Canadian Health Care System Overview PDF

NUSC 1P12: WEEK 2 PART 1: CHAPTER 2 THE CANADIAN HEALTH CARE DELIVERY SYSTEM WHAT DO WE KNOW? o What does it mean to ‘deliver’ health care? Is there a difference between ‘health care’ and ‘illness care’? o Recall from last week the evolution of the health care system o (medical, behavioural, socio...

NUSC 1P12: WEEK 2 PART 1: CHAPTER 2 THE CANADIAN HEALTH CARE DELIVERY SYSTEM WHAT DO WE KNOW? o What does it mean to ‘deliver’ health care? Is there a difference between ‘health care’ and ‘illness care’? o Recall from last week the evolution of the health care system o (medical, behavioural, socioenvironmental) o What are the underlying principles of health care in Canada? o Is health care a ‘right’? o What/where do we mean when we say ‘health care’? o Where do nurses fit in all this? o What are some of the challenges our system is facing? NURSES IN CANADA In Canada in 2019 o There were 439,975 regulated nurses: o o o o 300,669 Registered Nurses 6,159 Nurse Practitioners 127,097 Licensed/Registered Practical Nurses 6,050 Registered Psychiatric Nurses o 58.5% of regulated nurses worked in a hospital o Supply of male regulated nurses has grown by 15.4% since 2015 compared to an increase of 3.9% for female nurses o As a group, the nursing workforce is becoming younger Source: Canadian Nurses Association (CNA) and Canadian Institute for Health Information (CIHI) CANADA HEALTH ACT (CHA, 1984) o The Act sets out the primary objective of Canadian health care policy, which is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers“ (aka Medicare) o Federal legislation o o Governs how provinces/territories receive federal funding; some accountability for compliance with CHA Guarantees access to essential medical services regardless of employment, finances, or health CANADA HEALTH ACT: 5 PRINCIPLES & MANDATES PUBLIC ADMINISTRATION o every province/territory must administer and operate a not-for-profit health care system via regional/local authorities (public authority/admin.) COMPREHENSIVENESS o must cover all insured ACCESSIBILITY services; all services available under the insurance plan (e.g. OHIP) must be available to all residents with equal opportunity (must cover what is medically necessary) UNIVERSALITY o all insured residents are entitled to the same insured health services provided on the same terms and conditions (equitable, free of discrimination) o protects from extra charges for health care or discrimination (guaranteed reasonable access to insured care regardless of ability to pay) PORTABILITY o residents moving/traveling from one province/territory to another continue to be covered (coverage across Canada for all Canadians, some limitations FEDERAL & PROVINCIAL/TERRITORIAL RESPONSIBILITIES FOR HEALTH CARE Federal Government o Canada Health Act + laws and regulations to promote, preserve, and oversee healthcare in Canada o Holding provincial/ territorial gov’ts accountable to following the principles for delivery o Financial support for provincial delivery of health care (transfer payments) o Delivering direct health care services to veterans, First Nations, Inuit & Metis living on reserves, military personnel, inmates of federal penitentiaries, and RCMP officers o Address and prioritize emerging issues + fund programs and research FEDERAL & PROVINCIAL/TERRITORIAL RESPONSIBILITIES FOR HEALTH CARE Provincial/Territorial Governments (=13 independent health insurance programs) o Delivery and managing insured health (hospital and physician care) such as OHIP o Ontario Health: https://www.ontariohealth.ca/ o Planning, financing, and evaluating hospital and physician care o Building and managing hospitals and other care settings, hiring, managing, and compensating employees, etc. o Resource allocation and related policies to direct allocation, e.g. quality-based procedures (QBPs) o Managing some public health and prescription care o Role in authority over and regulation of health care professionals (e.g. nurses), plus setting of standards and competencies ONTARIO (CIHI, 2022) In 2022, per capita expenditure in ON approx. $8,213 o NB has the lowest spend: $8,010 o Highest is $21,978 in Nunavut Source (slides 7-12): Canadian Institute for Health Information (CIHI) National Health Expenditure Trends, 2022 CANADA (CIHI, 2022) 2022: Hospitals (24.3% of $), drugs (13.6% of $), and physician services (13.6% of $) are consistently the 3 largest categories of spending o Public health receives 5.3%; Home and community care receives 3.8% Spending on health in 2022= $331 billion ($7,507/person) o Overall, health spending represents 12.9% of Canada’s gross domestic product (GDP) o Spending in 2021 was $308 billion ($8,019/person) Approx. 