CHS 1&2 Flashcards
1867 British North America Act
Formation of Confederation: Dominion of Canada
Consisted of Ontario, Quebec, New Brunswick, Nova Scotia
Act that formed Canada, 1867
Sir John A. Macdonald
First Prime Minister
Provincial representation in government
Macdonald: First PM, Provincial reps
Federal Government Structure
House of Commons & Senate
Same structure today
1871 Census
Dominion’s population: 3,689,257
Shift towards healthcare focus
Healthcare Responsibilities Division
Federal: Marine hospitals, Indigenous care, quarantine
Provincial: Hospitals, asylums, social welfare
Federal Health Management (1867-1919)
Department of Agriculture managed federal health
Early projects addressed STIs, child welfare
Department Name Changes
Became Department of Pensions and National Health (1928)
Later, Department of National Health and Welfare (1944)
Health Canada (1993)
Renamed from Department of National Health and Welfare
Continued federal health responsibility
Origins of Medical Care in Canada
First doctors: civilian and military from England, France
Initial care: home-based, then hospitals
Medical Care Accessibility
Wealthier settlers received medical attention initially
Others got care from religious, charitable groups, Indigenous remedies
Growth of Medical Facilities
Canada’s first medical school: Montreal, 1825
Confederation led to increased doctors, hospitals, accessible care
Healing Practices of Indigenous Canadians
Centuries-old health and healing ceremonies
Passed down orally, limited written resources
Indigenous Healing Practices
Rooted in holistic, spiritual beliefs
Integral relationship with nature
Roles of Indigenous Healers
Varied names: medicine men, shamans, midwives
Recognition of women as powerful healers
Precontact Era Health Practices
Active lifestyles, healthy diet
Illnesses attributed to spirits, imbalances
Use of Herbal Medicines
Knowledge passed through oral teachings
Ceremonies and plants used in treatments
Incorporation into Western Medicine
Traditional medicines in modern practices
Continuation of Spiritual Ceremonies
Sweat lodge, healing circle, smudging
Variances among Indigenous groups
Healing Circle and Medicine Wheel
Smoke’s positive impact on participants
Individual and group prayers in ceremonies
Healing circle as therapy-like session
Medicine wheel symbolizing holistic health
Contact with Outsiders
Early contacts: Russian, French, Spanish, British
Diseases brought by outsiders: smallpox, tuberculosis, etc.
Traditional practices ineffectiveness with new diseases
Impact of British North American Act (1867) and Indian Act (1876)
assimilation attempts
Discrediting traditional healers due to disease treatment failure
Legal bans on Indigenous rituals, ceremonies
Consequences of Assimilation Efforts
Ban on spiritual and health practices till the 1950s
Loss of cultural norms for Indigenous people
Suffering due to residential schools
Current Challenges in Indigenous Health
Western medicine replacing traditions
Insufficient healthcare in isolated communities
Unmet goals in Health Canada’s determinants of health
Return of Health Responsibility to Indigenous Communities
Movement to integrate traditional practices
Focus on key health conditions affecting Indigenous populations
Indigenous Healing Traditions
Long, rich history in North America
Practitioners linked to spirit world, Mother Earth
Balance and harmony teachings in remedies
Development of Hospitals in Canada
Canada’s first hospital: Hôtel-Dieu de Quebec (1639)
Early hospital funding reliance on charity
Ontario government’s act for hospital grants
Evolution of Hospital Care
Early focus: Infectious diseases, private care
Advancements: Anesthesia, aseptic techniques
Creation of tuberculosis sanitariums
Mental Health Institutions
Stigmatization of mental illness
Establishment of care institutions
Limited recovery or release for patients
Advancements and Payment in Healthcare
Increased hospitals, government grants
Out-of-pocket payments, limited insurance coverage
Access to Medical Care
Support from charitable, religious organizations
Government efforts for improved access and affordable fees
Segregated Indigenous Hospitals
Origin: Church-operated “Indian” hospitals
Post-WWII expansion by Department of Health and Welfare
Challenges in Indigenous Hospitals
Underfunded, inadequate facilities and staff
Initial focus: Segregation for tuberculosis treatment
Treatment Issues in Indigenous Hospitals
