canadian health care system Flashcards
rosling
structural functionalism
-everything going well, no need to change
-progress happening, slowly
-focus on overall performance of a system/society as a whole rather than finer details
rosling- > go ing well
paulsen
marxism
-more tension and difference than what meets the eye
-there are major class and wealth divides
-things need to change
-focus on disparity between classes within nations
sin bad
British north america act of
1867
-health care the responsiblity of the provinces (not the federal government)
-each province had its own system
-no “universal health care”
consequences of no universal health care
-people paid hospitals/doctors directly
-many could not afford care
-major illness could reduce even the wealthy to poverty
canada medical act
1912
introduced by thomas roddick (parliament member/physician)
-aim of standardizing a qualification in medicine
-oversee the licensing of medical doctors
impacts of canada medical act
-set a standard for care and quality of physicians
-limiting # of doctors -> raised their income by creating an artificial scarcity
department of health
1919
first federal department of health established under PM Borden to address
1. quarantine (spread of infectious diseases)
2. food and drug standards and inspections
3. coordination of public health campaigns (STI, child welfare)
The Great Depression
1930s
lack of adequate nutrition and housing
increased rates of tuberculosis, pneumonia, influenza etc
-patients unable to pay medical bill
-> little cash in circulation
provincial health policy reform attempts
1930s
provincial governments initiate health policy reform
1930s Health Policy : Federal (National) level
1935 - PM bennett introduces “New Deal” system of social welfare (health insurance and employment insurance)
1937 - PM Mackenzie King - “New Deal” declared unconstitutional as they violate provincial/federal divison of jurisdiction
1940
arrival of Tommy Douglas
-father of universal health care
-70% budget to social services
-sask premier-> leader of federal new democratic party
-life changing health experience
-dream of universal health care
-reality in 1946 in sask -> opposed by physicians
saskatechewan medical care insurance act
(1961) Tommy Douglas
-increase health care facilities
-create universal access to hospitals
-creation of health services regions
-air ambulance for remote areas
-met with opposition
-vision not fully realized (financial berriers first step then illness prvention, health promotion, measures to address SDoH
1940s-1950s
Federal investments in Health care
1948 - national health grants program
-> feds cover 50% of costs for hospital construction
-> establish hospitals for primary place of medical treatment
1957 -hospital and diagnostic services act
-50-50 cost-sharing bw feds and P/Ts for hospital services
-mentally ill and care institutions not covered
medical care act
1966
implemented by the pearson liberal (federal) government
-modeled after sask health policy
-opposed by conservatives (too costly) and NDP (not comprehensive enough)
medical care act 4 criteria to get the payments
- universality
- comprehensiveness
- public administration
- portability
UCPP
established programs financing act
1977
-shift from cost-sharing to block funding with cap on amount
-change in ratio of funding (50/50 to 25% federal 75% provincial)
-more P/T decision power over how health care $ would be spent; BUT cap on cash transfers and shouldering a larger proportion of costs
growing concerns of established programs financing act
-provinces and territories strapped for cash
-growth in population -> expanded medical-hospital complexes -> increase in healthcare costs
-funding shortfalls -> extra billing + user fees
Ripple effects from EPFA (1977)
-equal access to health care as a right jeopardized again, threatening foundation of medicare
-fed commisson of health care convened in 1979, to evaluate if core principles of medical care act (1966) were being achieved
-recommended :
eliminate user fees and extra billing
change mechanisms for physicians fees
set national standard for portability, comprehensiveness, accessibility, public admin, universal coverage
canada health act *** major one need to know
1984
fed government will continue transfer payments to provinces as long as the provincial health insurance programs meet 5 funding criteria
Canada health act critera for federal $
universal - all eligible residents of a province or territory are equally entitled to all available health services that are insured under the respective health insurance plans
comprehensive coverage - ensures that eligible persons with a medical need have access to prepaid, medically necessary services provided by hospitals and physicians
accessible - ensures that eligible individuals in a province or territory have reasonable access to all insured health services on uniform terms and conditions
portable - protects all canadians moving from one province or territory to another by providing coverage for insured health services by their province of origin during the desginated waiting time in their new province
publicly administered - requires each provincial and territorial health insurance plan to be managed by a public authority on a non-profit basis
UCAPP
1980s - present
-not necessarily smooth -sailing afterwards
-role of neoliberalism
term used to signify the late-20th century political reappearance of 19th-century ideas associated with free-market capitalism after it fell into decline following the Second World War
-mid 1990s : fed cuts in transfer payments to the provinces
->ripple effect eg. alberta govt passed legislation that allowed private, for profit hospitals, feds didnt take effective measures to reverse this development
how public health care works
taxes-> medicare -> doctors
-most canadian health care delivered privately (clinics/doctors offices) but paid for publicly
-> financing health care vs. delivering health care
-non-insured individuals pay for care
those opposed private care say private health care…
-two tiered system
-does not adress doctor shortage + waitlists
-contravenes the 1984 health act
-decreased quality of care
-dismantle public system
-will take away already short - staffed
how much of health care delivery public in canada
about 70%
~30% from private sources (insurance and out of pocket)
-public spending (government pays) but private delivery (but user doesnt pas, government does)
-most hospitals publicy funded, operate under fixed budget
-
cambie surgery centre
billed both patients and the province
-legal if they are elective services and the doctor has opted out of the public health biling system
