Exam Flashcards
federal governments healthcare responsibilities
- Canada Health Act- deciding on principles
- Holding provincial/ territorial gov’ts accountable to following the principles for delivery (and adjusting $ based on this) (providing funding to provinces)
- Financial support for provincial delivery of health care
- Delivering direct health care services to veterans, First Nations and Inuit persons, persons living on reserves, military personnel, inmates of federal penitentiaries, and RCMP officers
- Shared role in health protection, disease prevention, health research, and health promotion
provincial/territorial healthcare responsibilities
- Delivering and managing insured health services (hospital and physician care) such as OHIP
- Evaluating physician and hospital care
- Planning, financing, and evaluating hospital and physician care
- Managing some public health and prescription care
challenges in healthcare
- Sustainability- $$$
- Currently reactionary and problem-based with heavy investment in acute care vs. health promotion and illness prevention (downstream vs. upstream)
- Not all Canadians have access to a primary care provider
- Aging population- living longer with chronic illness
access and equity for healthcare
- Geographic and contextual barriers to accessing health care, especially in rural areas
- Need to pay more attention to SDOH and needs of marginalized/ vulnerable populations
- Provision of social support systems for those affected by poverty and promoting access to basic needs is one way to sustain a health care system
- Primary health care focused on equity among populations with a progressive approach to distribution of comprehensive health care resources
- Immigrants face language and cultural barriers as well as lack of knowledge about how to navigate this complex healthcare system
policies
plans that guide actions (reflect values)
social policy
legal age for purchase of alcohol
public policy
smoking policies/ bi-laws
institutional/organizational policy
staffing ratios
health policies
formal and authoritative decisions centered around health; intended to influence actions (e.g. eligibility for services)
allocative policies
- Determine how priorities are set and how resources are allocated
- Distributive justice
- e.g. Ontario Drug Benefit Act; Canada Health Act
regulatory policies
- Designed to guide/ direct actions, behaviours, and decisions of individuals or groups
- e.g. Regulated Health Professions Act; Food and Drugs Act, controlled drug and substances act, canadian environmental protection act
health policy process
1) policy formulation - agenda setting, development of legislation
2) policy implementation - enactment of legislation; taking action; decision making related to implementation
3) policy modification - improvement of legislation, changes/adjustment as needed
lobbying
- advocacy and activism
- As the largest group of HCPs in Canada, nurses are highly representative of the Canadian public
- Nurses see the individual effects of public and social issues and may have ideas about strategies that can inform legislation protecting public interests
- Nurses have strong opinions about professional issues
- Nurses are morally and ethically sensitive advocates for patients and the public
micro level issues
- local level
- specific policy on your unit
mess level issues
- organizational level
- organizational (hospital wide) staff cuts
macro level issues
- population level
- lack of awareness in the population
-Structural determinants of health inequities
overview of todays health care economics
- We have a system with progressively higher standards regardless of cost.
- Heavy focus on technology and personal autonomy that ignores basic principles of social responsibility and distributive justice.
- Split between those who make spending decisions (patients, HCPs) and those who must actually pay for the decisions (government, insurance plans).
frivolous care
frivolous, wasteful, useless, ineffective, pointless
(eg. ICU life support for someone that has a very poor prognosis for recovery)
SES as a determinant of health
- Income is a significant contributor to health and, consequently, health inequalities
- Research indicates a significant difference in disease prevalence and in years of life lost between the highest and lowest income brackets
- Canadians have seen an overall increase in personal income due to decreases in unemployment and increases in basic wages; however, the poverty rate has not decreased proportionately. The gap between those with the highest and lowest incomes is widening
egalitarian
Equality
People who are similarly situated should be treated similarly
utilitarian
The greatest good for the greatest #
libertarian
Protect the rights of each person, allowing people to improve their circumstances on their own.
Privatized healthcare (commodity not a right)
communitarian
Community (vs. individual, country) at the centre of the value system
Value of the public good
health expenditure
1) hospital
2) physician
3) drugs
4) other institutions
5) other professionals
6) public health
10) public health
health care cost drivers
-High costs of new technologies and the push to use them in managing illness/ disease is driving up health care costs in acute care
-increase 3.9% total
-1% due to population growth
- 0.9% due to aging population
- 1.9% general inflation
recent economic trends and challenges
- the continued aging of the population will steadily increase future health spending
- Health care policy and decision-makers will be challenged to innovate in order to reform the way health care is provided
- Public drug programs limiting pricing for generic drugs, and expiring drug patents, have saved $; however, spending on specialized meds such as biologics and antivirals to treat hepatitis C have increased
- Physician spending has increased since 2005, due to an increase in the supply of physicians and the rise in physician fees
- Lack of accountability in the health care system
poverty & health
-Prevalence of poverty and homelessness continues in Canada.
