funds to provinces/territories) The purpose of equalization is to ensure provincial governments have enough revenues to provide similar public services at comparable tax rates The tidal equalization funding increases based on a three year average of normal GDP and is distributed to provnices using a formula outlined in legislation What are some current issues in the Canadian Healthcare System 1. Access for mental health services 2. Access to hospitals 3. Wait times 4. Not having enough family doctors 5. Shortages in nurses 6. Not enough funding in healthcare Policy Changes Problems that require urgent action Wait times for elective care are too long Services outside the Medicare basket are often inaccessible (medicare covers diagnostics, doctor work, blood work) Indigenous health disparities are unacceptable Changes in the way health services are delivered Healthcare was traditionally focused on hospitals and physician services Increasing care delivery with primary healthcare centers, home care and new medical equipment Now the system is still focused om hospital and ER misused for primary care services Dental care ⅓ of Candians don't have dental insurance, which was mainly associated to the factor of high costs New service in 2022-2023 was proposed for people who met certain requirements of income and are eligible for dental care coverage Pharmacare The Pharmacare Act, marking the first phase of a national universal pharmacare program. In 2024, the house of Commons passed bill C-64 The Pharmacare Act, which aims at providing coverage for essential medications like birth control, diabetes for individuals with a health card Public Funding Funded from provincial and federal levels Comes from personal taxes Additional funds from Sales tax and lottery proceeds go to public funding 70% is public funding Private funding 30% is privately funded Covered by out of pocket payments and private insurance (benefits from jobs) Some examples are dental care, eye care, personal health supplies, residential care facilities The Current System Where is Healthcare Delivered Institutional settings- Hospitals, LTCs, Psychiatric facilities Community settings- Public health services, physician offices, community centers/clinics, home care or assisted living centers Volunteer/Private Care- nursing agencies, private clinics Delivery Five Levels of health care services: 1. Health Promotion 2. Disease and Injury Prevention  3. Diagnosis and Treatment Primary Secondary Tertiary 4. Rehabilitation 5. Supportive Care Primary health care First level of contact for non-urgent care and ensuring continuity of care Able to directly perform direct care and provide referrals to other levels of care for patient depending on their needs Promotes improving health, prevention of disease, social justice and equity Example: Parents go to the doctor to check their child’s development (weight/height/immunity) to evaluate the health of their child on a consistent basis Secondary health care Care from a specialist following a diagnosis and referral from a primary care physician or nurse practitioner Can be provided at home or in the community Tertiary care Specialized care that focuses on complex cases and referred from secondary care (ex: bone marrow transplant) Takes place in hospitals that have diagnostic equipment that can perform complex procedures Context/challenges Climate change: Heat waves Economy of health Truth and Reconciliation Calls to Action Social Determinants of Health Aging Population Human Health Care Resources Two Tiered Healthcare A system where patients who can pay for private health services receive faster/better services than those using the public system Countries like UK, Ireland, Australia, Germany have the two tiered system Effects of Privatization Some argue that denying citizens the right to buy medical services violated the right to life in Canadian Charter of Rights and Freedoms while others see restricting this as protecting the greater good A universal healthcare system ensures that both rich and poor receive a standard of care.