74.7% of total health expenditure in 2021 came from public-sector funding (note pandemic impact). Other 25.3% is private insurance. o o o o This was 70% public + 30% private from 2000-2019 (20 years!) Private insurance (10.6%)=ave. $890/person Out of pocket (12.1%)=ave. $1,033/person Provincial and territorial government spending on health accounts for 65.6% of total health expenditure in 2019 (e.g. OHIP) (other 9.1% is federal, municipal government, and social security) SPENDING BY AGE (CIHI, 2022) o Cost per capita for infants (younger than age 1) in 2020: $14,541 o Cost per capita for youths (ages 1-14) in 2020 $2,166 o Cost per capita for those ages 15-64 in 2020: $3,705 o Cost per capita for seniors 65+ (making up 18% of Canada’s population, up from 14% a decade ago) in 2020: $12,521 o Seniors consume about 44% of all public sector health care dollars spent by provinces/ territories INTERNATIONAL (CIHI, 2022) 2020 (Year of most recent available data): o Canada - (25% private/75% public) spends 12.9% of GDP. Average of $7,507/person o US (55% private/45% public) spends 18.8% of GDP. Average of $15,275/person ­ Technically two-tiered system, but most of the population cannot gain access to the public provision of care. Basically, access to funded care is limited to military/veterans, elderly, disabled, and low-income families. o France (15% private/85% public) spends 12.2% of GDP. Average of $7,044/person o Germany (15% private/85% public) spends 12.8% of GDP. Average of $8,938/person o Sweden (14% private/86% public) spends 11.5% of GDP. Average of $7,416/person o Netherlands (15% private/85% public) spends 11.2% of GDP. Average of $7,973/person o Australia (28% private/72% public) spends 10.6% of GDP. Average of $7,248/person ­ Most similar to Canada for private/public split and per capita expenditure, but does technically operate using a two-tiered health care system with the majority of care publicly funded under universal care. All patients preserve the opportunity and in some cases are encouraged to seek private treatment at their expense. This is the same in the UK which has a split close to our 2021 split of 25%/75%. o New Zealand (20% private/80% public) spends 9.7% of GDP. Average of $5,757/person o United Kingdom (17% private/83% public) spends 12.0% of GDP. Average of $6,464/person HEALTH CARE COST DRIVERS Total health expenditure in Canada rose by 0.8% in 2022, following high growth in 2020 (13.2%) and 2021 (7.6%) Prior to the pandemic (2015-2019) growth in health spending averaged 4% a year, rises attributed to: ­High costs of new technologies and the push to use them in managing illness/disease (drives up health care costs in acute care) ­1% due to population growth ­0.9% due to an aging population ­ Canadians 65+ account for 16% of the population and use almost 46% of all public-sector health care dollars spent by the provinces and territories (e.g. OHIP spending) ­ Per-person spending increases with age (see previous slide ‘Spending by Age’) ­8.3% general inflation as of 2022 RECENT TRENDS & CHALLENGES Continued aging of the population will steadily increase future spending. Decision-makers will be challenged to determine a level of care (hospital, LTC, community care) that balances access, quality, and appropriateness of care with cost (CIHI, 2021). Health care policy and decision-makers will be challenged to innovate in order to reform the way health care is provided (CIHI, 2017). Public drug programs limiting pricing for generic drugs, and expiring drug patents, have saved $; however, spending on specialized meds such as biologics and antivirals to treat hepatitis C have increased (CIHI, 2017). Physician spending has increased since 2005, due to an increase in the supply of physicians and the rise in physician fees (CIHI, 2020). Lack of accountability in the health care system (Romanow Report, 2002) Health human resources (high vacancy rates, burnout) Privatization of services Recentralization (shift from local health authorities to a single central authority, e.g. LHINs to Ontario Health) Consumer involvement and personalized medicine (Potter et al., 2024, p. 29) SYSTEM SUSTAINABILITY With rising costs, changing demographics (including an aging population), and evolving needs, the system is in crisis and requires reform to ensure sustainability Pharmacare - a public drug plan for Canada that is universal, comprehensive, evidence-based and sustainable is one cost-reduction strategy ­ “A Prescription for Canada: Achieving Pharmacare for All” ­ We are the only country in the world with universal health care that doesn’t have universal coverage for prescription drugs ­ We spend more on drugs than we do on doctors! ­ Gaps in coverage and access are unfair and lead to poor outcomes (1 struggle to afford their medications) in 5 Canadians LET’S LOOK UPSTREAM… And also zoom out and remember ‘context’… PRIMARY CARE & PRIMARY HEALTH