CHS 1,2 PPT Flashcards
Canada’s Health Care System
Considered highly esteemed worldwide.
Regarded as a cherished social program among Canadians.
Evolved significantly since its beginnings in 1867.
Health vs. Health Care
Health: The state of overall well-being.
Health Care: Specific medical services offered.
British North America (BNA) Act
Created Canada in 1867, establishing two levels of government.
Does not explicitly include “healthcare” as a legislative power.
Interpreted flexibly by the Supreme Court concerning health matters.
BNA Act Powers on Health
Federal Government: Marine hospitals, Aboriginal populations, quarantines.
Provinces: Hospitals, asylums, charities, and related responsibilities by default.
Federal vs. Provincial Responsibilities
Federal government responsible for specific groups (Aboriginal communities, RCMP, etc.).
Provinces responsible for delivering health care to the majority of Canadians.
Evolution of Health Canada
1919: Federal Department of Health established.
1928: Renamed Department of Pensions and National Health.
1944: Renamed Department of National Health and Welfare, expanded federal responsibilities (food and drug control, public health programs, civil service health care, Laboratory of Hygiene).
1993: Renamed Health Canada.
Origins of Medical Care in Canada
1825: First medical school in Montreal.
Before 1867: Limited organized health care; wealthy afforded care, poor relied on religious/charitable aid or family/friends.
Post-Confederation: Medical and hospital care becoming more accessible.
Canadian Medical Association & Dentistry
1867: Creation of Canadian Medical Association.
Late 1800s: Few dentists in Canada; significant dental issues among schoolchildren.
Mental Health Services
Pre-Confederation: Mentally ill individuals either kept at home or treated brutally.
Post-Confederation: Advocacy for improved mental health facilities by Canadian National Committee for Mental Hygiene.
1950s: Discovery of drugs aiding in controlling mental patients’ behavior, leading to community reintegration.
Aboriginal Medicine and the Shaman
Shamans or Medicine Men: Aboriginal healers with a strong connection to the spirit world and nature.
Remedy Practices: Utilized local plants, herbs, roots, and fungi for treating illnesses, some of which persist in modern medicinal practices.
Integration into Western Medicine: Traditional Aboriginal medicines incorporated into contemporary Western medicine.
Introduction of Public Health
1832-1833: Upper and Lower Canada established boards of health; other provinces followed in the early 1900s.
Responsibilities: Enforced quarantine, sanitation laws, immigration restrictions, and prevented the sale of spoiled food.
Focus on Maternal and Child Health: Emerged as a significant aspect of public health initiatives in the early 20th century.
Role of Volunteer Organizations in Healthcare
18th-19th Centuries: Volunteer organizations fulfilled healthcare needs in Canada.
Organizations Include: Order of St. John (St. John Ambulance), Canadian Red Cross Society, Victorian Order of Nurses (VON), YMCA, YWCA, Children’s Aid Society (now Children’s Aid Foundation), Canadian National Institute for the Blind (CNIB).
Public Health Initiatives:
Controlling Infectious Disease
Travel Safety Measures
Reducing Chronic Diseases
Safer and Healthier Foods
Vaccination Programs
Motor Vehicle Safety
Maternal and Child Health (Healthier Mothers and Babies)
Water Fluoridation
Family Planning Services
Promoting Safer Workplaces
Decreasing Tobacco Use
Addressing Social Determinants of Health
Contributing to Universal Policies
Overall Focus
Role of Nurses in Early Healthcare
Early 1600s: Hôtel-Dieu Hospital in Quebec initiated the first structured training for North American nurses.
1873: Mack’s General and Marine Hospital in St. Catharines, ON, established the first nursing school.
1881: Toronto General Hospital began a nursing school, followed by most major hospitals.
Formalization of Nursing Organizations and Education
1908: Canadian National Association of Trained Nurses became Canada’s first formal nursing organization.
1919: University of BC introduced the first degree program for nurses.
Early 1970s: Transition of nursing education from hospitals to colleges and universities.
Development of Hospitals in Canada
1639: Hôtel-Dieu Hospital in Quebec City became Canada’s first hospital.
Early Hospitals: Primarily charitable institutions.
Late 1800s: Ontario enacted an act providing grants to hospitals, forming the basis for current provincial government funding.
Early 1900s: Establishment of tuberculosis sanitariums and institutions for the mentally ill.
Hospital Growth and Healthcare Expenses
Hospital Growth: Increased with government grants and medical advancements.
Patient Expenses: Physician and hospital services remained out-of-pocket for many.
Charitable Assistance: Reliance on charitable and religious organizations for those unable to afford care continued.