Forced admissions, Indian Act amendment
Mistreatment, experiments with TB treatments
Transition of Indian Hospitals
Shift to segregated general hospitals
Little regard for Indigenous healing or culture
Transition to Medicare and Facility Closure
Introduction of Medicare, closure of majority Indian hospitals
Example: Sioux Lookout MenoYaWin Health Centre
18th and Early 19th Century Healthcare
Volunteer organizations addressed healthcare needs
Little to no government or agency funding
Order of St. John
Introduced to Canada in 1883
Offers first aid, healthcare, community services
Canadian Red Cross Society
Founded in 1896
Early home care, public health initiatives
Blood collection, contaminated blood crisis
Canadian Blood Services
Established post-contaminated blood crisis
Responsibilities, educational courses, community support
Victorian Order of Nurses (VON)
Founded in 1897
Focus on healthcare for women, children in remote areas
Victorian Order of Nurses (VON)
National provider of home care and health services
Financial difficulties, service termination in several provinces
Continued operations in Ontario, Nova Scotia
Children’s Aid Society (CAS)
Founded in 1891, focused on child protection
Initial focus: Food, shelter for disadvantaged children
Transition to family preservation, adoption oversight
Introduction of Public Health Concepts
Sanitation-disease relationship by William Kelly
Establishment of health boards, quarantine laws
Public opposition to health measures, smallpox vaccine
Provinces’ formal public health organizations in early 1900s
Public Health Units Responsibilities
Pasteurizing milk, testing cows for tuberculosis
Managing tuberculosis sanatoriums, STI control
Focus on maternal and child health care
Early Role of Nursing in Healthcare
Nursing integral in Canadian healthcare pre-Confederation
Establishment of first structured nurse training programs
Proliferation of hospital-based nursing schools
Evolution from diploma to degree programs
Nursing Education Evolution
Canadian National Association of Trained Nurses (CNATN)
Transition from hospital-based to college, university education
Introduction of Nurse Practitioners (NPs)
Roles of RPNs, LPNs, and PSWs in healthcare
Nursing Specializations
Opportunities in pediatric nursing, cardiology, etc.
Educational programs for Registered Psychiatric Nurses (RPNs)
Incentives for Doctors in Sarnia, Saskatchewan
$1500 incentive to keep doctors from joining the army
Provincial act allowing tax collection for retaining physicians
Early Attempts at Publicly Funded Health Care
Liberals’ unsuccessful campaign for publicly funded healthcare in 1919
Public pressure for a more accessible healthcare system in the 1930s
R.B. Bennett’s Social Insurance Act
1935 proposal for social benefits, health insurance
Unconstitutional declaration by Supreme Court
Progress in Federal Oversight of Social Programs
Federal government’s gain in overseeing social programs
Introduction of national unemployment insurance in 1940
Introduction of Social Programs
Family allowances for children in 1944 (“the baby bonus”)
Impact on social programs and health insurance formalization
Post-World War II Shift in Thinking
Shift toward governments providing basic services
Middle class caught between rich and poor in healthcare access
Advancements in Medical Discoveries
Advancements leading to organized healthcare
Social movements advocating federal involvement
Government Initiatives in Healthcare
Federal grants for healthcare development in 1948
Introduction of national old-age security and allowances for disabled adults
Challenges in Implementing National Health Care
Struggles between federal government and provinces
Restrictions imposed on healthcare funds by the federal government
Introduction of Hospital Insurance Plans
1957 Hospital Insurance and Diagnostic Services Act
Federal assistance for provinces adopting insurance plans
Equalization Payment System
Aim to balance healthcare service provision between provinces
Coverage details and increase in hospital admissions
Tommy Douglas and Medicare
Douglas campaigned for affordable healthcare for all
Believed in government responsibility for social health insurance
Saskatchewan’s Initiatives
1939 Municipal and Medical Hospital Services Act
1947 Hospital Insurance Act offering care for a premium
Introduction of Medicare in Saskatchewan
Douglas’s push for comprehensive, publicly funded medical care