CARE PRIMARY CARE o Focus is on personal health services (individual) PRIMARY HEALTH CARE o Includes primary care and health education, nutrition, maternal and child health care, family planning, immunizations, and control of locally endemic disease (programs, population health priorities) o Emphasis on health promotion and disease prevention (upstream) 4 PILLARS OF PRIMARY HEALTH CARE TEAMS ACCESS INFORMATION care teams, interdisciplinary, providers in addition to primary physician/NP 80% of Canadians report having a family doctor, street nursing and other programs attempt to reach people “in place”) access to health information, electronic records, health literacy; increases knowledge, selfmanagement and communication HEALTHY LIVING prevention, chronic illness management, selfcare; consider impact of factors such as social, economic, and environmental on health LEVELS OF HEALTH CARE Level 1: Health Promotion Enabling people to increase control over and improve their health Wellness services Promotion of self-esteem in children and adolescents Advocacy for health public policy Ottawa Charter for Health Promotion Level 2: Disease & Injury Prevention Reduce risk factors for disease and injury Prevention strategies Clinical actions (e.g. Immunization) Behavioural aspects (e (e.g. Climate control activism) Level 3: Diagnosis & Treatment Recognizing and managing the existing health problems of individuals Primary care (first point of contact with health care system) Secondary care (provision of specialized medical service) Tertiary care (specialized technical care for complicated health problems) Level 4: Rehabilitation Improving the health and quality of life of those facing life-altering conditions Required after physical/mental illness, injury, or addiction Services include: Physiotherapy, Occupational therapy, Respiratory therapy, Social services Level 5: Supportive Care For patients with chronic illness, progressive illness, or disability Long-term care and assisted-living facilities, adult day care centers, home care Also includes respite care and palliative care SETTINGS FOR HEALTH CARE DELIVERY (SEE PP. 27-29 IN POTTER ET AL., 2024 FOR DESCRIPTION OF EACH) INSTITUTIONAL SECTOR COMMUNITY SECTOR INPATIENT o o o o Hospitals Long-term care (LTC) facilities Psychiatric facilities Rehabilitation centers OUTPATIENT; IN PLACE o o o o o o o o o o Public health Physician offices Community health centres and clinics Assisted living Home care Adult day support programs Community and voluntary agencies Occupational health Hospice and palliative care Parish nursing PART 2 - CHAPTER 4 COMMUNITY HEALTH NURSING PRACTICE [BREAK] COMMUNITY HEALTH What connections can we make between Community Health Nursing and the following previously discussed concepts? o Health promotion o Primary care o Sustainability of the healthcare system o Vulnerable populations and social determinants of health o Context (relational practice) o An aging population COMMUNITY HEALTH NURSING CARE Focuses on health promotion and protection, disease and injury prevention, and restorative and palliative care Promotes health of populations and community groups o (how is self + other + context different for community health vs. acute care nursing?) What access barriers may be overcome when care can be received at home or close to home? What can this mean for patients/families, healing/recovery, and health maintenance? COMMUNITY HEALTH NURSING PRACTICE Includes: o public health nursing o home health (community-based) nursing o community mental health nursing o street health o outpost nursing o parish nursing o Primary health care principles guide community health nurses to use empowerment-based models of community practice… What is “empowerment”? EMPOWERMENT o A process by which people, individually, and collectively in organizations and communities, exercise their ability to effect change to enhance control, quality of life, political effectiveness, and social justice o Both an outcome and a process o Exists in dynamic power relations among people, expressed as “power with” rather than “power over” PUBLIC HEALTH NURSING o Improves the health of populations in the community o Emphasis in public health: the health of the entire population (at various levels including local, national, global) o E.g., improve food and water safety, pandemic/ infectious disease management, dental health, vaccination, safety, messaging, etc. https://www.niagararegion.ca/health/ POPULATION HEALTH “An approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups” (PHAC, 2016) Action is directed primarily at community levels with attention toward priority populations (this can vary by community and health issue) POPULATION HEALTH PROMOTION MODEL (remember this from Chapter 1?) FRAMEWORK FOR PUBLIC HEALTH PROGRAMS (IN OTHER