First Attempts at National Health Insurance
1919: A publicly funded healthcare system was part of a Liberal election campaign but wasn’t implemented successfully.
Government Actions Towards Social Issues
1935: Conservative government pledged to address social issues like minimum wage, unemployment, and public health insurance.
Initiation of Federal Programs
1940: Amendments to the British North America Act introduced a national unemployment insurance program.
1944: Introduction of the “baby bonus” by the federal government.
National Health Grants and Initiatives
1948: Establishment of National Health Grants program, providing funds to provinces to modernize hospitals, train healthcare providers, and conduct research.
1952: Supplementing grants with a national old age security program.
1954: Federal support for disabled adults unable to work began.
Post-World War II Political Landscape
Desire for Publicly Funded Healthcare: Canadians sought security and equity through a publicly funded healthcare system.
Medical Advancements: Ongoing discoveries enhanced treatment, care, and diagnostic capabilities.
Shift to Hospital-Based Care: A notable shift occurred towards hospital-based care for medical services.
Progress Toward Prepaid Hospital Care - Federal Act
1957 Federal Act: Hospital Insurance & Diagnostic Services Act.
50/50 Cost Sharing: Offered to provinces for implementing comprehensive hospital insurance plans.
Equalization Payment System: Wealthier provinces assisted financially poorer ones for equitable care.
Scope of the Act: Provided full care in acute care hospitals, including outpatient clinics.
Challenges and Impacts of Hospital Care
Limited Coverage for Allied Health Workers: Provincial insurance plans covered certain services only if provided in hospitals.
Hospital Admission Increase: Led to a significant rise in hospital admissions, whether warranted or not.
Dramatic Spending Increase: Hospital service expenditures soared as a result.
Progress Toward Prepaid Medical Care - Saskatchewan’s Initiative
Saskatchewan’s Medicare: Tommy Douglas, premier of Saskatchewan, advocated for comprehensive, non-discriminatory hospital and medical insurance.
Tommy Douglas’s Vision: Strived for an affordable healthcare system regardless of income, disabilities, or health conditions.
Quote from Tommy Douglas
“Courage my friends; ‘tis not too late to build a better world” - Tommy Douglas
Progress Toward Prepaid Medical Care in Saskatchewan
1939: Saskatchewan enacts the Municipal and Medical Hospital Services Act, allowing municipalities to tax for financing hospital and medical services.
1947: Saskatchewan passes the Hospital Insurance Act, ensuring residents hospital care for a modest premium.
1960: Proposal for publicly funded medical care by Tommy Douglas sparks concerns among SK doctors about provincial control.
1962: Saskatchewan Medical Care Insurance Act takes effect, offering doctors the option to opt out; by 1965, most doctors were part of the plan.
The Hall Report and Medical Care Act
The Hall Report (1960): Initiated by the federal government and led by Justice Emmett Hall, supported a national medicare program and advocated for increased numbers of doctors to meet population needs.
Medical Care Act (1966): Implemented on July 1, 1968, involved 50/50 cost sharing for provincial/territorial medical insurance plans.
Criteria for Funding: Provincial plans had to meet criteria such as universality, portability, comprehensive coverage, public administration, and accessibility.
Scope: Initially covered in-hospital care and physician services.
Impact of the Medical Care Act
Restructuring and Recognition: Signaled the need for community-based care and restructuring of funding formulas due to rising physician and hospital costs.
Creation of the Canada Health Act
Factors Prompting the Act: The Hall Report and the Parliamentary Task Force on Federal-Provincial Arrangements spurred the creation of the Canada Health Act.
Replaced Acts: Replaced the Hospital Insurance and Diagnostic Services Act and the Medical Care Act.
Canada Health Act (1984)
Enactment: Became law in 1984, serving as the foundation of the current healthcare system in Canada.
Lesson Summary - Evolution of Canadian Healthcare
Formal Start: The formal Canadian healthcare system began with the British North America Act (BNA Act).
Federal-Provincial Assignments: The BNA Act allocated federal and provincial responsibilities in healthcare.
Hospital Insurance Initiation: Started with the Hospital Insurance and Diagnostic Services Act.
Saskatchewan’s Role: Saskatchewan led the way in publicly funded medical care.
Medical Care Act 1966: Passed following the Hall Report.
Established Programs Financing Act: Came after the Medical Care Act, leading to the Canada Health Act.
Canada Health Act - Overview
Enactment: Became law in 1984 and received royal assent in June 1985.
Current Status: Still in effect and guides the healthcare delivery system in Canada.
