Evolution of Health Care: An Overview PDF

Evolution of Health Care: An Overview  In 1867, the British North America Act established the Dominion of Canada, which consisted of Ontario, Quebec, New Brunswick, and Nova Scotia.  Each province had its own  Representation in government  Law-making body  L...

Evolution of Health Care: An Overview  In 1867, the British North America Act established the Dominion of Canada, which consisted of Ontario, Quebec, New Brunswick, and Nova Scotia.  Each province had its own  Representation in government  Law-making body  Lieutenant Governor  Health matters received little attention in the British North America Act. The federal government was responsible for the Establishment and maintenance of marine hospitals Division of Care of Aboriginal populations Responsibiliti Management of quarantine es for Health The provinces were responsible for Establishing and managing hospitals, asylums, charities, and charitable institutions All other health-care-related responsibilities by default Marine Hospitals  The Marine Hospital at Douglastown, NB (1830) is the oldest surviving marine hospital in Canada.  Until 1921, it provided care for sick or disabled seamen who were working in the timber trade along the Miramichi River. This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY  Food and drug control In 1919, the Department of Health was created. The development of public health programs In 1944, it was renamed the Department of National Division of Health and Welfare, and federal responsibilities expanded to include Responsibiliti Health care for members es for Health of the civil service The department was renamed Health Canada in the late 1990s. Operation of the Laboratory of Hygiene  Doctors first arrived with the European settlers (mostly from England and France). The first medical school was established in Montreal in 1825 (5 years later it would become The the McGill University Faculty of Medicine) Origins of Medical Only the wealthy could afford Care in care; those who could not afford care received it through religious Canada and charitable organizations or from family and friends. Aboriginal Medicine and the Shaman  Sometimes referred to as shamans or medicine men, Aboriginal healers  Were believed to have a strong connection to the spirit world and Mother Earth Possessed an understanding of healing and the use of herbal medicines  Knew how to use local plants, herbs, roots, and fungi to remedy common sicknesses that are still prevalent today Many traditional medicines have been incorporated into contemporary Western medicinal practices This Photo by Unknown Author is licensed under CC BY-NC-ND  History indicates that prior to contact with Europeans (sometimes referred to as the precontact era) Indigenous people were very healthy. They led an active lifestyle and ate a healthy diet—sources of food were from the land: hunting, fishing, and harvesting local vegetation (most bands moved to maximize seasonal food sources). Hudson’s Bay Company traders brought with them smallpox, tuberculosis, influenza, whooping cough, and measles. The effect on the Indigenous population was disastrous, resulting in the death of thousands. Aboriginal Health The British North American Act (1867) and the India Act (1876) set the stage for the assimilation of Indigenous people, applying numerous restrictions to their practices and way of life. The inability of Indigenous healers to successfully treat the newly introduced diseases allowed non-Indigenous people to discredit traditional healing ceremonies and the legitimacy of traditional healers. Subsequent amendments to the Indian Act legally banned most Indigenous spiritual and health related rituals, ceremonies, and practices until the 1950s and beyond. Concept of Public Health is Introduced & Role of Volunteer Organizations  Upper and Lower Canada (now Ontario  In the eighteenth and early and Quebec) each established a board of nineteenth centuries, Canadians’ health, in 1832 and 1833, respectively. health care needs were met by  The remaining provinces followed suit in volunteer organizations, such as the early 1900s.  The Order of St. John (later known as These boards of health St. John Ambulance)  Enforced quarantine and sanitation  The Canadian Red Cross Society laws  Victorian Order of Nurses (VON)  Imposed restrictions on immigration (to  Children’s Aid Society prevent the spread of disease)  Stopped the sale of spoiled food  Maternal and child health care became a focus of public health initiatives at the beginning of the twentieth century  Development of Hospitals in Canada In the early 1900s, Canada’s first tuberculosis hospital, the Hôtel- Many early hospitals sanitariums and Dieu de Quebec, were charitable institutions to care was established in institutions. for mentally ill Quebec City in people were 1639. established.  In 1940, the provincial and federal governments In 1919, a publicly funded amended the British health care system North America Act and formed part of a Liberal introduced a national election campaign but unemployment insurance was not successfully program. implemented. 