Passage of the Saskatchewan Medical Care Insurance Act in 1961
Challenges and Implementation of Medicare
Saskatchewan doctors’ opposition leading to a strike
Amendments to the Medical Care Insurance Act to repair relations with doctors
Expansion of Medicare Nationwide
Adoption of similar plans by other provinces and territories
Current remuneration methods for physicians
Federal Government’s Commitment to Health Insurance
The Hall Report, the Medical Care Act, and the Established Programs and Financing Act
Significant events leading to the Canada Health Act
Post-EPF Act Events
Provincial overspending led to healthcare cuts
Hospitals made cuts, laid off staff, and reduced services
Extra Billing and Tensions
Doctors started extra billing, breaching the Medical Care Act
Public opposition grew due to limited access to healthcare
Justice Emmett Hall’s Review
Review conducted in response to emerging issues
Recommendations highlighted the illegality of extra billing
Hall’s Recommendations
Suggested eliminating extra billing
Proposed options for doctors and patients under the Medical Care Act
National Health Standards and Council
Hall suggested national standards for healthcare
Recommended creating an independent National Health Council
Parliamentary Task Force Findings
Task force reviewed funding arrangements
Recommendations led to adjustments in equalization payments
Impact on Legislation
Reports led to the development of the Canada Health Act
Canada Health Act replaced previous healthcare legislation
Canada Health Act Establishment
Passed in 1984 under Prime Minister Trudeau
Received royal assent in June 1985
Primary Goal of the Act
Aims to provide equal, prepaid, and accessible healthcare
Guiding Canadian healthcare policy objectives
Criteria and Conditions
criteria-
Involves public administration, comprehensiveness, universality, portability, and accessibility
conditions-information and recognition
Public Administration
Requires health insurance plans to be managed by a public authority
Prohibits control by private enterprises for profit
Ensures accountability and public audits
Comprehensive Coverage
Provides prepaid, necessary medical services
Covers physicians, hospitals, select dental services
Aims for equal accessibility without barriers
Universality
Entitles all eligible residents to insured health services
May allow subsidies for low-income individuals
Aims to prevent discrimination in access
Portability
Canadians moving between provinces are covered by their province of origin during waiting periods.
Most provinces have a three-month waiting period before health insurance becomes active.
Waiting periods exist for newcomers and Canadians returning from abroad.
Each province has specific rules for absence duration while retaining health coverage.
Accessibility
Ensures reasonable access to insured health services on uniform terms.
Access to services may vary in remote or underserved areas.
People lacking local services must be granted access elsewhere.
Conditions in Canada Health Act
Information: Provinces must provide federal government health care info.
Recognition: Provincial governments must acknowledge federal contributions.
Interpreting Medically Necessary Services
“Medically necessary” subjectivity in health services.
Determination involves clinical judgment by health care providers.
Varied range of insured services across provinces/territories.
Services shouldn’t be for patient/physician convenience alone.
Additional Components of Canada Health Act
Extended health care services: Nursing home care, adult residential services, home care.
Optional services vary by province: Chiropody, massage therapy, dental care, etc.
Caps on coverage: Example - $200/month for physiotherapy.
After Canada Health Act: Post-Implementation
Resistance to the Act from physicians and affected groups.
Ontario physicians’ 25-day strike against Act.
Opposition by Canadian Medical Association.
Provinces had extra billing/user charges pre-Act.
Federal penalties for noncompliance; later offered reimbursement.
Ongoing defiance by some provinces; funding withheld.
Social Union (1997)
Collaboration for a social renewal program.
Equal recognition, fairness, dignity for Canadians.
Mobility, removal of residency-based barriers.
Monetary transfers to support social programs.
Commissioned Reports
Key reports: Mazankowski, Kirby, Romanow.
Impact of Romanow Report
Romanow Report’s impact on federal funding.