Primary Goal of the Canada Health Act
Objective: Aims to provide equal, prepaid, and accessible healthcare to eligible Canadians.
Eligibility Criteria
Residency Definition: Defines a resident as a person lawfully entitled to be or remain in Canada, making their home and ordinarily present in the province. Excludes tourists, transients, or visitors.
Minimum Residence: Each jurisdiction determines its own minimum residence requirements.
criteria and conditions of the Canada Health Act
Criteria: Public administration
Comprehensive coverage
Universality
Portability
Accessibility
conditions:Information
Recognition
public administration
All administration of provincial health insurance must be carried out by a public authority on a non profit basis
comprehensiveness
All necessary health services, include hospitals, physcians and surgical dentists, must be insured
universality
All insured residents are entitled to the same level of health care
portability
A resident that moves to a different province or territory is still entitled to coverage from their home province
accessibility
All insured persons have reasonable access to healthcare facilities
Public Administration in Health Insurance Plans
Managed by Public Authority: Health insurance plans must be overseen by a public authority accountable to the provincial or territorial government.
Non-Profit & Publicly Audited: The management should operate on a non-profit basis and be subjected to public audits.
Distribution of Services
Regional Health Authorities or Equivalent: Services can be distributed through regional health authorities or similar structures.
Comprehensive Coverage - Eligible Services
Prepaid Services: Eligible individuals with medical needs are entitled to prepaid services provided by physicians, hospitals, and select dental surgeons in hospital settings.
Accessibility and Service Availability
Equal Availability: Services must be equally accessible to all residents without barriers to access.
Customized Service Selection: Each jurisdiction can choose specific services included in their plan, which may encompass home care, chiropractic care, specific eye care conditions, and pharmacare for certain populations.
Universal Offering: Selected services must be available to every eligible resident.
Universality - Entitlement to Services
Equal Entitlement: All eligible residents are entitled to insured health services under provincial or territorial plans on uniform terms.
Subsidization Based on Ability to Pay: Health premiums, if applicable, must be subsidized based on the individual’s ability to pay.
Equal Entitlement for All: Regardless of age, religion, health status, or race, every person is entitled to the same health services.
Portability - Coverage Across Provinces
Inter-Provincial Moves: Residents moving between provinces are covered during any waiting period by their former province.
Maximum Waiting Period: Waiting periods cannot exceed three months.
Coverage for Canadians Abroad: Canadians leaving the country are insured for a specific timeframe, depending on their jurisdiction.
Restriction on Elective Interventions: Canadians cannot seek elective interventions in another province or territory without prior approval in certain cases, such as service unavailability at home.
Accessibility - Reasonable Access to Services
Uniform Access: Eligible persons should have reasonable access to all insured services under uniform terms and conditions.
Location Access: Access is provided in the closest location where services are available, whether within the province, another city, or even in the U.S.
Factors Affecting Availability: Availability might be impacted by remoteness (e.g., Yukon), shortage of beds, or lack of healthcare providers.
Wait Time Considerations: If a province’s established maximum wait times for treatment exceed a set limit, the person is insured in another location with a shorter wait time.
Access vs. Availability: Access applies to where and when services are available but doesn’t guarantee equality in their availability.
Conditions for Provincial and Territorial Governments
Information Provision: Provincial and territorial governments are obligated to provide the federal government with information about the insured health services offered within their jurisdiction.
Recognition of Federal Contributions: They are also required to publicly recognize the financial contributions made by the federal government towards insured health services.
Definition of “Medically Necessary”
No Detailed Specifications: The Canada Health Act doesn’t specify insured services but uses the term “medically necessary.”
Subjective Clinical Judgment: “Medically necessary” is a subjective clinical judgment made by physicians. It typically involves services necessary to maintain, restore, or palliate health.
Determination Process: Physician governing bodies and governments collaborate to define what constitutes “medically necessary” and thus insured services, subject to periodic changes based on the standard of care.
Specifically Outlined Insured Services: The Act lists extended health care services considered medically necessary and insured, including intermediate nursing home care, adult residential care, some components of home care services, and services in ambulatory care centers.
Provincial/Territorial Discretion: Each province/territory determines additional insured services beyond medically necessary ones, and these decisions can be periodically amended.
User Charges and Extra Billing
Prohibited by the Canada Health Act: The Act prohibits user charges and extra billing, deeming them as barriers to care.
Financial Penalties for Jurisdictions: If jurisdictions allow such fees (as a deterrent for service misuse), the federal government deducts the collected amounts from the subsequent transfer of funds.
Exceptions for Non-Medically Necessary Services: Extra billing might be permitted by provincial/territorial plans for services not classified as medically necessary, where a portion might be paid by the plan.
