Chapter 6 Flashcards
A Brief History of Health-Care Policy in
Canada
Prior to the late 1940s, access to health care was based solely on one’s ability to pay.
* From 1880 to the 1950s, there were a variety of pre-payment health plans across Canada, sponsored by local governments, industries, and volunteer agencies.
* However, these voluntary plans did not cover all medical services and were available to only those who could pay the premiums.
* Provincial governments were slow to move toward universal health care and they only reacted under pressure from non-governmental groups
Thomas Clement (“Tommy”) Douglas (1904 – 1986) led the first social democratic government elected in Canada
(the CCF in Saskatchewan in 1944).
* He became the first leader of the newly formed New Democratic Party in 1961.
* CCF (Tommy Douglas) was committed to public social services and health care that would be available to all regardless of ability to pay
The Fight for Universal Health Care
The Marsh Report (1943) is a critical event in the history of social welfare.
* It detailed the need for comprehensive, universal social
programs, including health care.
* … “The most important single document in the history of the
Welfare State in Canada.”
* The report recommended that the country establish a
“social minimum,” a standard aimed at protecting the
disadvantaged through policies such as social insurance
and children’s allowance.
Ex) The Family Allowance began in 1945 as Canada’s first
universal welfare program. A family or child allowance is a
monthly government payment to families with children to help
cover the costs of child maintenance
Key Events Leading up to Canada’s Health-Care Model
SK was the centre of a struggle b/t the medical community and
the provincial government under the leadership of Tommy
Douglas.
The SK universal health care program was finally launched in 1962.
* The Hall Report of 1964 recommended a comprehensive health
service patterned on the Saskatchewan model.
* The Medical Care Act was passed in 1968.
* By 1972, all provinces and territories had extended their plans to
include physicians’ services, although physicians were permitted
to “opt out” and extra billing was permitted.
* The Canadian Health Act (1984) changed the funding structure,
prohibited opting out and extra billing, and further strengthened
the universal nature of the public health care system in Canada
The Romanow Report (2002)
Royal Commission on the Future of Health Care in Canada
(under the leadership of Roy Romanow).
* Its mandate was to engage Canadians in a national dialogue on the future of health care and to make recommendations to preserve the long-term
sustainability of Canada’s universally accessible, publicly funded health-care system
The Romanow Report has been the backdrop for the major
debates over health care in recent years. The report’s recommendations had three main themes:
(1)Strong leadership is needed to maintain medicare,
(2)The system should become efficient and
responsive, and
(3)Both short-term and long-term strategies are
needed to maintain universal health care
The Commission’s report also addressed
Aboriginal health, access to health care, and the
impact of globalization and applied research
Today, Canada’s healthcare system – commonly referred to as medicare – is funded by government insurance, and is
1) publicly delivered by hospitals and other healthcare
settings and
2) privately delivered mainly by physicians (who are
self-employed or employed by physician-owned
corporations)
The Five Principles of Medicare
Each Province Must Meet the Five Principles to receive
funding from the federal government
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Threats to Canada’s Public Health-Care System
Comprehensiveness: “All necessary health services, including hospitals, physicians, and surgical dentists, must be insured.”
* Some provinces try to reduce costs by reducing comprehensiveness because Canada Health Act states that the provinces should determine which services are “medically necessary.”
Contracting out:
* Governments are contracting out the management of some hospitals to private companies.
* Some services (e.g., catering laundry, and cleaning) have been contracted out to private, for-profit organizations.
Several trends indicate increased privatization in our system:
Universality: “All insurred residents are entitled to the same level of health care.”
* Ex 1) SK recently passed legislation that allows patents to pay privately for MRIs.
* Ex 2) Quebec introduced legislation that will allow physicians to bill for a range of “ancillary” products and services (e.g., eye drops, colonoscopies)
The Components of Well-Being
The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions we experience. These conditions are known as the social determinants of health (p. 184)
“A health care system—even the best health care system in the world—will be only one of the ingredients that determine whether your life will be
long or short, healthy or sick, full of fulfillment, or empty with despair.”
The Honourable Roy Romanow
Well-being Is Determined by Health and Social Services
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A Canadian Model of the Social Determinants of Health
Aboriginal status
Gender
Disability
Housing
Early life
Income and income distribution
Education
Race
Employment and working conditions
Social exclusion
Food insecurity
Social safety net
Health services
Unemployment and job security
As a result of the Indian Act, the federal government has
self-appointed jurisdiction over Indigenous peoples’ health care.
* The health status of some Indigenous peoples lags far behind that of other Canadians.
* Some communuities are healthy and thriving, but others face many
challenges, often stemming from the residual impacts of colonization.
The Residual Impacts of Colonization
The Health Gap
The Assembly of First Nations (AFN) points out that the health gap between First Nations people and the general population is widening.
* 62 percent of adult Canadians over the age of 15 reported their health as being excellent or very good.
* However, only 58 percent of Métis, 53 percent of First Nations people living off reserve, and 50 percent of Inuit adults identify their health as excellent or very good
The Advantageous Role of Community Health Centres
Social Determinant of Health!!
* Focus is on prevention, education, community
development, social action, and health promotion
* CHCs address four main determinants of health: living and
working conditions, available social support, individual
behaviour, and genetic makeup
* Social workers are central to the provision of both direct
care and community development in the CHC model of
health-care delivery
Medical Social Work Practice
Medical social work practice includes direct casework,
group work, discharge planning, family consultation, patient
advocacy, counselling for terminally ill patients, training of
other professionals, and policy and administration.
* Almost every hospital in Canada has social workers
employed in its departments, including emergency
services, oncology, pediatrics, surgery, intensive care,
rehabilitation, gerontology, and orthopedics
Interdisciplinary Team Work
In a hospital setting, the social worker
is often a member of an
interdisciplinary team that includes
members of other health professions,
such as general medicine, nursing,
nutrition, phsyiotherapy, occupational
therapy, and psychiatry.
* The role of social workers is
becoming more central in this holistic
approach to health and healing, which
addresses not only the physical
aspects of health, but also the social,
cultural, mental, and spiritual aspects.
Stories from the Field
- Hospital Discharge Planning
Social work practice with clients ending a hospital stay
* Sam’s Story… Adjusting to altered life circumstances - Community Health Care
Social work practice in community health care
* Kicho’s Story… Benefitting from a cancer support group - Hospice and Palliative Care
Social work practice with persons who are dying
* Sidney’s Story… Facing death with courage and dignity
Social Worker Profile: Marg Hancock
