Chap 6 Health Care Flashcards
Health care / comprehensiveness
It must cover all health services provided by hospitals, physicians or dentists and additional services where the law permits it
Health care / 5 criteria provinces and territories must meet under the Canada health act
1) public administration
2) comprehensiveness
3) universality
4) portability
5) accessibility
Health care / universality
All provinces or territory’s residents must be covered by the plan
Health care / accessibility
The same service must be provided for all residents in all provinces or territories
Health care / 2 services prescribed by the health act
1) extended heath care service
2) insured health service
Canada Health Act/ 4 extended heath care services
1) nursing home intermediate care service
2) adult residential care service
3) home care service
4) ambulatory health care service
Canada Health Act/ insured health service
This means hospital service, physician service and surgical dental services provided to insured persons, but does not include any health services under any other act of parliament and provincial workers’ compensation
Canada Heath Act /3 prohibitions
1) extra billing
2) user charge/fee
3) any service provided by a provincial plan may be not provided by a private clinic for a fee
Canada Health Act/ excluded coverage
1) Uninsured hospital service (private room, telephone and television)
2) uninsured physician service ( telephone advice, medical certificate, court testimony, cosmetics service, tattoo removal)
Canada Health Act / 4 people not covered
1) member of Canadian forces
2) royal Canadian mounted police
3) prisoners
4) persons who have not completed s min period of residence in Canada
Alternative medical practitioners partially covered by some provinces and territories
Chiropractors, podiatrists, osteopath, naturopaths, licensed massage therapists, acupuncturists, physiotherapist
opted out and non participating physicians
every jurisdictions allows physicians to operate outside the provincial and territorial health plan and bill their patients directly;
opted out doctors (definition)
bills the patient directly at the amount not exceeding the amount in the schedule of benefit and the patient is then reimburced
non participating doctors
bills the patient directly without regard to the limits of the schedule of benefits and the patient cannot be reimbursed
Health care : 5 priority areas
1) Cancer care
2) Cardiac treatment
3) diagnostic test
4) Joint replacement
5) Cataract surgeries
health care: 5 areas that need to be addressed
1) Wait time for children
2) Surge capacity
3) Health Human Resource
4) Gender based analysis
5) Cinderella diseases
Health care: surge capacity
ability to access unused capacity outside of the local region or province in case of an emergency
health care: Cinderella diseases
Diseases that were not recognized or prioritized in the 5 areas selected in the benchmarks
health care: 5 reasons for longer wait time
1) poorly organized services
2) shortage of healthcare workers
3) physicians not working in teams
4) cuts to hospital services
5) need for more long term and home care
American health care: medicare
universal health care for people over 65
American health care: medicaid
universal healthcare for low income people
2 types of supplementary health care plan
1) group plans provided by employers
2) private plans paid for by individuals
Group health plan
Offered by employer or associations. When premiums are only paid by employers, employees must pay extra for family coverage
Health care: cafeteria plan
each employee is allocated a certain number of points and chooses the coverage he or she will spend the points on
health care group plan coinsurance and deductible requirements
annual deductible between 35 and 50$ and there is no penalty for being under-insured since rates increase every year
Long term care insurance
can apply for it between 18 and 80. Once in place, it cover for life if you have cognitive impairment or can no longer perform 2 of the 6 activities of daily life
3 types of long term care insurance
1) Reimbursement policies
2) indemnity policy
3) income policy