Creation of Canada Health Transfer (CHT) & Canada Social Transfer (CST).
National wait time limits posted online.
First Ministers’ Meeting, 2000
Identification of health care issues.
Promises for collaborative work.
Key concerns: health promotion, access, primary care, equipment, medication costs.
First Ministers’ Accord on Health Care Renewal, 2003
Commitment to universal health care.
Standards of care and access to services.
Health Reform Fund allocation.
Indigenous health care improvements.
First Ministers’ Meeting on the Future of Health Care, 2004
$41 billion federal commitment for health care.
Renewed commitment to Canada Health Act criteria.
Expanded responsibilities of the Health Council of Canada.
Establishment of the Aboriginal Health Transition Fund.
Annual Conference of Ministers of Health, 2005
Focus on catastrophic drug coverage.
Measures for standardizing drug prices.
Control over pharmaceutical industry relations.
Kelowna Accord, 2006
$5 billion federal commitment over 5 years.
Blueprint on Aboriginal Health for improved outcomes.
Unfulfilled promises due to the fall of the government.
The Mental Health Commission of Canada (MHCC), 2007
Addresses mental health issues, addictions, and homelessness.
Provides services for inmates, housing, healthcare, and families.
Focus on combating the opioid crisis and supporting addicts.
Releases annual progress reports and strategic frameworks.
2014 Health Accord
New formula for Canada Health Transfer (CHT) payments.
Transfer payments tied to GDP rate, not falling below 3%.
Allocation on equal per capita cash basis without spending restrictions.
Unilateral crafting by the federal government led to discord.
The 2017 Health Accord
Initiated discussions for a new Canadian Health Accord in late 2016.
Federal offer: 3.5% annual increase in Canada health transfers, $11.5 billion for mental health and home care.
Initially rejected offer: requested 5.2% annual increase, removal of spending conditions.
Provinces negotiated separately: Nova Scotia, New Brunswick, Newfoundland and Labrador.
Agreements made with other provinces: specific funding for home care, mental health, and opioid crisis.
Additional funding subject to terms of each agreement.
Other Initiatives
Provinces and territories promote healthcare initiatives within their jurisdictions.
Involvement of politicians, stakeholders, and residents in decision-making.
Examples: Saskatchewan’s Patient First Review, E-Patient and Family-Centred Care (PFCC) Framework.
Healthcare in Canada - Historical Overview
Arrival of European settlers in the 1500s and 1600s brought doctors and nurses.
Emergence of volunteer organizations in the 1700s for healthcare delivery.
Public health concept emerged in the early 1800s.
Federal and provincial governments shared health responsibilities post-1867.
Initial government funding for hospitals in the late 1800s.
First nursing school established in St. Catharine’s, Ontario in 1873.
Indigenous practices rooted in holistic beliefs.
Integration of traditional practices with Western medicine in modern Canada.
First federal attempt at publicly funded healthcare in 1919.
Prepaid hospital care introduced in 1948.
Hall Report, Medical Care Act, and Established Programs and Financing Act shaped the path to the Canada Health Act.
Canada Health Act established criteria and conditions for healthcare delivery in 1984.
Canada Health Act & Challenges
Canada Health Act criteria: public administration, comprehensive coverage, universality, portability, accessibility.
Act’s definition of “medically necessary” subject to debate.
Extra billing and user charges allowed only for non-medically necessary services.
Opposition from physicians and Canadian Medical Association.
Healthcare system encountered challenges post-implementation.
Commissioning of reports to address healthcare status.
Challenges faced after Canada Health Act implementation.
Opposition from medical professionals and subsequent difficulties.
Initiatives by provinces and territories for healthcare reforms.
Meetings leading to the creation of new health accords.
Impact of various health accords on funding and healthcare.
2003 healthcare renewal accord and its changes in healthcare policy.
Recent Health Accords
Paul Martin’s health accord ensured a 6% annual increase in federal transfers.
Harper government’s imposition of a reduced transfer rate in 2014.
Trudeau’s 2017 health accord maintained CHT formula with added funding for specific services.