1935 1944 Introductio 1919 1940 n of Health Insurance In 1935, the Conservative In 1944, the federal government pledged to government introduced address social issues the “baby bonus.” such as minimum wage, unemployment, and public health insurance. Post World War II: Political Landscape  Canadians wanted the security and equity of a publicly funded health care system. Canadians, particularly the middle class, had felt the impact of not having access to appropriate health care. The rich could afford proper care; the poor could turn to charities. The expanding middle class was caught in between.  Medical discoveries were advancing treatment, care, and diagnostic capabilities.  There was a shift to hospital-based care.  In 1948, the federal government set up a number of grants to fund the development of health care services in partnership with the provinces.  In 1952, these grants were supplemented by a national old age security program.  In 1954, the federal government began providing support for adults who were disabled as unable to work. Progress Toward Prepaid Hospital Care  In 1957, the federal government introduced the Hospital Insurance and Diagnostic Services Act, which provided federal dollars to provinces and territories willing to implement a comprehensive hospital insurance plan.  Some provinces and territories were not able to implement comprehensive services because of population distribution.  Through an equalization payment system, richer provinces would share revenue with poorer provinces to provide care for all.  The Hospital Insurance and Diagnostic Services Act  Provided residents with full care in an acute care hospital  Included care provided in outpatient clinics Making Medicare: The History of Health Care in Ca nada (youtube.com) Progress Toward Prepaid Medical Care Tommy Douglas, known as the father of medicare, was the premier of Saskatchewan from 1944 to 1961.  Douglas campaigned for an affordable comprehensive hospital and medical insurance plan.  The Saskatchewan Medical Care Insurance Act was passed in 1961.  Most other provinces and territories adopted similar plans over the next few years.  The federal government remained committed to a comprehensive health insurance program.  Significant events leading up to the Canada Health Act included:  The Hall Report (1960)  The Medical Care Act (1966)  The Established Programs and Financing (EPF) Act (1977) This Photo by Unknown Author is licensed under CC BY-NC-ND The Canada Health Act The Canada Health Act became law in 1984  The Act received royal assent in June 1985 and is still in place today  The Act governs and guides, and perhaps limits, our health care delivery system  The Act’s primary goal is to provide equal, prepaid, and accessible health care to eligible Canadians  Eligible Canadians are those who are lawful residents of a province or territory Criteria 1. Public administration 2. Comprehensive coverage 3. Universality 4. Portability 5. Accessibility Conditions 1. Information 2. Recognition Interpreting the Canada Health Act Canada Health Act - Canada.ca  The Canada Health Act does not detail which health services should be insured  Instead, the Act states that only those procedures and services that are judged to be medically necessary are covered by provincial and territorial insurance  Physicians, through their governing body, and government officials, usually from the Ministry or Department of Health, select which services are medically necessary  Lists of insured services are regularly reviewed and revised by the provinces and territories Three Major Reports on the Status of Health Care in Canada  The Mazankowski Report: A Framework for Reform (2001)  The Kirby Report: The Health of Canadians – The Federal Role (2002)  The Romanow Report: Building on Values: The Future of Health Care in Canada (2002) Box 1.10 – Thompson text  Stable and Strong – New Brunswick Health System Overview health-system-overview.pdf (gnb.ca) Break – 20 minutes Roles of Federal & Provincial/Territori al Governments in Health Care Health Health Canada is responsible for helping Canadians maintain Canada and improve their health. Objectives & Responsibiliti es It ensures that high-quality health services are accessible and works to reduce health risks. Works with the provinces and territories by managing funding and ensuring compliance with the Canada Health Act Provides health care Participates in coverage for Inuit and First Informs Canadians national campaigns Veterans and Inmates of federal Residents of remote members of the Nations about world health for health promotion military personnel penitentiaries and isolated areas Royal Canadian communities concerns and disease Mounted Police prevention Health Canada: Notable Branches & Agencies Branches Agencies  First Nations and Inuit Independent agencies that Health Branch report to the health  Opioid Response Team minister  Public Health Agency of  Health Products and Canada Food Branch  Canadian Institutes of Health Research Global Organizations Collaborating with Health Canada The World Health Organization (WHO) provides leadership in health matters on a global level. The organization:  Spearheads global research  Monitors and assesses health trends  Recommends policies and actions regarding population health initiatives  Gathers information and statistics on health matters at an international level The WHO recommends policies and actions regarding population health initiatives to countries around the world. It is also instrumental in gathering information and producing statistics on health matters at an international level and coordinating responses to global health threats. The WHO, like Canada and many other countries stresses the important role of social determinants of health in influencing an individual’s opportunity to live a healthy life, the risk factors for acquiring illnesses, and their impact on life expectancy. (8) Myths and realities about Canada's healthcare s ystem - YouTube   Within each provincial and territorial government there is a ministry or department of health that is assigned to managing health care.  