WORDS, WE AIM TO MOVE THE INDIVIDUAL AND THE ‘COLLECTIVE’ TOWARD HEALTH SIMULTANEOUSLY WITH PARALLEL EFFORTS) HOME HEALTH NURSING o Also known as ‘community-based nursing’ o Acute, chronic, and palliative care of individuals and their families that enhances their capacity for self-care (aka selfmanagement) and promotes autonomy in decision making o Reduces barriers to accessing care o More cost-effective than hospitalization (can replace hospitalization and can also reduce length of hospitalization as care can continue after discharge) VULNERABLE POPULATIONS o High-risk groups (impacted by SDOH) o Vulnerability and the determinants of health o People who live in poverty o People who are homeless o People who live in precarious circumstances o People with chronic conditions and disabilities o People who engage in stigmatizing risk behaviours o Indigenous peoples o New immigrants and refugees VULNERABLE POPULATIONS Working with vulnerable populations requires competent care oCulturally competent and safe care oUnderstanding clients’ cultural beliefs, values, and practices oWorking with them to determine their needs and interventions Consider what you are learning about in 1P10 about communication and therapeutic relationships VULNERABLE POPULATIONS Harm reduction o Offer alternatives to reduce consequences of high-risk behaviour o Accept alternatives to abstinence o Reduce barriers to treatment o Provide user-friendly access https://positivelivingniagara.com/service-provider/streetworks-needleexchange/ o Harm reduction program providing safer injection and inhalation supplies to individuals in the Niagara region o Individuals can access the StreetWorks program by coming into the office at 120 Queenston St., St. Catharines, open from 9am-5pm, Monday-Friday. o They also meet people where they are (homes, at a Tim Hortons, etc) across the Niagara Region. The van runs Monday-Friday from 6pm-10:30pm. The van is discreet and unmarked. COMMUNITY ASSESSMENT o Assessment of the community, the environment in which people live and work (the local context) o Examination of the locale or structure, the social system, and the people o Locale/structure o Physical environment; Location of services; Places where residents gather o Social system o Schools; Health care facilities; Recreation; Transportation; Government o People o Data collection from observation of activities or interviewing key informants (using your communication skills!) o Community statistics; Population demographics; Population health status; Social and environmental health history o Essential to identify community resources and capacities, as well as issues and problems PROMOTING CLIENTS’ HEALTH Nurses care for clients from diverse backgrounds and settings. Nurses need to understand clients’ everyday lives. Nurses need an accurate assessment of clients to design interventions that promote health and prevent disease. A FEW PRACTICE QUESTIONS… QUESTION Which following statement is true about an insured resident in Canada? A. They are entitled to health care services provided by the plan on certain terms and conditions, depending on where they are living. B. They are able to access health care services in their province only, without cost or penalty. C. They have reasonable access to medically necessary hospital and physician services, regardless of income, age, health status, gender, or geographical location. D. They have to maintain only partial personal coverage when they move or travel within Canada or travel outside of Canada. C QUESTION Which statement about community health nursing is correct? A. It operates the same today as it has since nurses began working with community groups. B. It is resistant to many social, economic, political, and demographic influences in Canada. C. It is changing from universal programs to those directed to high-risk or vulnerable groups (or ‘priority populations’). D. It focuses primarily on behaviour modification and healthy lifestyles and workplace changes. C QUESTION Vulnerable populations A. B. C. D. Are individuals who are cared for by community health nurses Are individuals who have unusual and chronic conditions Are only individuals who are poor and live on streets Can be understood in relation to the social determinants of health D QUESTION Which statement is true about population health in Canada? A. B. C. D. It is the name of a new type of community health nursing. It is a form of statistical data that addresses health concerns. It addresses the entire population and is aimed at eliminating health disparities. It addresses concerns that are present in certain populations. C VIDEO (3:45): OVERVIEW OF CANADIAN HEALTH CARE SYSTEM http://www.healthforceontario.ca/en/Home/All_Programs/Access_Centre/Resources/Vi deos/Orientation_to_the_Canadian_Health_Care_System_Part_I