Provinces initially rejected terms, leading to separate negotiations.
2003 accord’s impact on healthcare policies and the Health Council of Canada’s role.
Impact of different government health accords.
Changes in transfer rates and funding models.
The significance of specific health accords in modern healthcare.
The role of the Health Council of Canada in health outcome reporting.
Residential Schools Overview
Church-run boarding schools funded by the government.
Aimed to assimilate Indigenous children into Canadian society.
Opened in 1831 and closed in 1996.
Estimated 150,000 Indigenous children impacted.
Forced separation from families and communities.
Stripping of identities, language, and culture.
Various levels of abuse experienced.
Harsh conditions, inadequate nutrition, and neglect leading to deaths.
2007 Indian Residential Schools Settlement due to lobbying.
2008 formal apology from Prime Minister Harper.
Settlement included compensation and support programs.
Multimillion-dollar fund for compensation and recovery.
Creation of the Residential Schools Resolution Health Support Program.
Criticisms faced regarding fund usage and legal fees.
Newfoundland’s Cottage Hospital System
Developed in the 1930s.
Covered 1,500 scattered communities.
Included small hospitals and mobile care.
Innovatively addressed remote healthcare.
Hall Report & Medical Care Act
Issued in 1960, crucial to healthcare changes.
Medical Care Act passed in 1966 for national medicare.
Act shared costs based on criteria by Tommy Douglas.
Aimed to double physicians and transition to public plans.
Focus on new schools/hospitals & more physicians.
Proposed public insurance plans.
Implemented in 1968 with provinces’ acceptance.
Ensured criteria like universality, portability.
Initially covered hospital and physician care.
Sparked focus on community care and funding restructuring.
Established Programs Financing Act
Introduced in 1977.
Changed funding for healthcare and education.
Replaced 50/50 formula with block transfers.
Enabled funding of community-based services.
Canada Health Act: Eligibility and Objective
Eligibility for lawful residents.
Resident defined under specific criteria.
Objective: Protect, promote, and restore well-being.
Alternative Health Care Strategies
New Brunswick’s foresight and challenges.
“Hospital without walls” concept.
Establishment of the Extra-Mural Program.
Investigations in other provinces/territories.
The Mazankowski Report: A Framework for Reform (2001)
Commissioned by Alberta’s Ralph Klein.
Focus on preserving/enhancing quality health services.
Support for private health care.
Recommendations on delisting certain services.
Advocacy for electronic health records and cards.
Rejected tax-based revenue and higher premiums.
The Kirby Report: The Health of Canadians—The Federal Role (2002)
Led by Senator Michael J. Kirby.
Similarities to the Mazankowski Report.
Recognition of unsustainable healthcare funding.
Proposal for new taxes or income-based premiums.
Setting limits to wait times.
Government-funded assistance for medications.
Investment in IT and advanced medical equipment.
Initiatives to recruit and retain healthcare providers.
Dissemination of Mazankowski’s e-health initiative.
Kirby Report’s federal role in healthcare.
Proposal differences with Romanow Report.
Ontario’s adoption of health payment premiums.
Debate on income-based healthcare models.
Controversies around treatment outside Canada.
Impact on recruitment/training of healthcare workers.
Mixed reception compared to Romanow Report.
The Romanow Report - Building on Values: The Future of Health Care in Canada (2002)
Led by Roy Romanow, former premier of Saskatchewan.
Aims: Recommendations for Canada’s health care survival, emphasis on health promotion.
Gathered advice from Canadians through public forums.
Opposed health care privatization and new private initiatives.
Proposed the creation of the Health Council of Canada.
Proposed funding through government surplus or tax increase.
Suggested adding accountability to the Canada Health Act.
Recommendations: Extending coverage for various health services.
Proposed extending Employment Insurance benefits for caregivers.
Suggested coverage for catastrophic drug costs.
Recommended national body for drug price control and monitoring.
Proposed an independent agency for prescription drug review.
Advocated for centralized wait list monitoring without suggesting wait time limits.