Resistance and Reactions
Primary Resistance: Most resistance came from physicians and directly affected individuals due to imposed restrictions.
Ontario Doctors’ Strike (1986): A 25-day strike primarily centered around the issue of professional freedom.
Opposition from Medical Association: The Canadian Medical Association opposed the Act’s implementation.
Phase-Out of Extra Billing: Existing extra billing practices were to be rescinded within three years or face jurisdictional penalties, although some practices persist today.
Challenges Faced by the Healthcare System: Functioning within allocated budgets became increasingly challenging. Provinces requested extra funds as federal funding decreased, leading to hospital restructuring, downsizing, layoffs, service cuts, and closures.
Adapting Measures
Innovative Strategies: The system adapted through innovative and alternative healthcare strategies to cope with challenges.
Priority on Home Care: Across the country, home care became a priority in healthcare delivery.
Introduction of Health Care Teams: Emergence of collaborative health care teams for comprehensive patient care.
Improving Primary Care Access: Efforts were made to enhance access to primary care services amidst system challenges.
Medical Model of Health Care
Physician based
Illness-focused
Hospital-based care
Curative
Problems isolated
Health care provider dominated
Primary Health Care Reform Goals
Team-oriented care
Emphasis on overall health
Community-based care
Focus on health promotion and disease prevention
Comprehensive/integrated care
Collaboration with patient, family and loved ones
Social Union Formation
1997: First ministers convened, seeking an increase in federal funding.
1999 Agreement: Agreement reached on proposal for increased provincial and territorial spending flexibility, limiting federal authority over social policy jurisdiction.
Goals of Social Union
Clarification of Federal Funding Role: Define the federal government’s funding role and commitment.
Collaborative Improvement: Collaboration to enhance health care and social programs for Canadians.
Maintenance of Canada Health Act Criteria: Commitment to maintain the five criteria outlined in the Canada Health Act.
Information and Innovation Sharing: Sharing of information and innovations among stakeholders.
Transparency: Commitment to keep Canadians informed.
Collaboration with Aboriginals, Governments, and Organizations: Working collaboratively with Aboriginal groups, governments, and organizations.
Federal Spending Commitment: Federal government committed to increasing health care spending over a five-year period.
Romanow Report (2002)
$10 Billion Federal Spending: Earmarked over a decade to address identified issues.
Canada Health Transfer (CHT) and Canada Social Transfer (CST): Replaced the Canada Health and Social Transfer (CHST).
Continued Health Promotion Campaigns: Undertaken by all levels of government.
Implementation of Wait Time Limits: Enforced across the country.
Funding for IT and EHRs: Made available in all jurisdictions.
Catastrophic Drug Plans: Established in most jurisdictions.
Meetings & Accords
2000 First Ministers’ Meeting: Identified issues and commitments.
2003 First Ministers’ Accord on Health Care Renewal: Preservation of universal health care, outlining care standards, Health Reform Fund creation.
Recommendation for Compassionate Care Provisions (Implemented in 2012): Benefits through EI program, job protection through Canada Labour Code.
2004 First Ministers’ Meeting on the Future of Health Care: $41M federal funding over ten years, establishment of the Health Council of Canada, Aboriginal Health Transition Fund.
2005 Annual Conference of Ministers of Health: Consideration of catastrophic drug coverage, discussion on standardizing drug costs, pledged improvement in drug company relationships.
2006 Kelowna Accord: Federal allocation of $5B over five years for Aboriginal health, housing, education; promises unmet due to federal government change.
2007 Mental Health Commission of Canada (MHCC): Established to identify mental health issues and recommend improvements, funded by Health Canada.
2014 Health Accord: Unilaterally created by the federal government, adjusted CHT transfers on an equal per capita basis.
2017 Renewed Health Accord: Negotiated separately by provinces, requiring a percentage spending on home care and mental health services.
summary Canada Health Act (1984)
Established Criteria: Laid foundation for collaborative health care funding.
Primary Goal: Provide equal, prepaid, and accessible health care to eligible Canadians.
Federal Responsibility: Concerned with funding and ensuring compliance with the Act.
Provincial/Territorial Responsibility: Administration of health insurance plans and service delivery to eligible residents.
“Medically Necessary” Coverage: Act aims to cover services deemed medically necessary.
Role of Social Union and Agreements
Social Union Creation: Followed by agreements shaping funding provisions.
Collaborative Approach: Act and subsequent agreements continue to influence Canadian health care.
Current Relevance: Despite changes and reforms, the Act remains integral to health care in Canada.
