1 Canadian Healthcare Flashcards
what are the 5 principles the Canada Health Act enforces? how is it enforced?
UNIVERSALITY: all insured residents must have access to health services on uniform terms and conditions
COMPREHENSIVENESS: coverage of all medically necessary hospital and physician services
ACCESSIBILITY: ensuring reasonable access to health services without financial barriers
PORTABILITY: health coverage follows residents across provincial borders
ADMINISTRATION: health insurance plans must be managed by public agencies on a non-profit basis
** note: provinces and territories must follow these principles to receive federal funding (bc P/T maintain primary jurisdiction over healthcare delivery)
of the GDP dedicated towards health spending, what of it is for the public and private sectors? (what was spent on public insurance or private insurance/out-of-pocket payments?)
public sector: 70%
private sector: 30%
describe what the provincial/territorial health insurance plans cover? what does private insurance cover?
each insurance plan covers all medically necessary hospital and physician services
meaning, supplementary services are largely privately financed (out-of-pocket or private insurance)
—- e.g. vision/dental, outpatient prescription drugs, rehabilitation services, private hospital rooms
what proportion of Canadians have private insurance?
2/3
while, public insurance covers all Canadians
describe the coverage of provincial/territorial insurance plans
provincial/territorial insurance plans must provide first-dollar coverage of medically necessary physician/diagnostic/hospital services (including inpatient prescription drugs) for all eligible residents
all provincial/territorial governments also provide public health and prevention services (including immunization) as part of their public programs
no nationally defined statutory (“required by the law”) benefits package…
most public coverage decisions are made by provincial/territorial governments in conjunction with the medical profession
coverage varies across provincial/territorial insurance plans for services not federally mandated as medically necessary, including outpatient prescription drugs, mental health care, vision/dental care, home care, midwifery services, medical equipment, and hospice care
describe provincial/territorial coverage of prescription drugs
most provinces have public prescription drug coverage programs for specific populations
e.g. recipients of social assistance, seniors aged 65+, children/youth
some programs charge premiums, often income-related
to help cover needed prescriptions, provinces and territories provide outpatient drug plans to some individuals lacking private employer-sponsored insurance
most provincial/territorial outpatient drug plans operate as payers of last resort, targeting people on social assistance or of retirement age
provincial/territorial governments also provide some relief for people with high out-of-pocket expenses
describe the plans put in place to increase physicians
subsidized medical degree costs
most provinces have their own rural practice initiatives. e.g. Alberta’s rural, remove, northern program guarantees physicians an income greater than CAD 50,000
describe the role family physicians play in Canadian healthcare
family physicians act largely as gatekeepers, and many provinces pay lower fees to specialists for non-referred consultations. having family physicians as gatekeepers saves the province money. fewer patients see specialists unnecessarily; primary care is also less expensive
where do physicians mainly work?
most physicians are self-employed in private practices
in 2014, about 46% of general practitioners worked in a group practice, 19% in a professional practice,
15% in a solo practice
(solo practice is pricey for physicians).
terms of patient-practitioner relationship?
patients have free choice of a general practitioner; tho in practice, patients may not be accepted into a physician’s practice if the physician has a closed list
the requirements for patient registration vary considerably by province and territory, but no jurisdiction has implemented strict rostering (i.e. easy to switch your assigned physician)
what is the primary form of payment for physicians?
fee-for-service
there has been a movement towards alternative forms of payment, such as capitation
capitation: fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of healthcare services - could be potentially good or bad for physicians, time =/= work put in
how are specialists paid?
specialists are paid mostly on a fee-for-service basis because of complex services (variations across provinces)
specialists who bill provincial/territorial public insurance are not permitted to receive payment from privately insured patients for services that would be covered under public insurance
describe management of hospitals in Canada
mix of public and private (but predominantly not-for-profit) organizations. in most provinces and territories, many hospitals are publicly owned, whereas in Ontario they are predominantly private, not-for-profit corporations
often managed by delegated health authorities or hospital boards representing the community
hospital-based physicians generally are not hospital employees and are paid fee-for-service directly by the provincial ministries of health
describe mental health care coverage
physicians-provided mental health care is covered under Canadian Medicare (OHIP eligible), in addition to a fragmented system of allied services
hospital-based mental health care is provided in specialty psychiatric hospitals and in general hospitals with mental health beds
provincial/territorial governments all provide a range of community mental health and addiction services, including case management, help for families and caregivers, community-based crisis services, and supportive housing
describe long-term care coverage
long-term care and end-of-life care provided in nonhospital facilities and in the community are not considered insured services under the Canada Health Act
BUT
all provinces provide some residential care and some combination of case management and nursing care for home care clients, but there is considerable variation when it comes to other services, including medical equipment, supplies, and home support. Many jurisdictions require copayments
eligibility for home and residential long-term care services is generally determined via a needs assessment based on health status and functional impairment
the government funds personal and nursing care in residential long-term facilities.
financial supplements based on ability to pay can help support room-and-board costs