The health ministries or departments oversee a variety of sub- divisions, branches, agencies, and programs that assume Provincial/Territorial responsibilities for various matters and types of health care. Ministries of Health  Ministries also work with other service partners in the community— some government-funded, others private or nonprofit, and others a combination of government and private initiatives. Does Canada have a national health insurance plan?  The answer is no.  Canada has universal health care implemented by thirteen single-payer insurance plans each administered and operated by a province (10) or territory (3)  These provincial and territorial health insurance programs are frequently referred to collectively as Medicare.  Although the federal government works in partnership with the provinces and territories to deliver health care, the provinces and territories maintain the bulk of the responsibility for its delivery.  The Constitution Act, 1982 replaced the British North America Act of 1867. (Box 3.1) The Constitution Act outlined the division of heath care responsibilties - provincial and territorial governments oversee matters relating to the personal health of their populations - the promotion of good health, preventive care, health maintenance, and the diagnosis and treatment of health problems. Universal healthcare To receive continued federal funding for health care, implementation however, provinces and territories must abide by the principles and conditions of the Canada Health Act (CHA), which obliges them to operate a health insurance plan that covers hospital care and medically necessary treatment for eligible residents. Provincial/Territorial Ministry of Health Within each provincial and territorial government there is a ministry or department of health that is assigned to managing health care. The health ministries or departments oversee a variety of sub-divisions, branches, agencies, and programs that assume responsibilities for various matters and types of health care. Ministries also work with other service partners in the community—some government-funded, others private or nonprofit, and others a combination of government and private initiatives.  In order to ensure clinical care is delivered uniformly, effectively and efficiently the Government of New Brunswick has transitioned to two Regional Health Authorities (RHAs) from the previous eight RHAs. The two new RHAs have a broad mandate to deliver health services within New Brunswick. New Each RHA has a Board of Directors appointed by the Brunswick Minister of this department. The chairs and other members of the boards are compensated. Regional Health Authorities 5169-MAP-no-highways-bigger names (gnb.ca)   Approximately 60% of Canadians carry private health insurance, provided either through group employment benefits, or purchased personally.  Insurance offsets the costs of services not covered by provincial and territorial health services.  Group employment benefits cover the employee and their Private families and or dependents for a selection of goods and services deemed not medically necessary, such as vision and Health dental care, physiotherapy, chiropractic visits, private nursing services, assistive devices, and enhanced medical services Insurance (e.g., semi-private hospital room).  Eligibility - All of the following criteria must be met for a person to be eligible for provincial or territorial health insurance:  Canadian citizenship or permanent resident  status; Resident of the province or territory in which he Public Health  or she is seeking health coverage Insurance Physically resides in that jurisdiction for at least 5 months of the year (this criterion varies slightly among jurisdictions, e.g. NFLD). Group Activity - Scavenger Hunt Drug Plans (gnb.ca) Medicare (gnb.ca)  Group 1 – What is the cost of an ambulance transfer to the hospital in case of emergency?  Group 2 - What is the cost of an ambulance transfer from one hospital to another?  Group 3 – What insured practitioner services are covered by Medicare?  Group 3 – Is an annual physical examination by a physician a service covered by Medicare?  Group 4 – Who is not eligible for NB Medicare?  Group 5 – What if your work takes you outside NB regularly are thereexemptions for contract or mobile workers?  Group 6 – If you are a student attending UNBSJ from another province what province is responsible for any medically necessary health care costs that you require while in NB? Your home province or NB?  Group 7 – What 3 services does NB Medicare cover if you require healthcare outside of Canada?  Group 8 – Are community pharmacy dispensing fees covered by Medicare?  Group 9 – If you are a NB resident and had to pay out of pocket for health care outside the province is there a way to be reimbursed for some of the costs?  Group 10 – Does a physician have the right to bill a patient directly if they do not have a valid Medicare card? Group Work