-Poverty had decreased significantly in canada, but millions still live in poverty
-Poorer people are sicker than people with adequate financial resources.
-Psychological effects of poverty include helplessness and lack of control over one’s daily life.
- 20% of people in Ontario live in poverty
-1 in 7 Canadians live in poverty
-1 in 10 families in Canada experience food insecurity
-At least 35,000 people are homeless on a given night
-Over ⅓ of food bank users are 18 and under
-Lower income is associated with increased burden of diseases and higher mortality
according to WHO health institutions can deal with poverty, health, and equity in 5 ways
1) poor and marginalized are considered the priority population
2) upstream approaches
3) those with the least resources pay the least
4) promote access and ensure quality
5) monitoring, advocating and taking action to address the potential health equity and human rights
screening for poverty
-This tool encourages primary providers to
screen everyone; consider poverty as a risk factor; and intervene.
-20% of families in Ontario are living in poverty
homelessness
-At least 235,000 Canadians experience homelessness in a year
-35,000 Canadians are homeless on any given night
-Premature death is 8 to 10 times higher among people who are homeless
-Precarious housing - unaffordable, substandard amenities, poor construction, overcrowding, health hazards, hygiene risks
Relative homelessness- living in sub-standard housing
-Hidden/concealed homelessness- living in a car, with friends and family, moving often
-Absolute homelessness- living on the street or in shelters
health inequity
-Significant interface of poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism
-Poverty underpins homelessness
-Women experiencing intimate-partner violence move frequently and often deal with homelessness and poverty
-Poverty and homelessness are linked to a higher rate of intimate partner violence and other abuse
-The elderly may experience homelessness as they face mounting health/ medication costs + living costs on a fixed income
-28-34% of the shelter population is indigenous; 24.4% of shelter users are older adults and seniors
The WHO Commission on the SDOH: Recommendations
1) Improve daily living conditions
-Emphasis on early child development, education, living/ working conditions and social policy
2) Tackle the inequitable distribution of power, money, and resources
-Strong governance valuing collective action
3) Measure and understand the problem and assess the impact of action
-Acknowledge there is a problem, measure and monitor health inequity at the national and international level, and evaluate the health equity impact of policy and action
racism
Minority groups are more likely to be intertwined with poverty, homelessness, intimate-partner violence, an increasing elderly population, and racism.
workplace ethics
Employee relationships
Accounting practices
How to treat suppliers
Reporting of misconduct
bioethics
Case consultation
Ethics education
Policy development
Research on ethical issues
what do bioethicist’s do?
Consultation
Education
Policy review & development
Research
common bioethics issues
1) Consent, capacity, SDM
2) transition/discharge
3) Withholding or withdrawal of treatment
4) Living at risk
5) Disclosure
codes of ethics
Outlines what you should do or should not do
Minimum set of rules & obligations
Established by a regulating body (eg. CNO)
ethical theories
Frameworks that help support and navigate ethical decision making
Ethics decision making tools are often informed by different theories
Tool for Decision Making - IDEA
I - Identify the facts
D - determine the ethical principles in conflict
E - explore the options
A - act on your decision and evaluate
gender
-socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. Society is moving toward acceptance of gender as a more fluid and diverse concept.
-Examples of gender characteristics: in most countries women earn less $ than men for similar work
sex
-the different biological and physiological characteristics of males and females, such as reproductive organs, chromosomes, hormones, etc
-Aspects of sex will not vary substantially between societies, while aspects of gender may vary greatly.
gender equity in health
-Refers to a process of being fair to women and men with the objective of reducing unjust and avoidable inequality between women and men in health status, access to health services and their contributions to the health workforce
-Women and men have equal conditions to realize their full rights and potential to be healthy, contribute to health development and benefit from the results. Achieving gender equality will require specific measures designed to support groups of people with limited access to such goods and resources
gender/sex culture and history
-Legalization of same-sex marriage in Canada in 2005 through the passing of the Civil Marriage Act
-Legalization of same-sex marriage (and the related resistance/ controversy) shows there is still discrimination against lesbians and gay men
How can issues related to gender or culture manifest in professional relationships?
-Employment equity, employment opportunities, sexual harassment, role strain
gender in nursing
-The feminization of nursing and women’s work, alongside the social construction of gender, has contributed to the real and perceived lack of power of nurses relative to physicians (a historically “masculine” profession)
-Gender is an important part of the position of nurses relative to other HCP, in particular physicians
-Many would argue this, citing evidence of the increasing numbers of females in medical school and males in nursing school; however, societal views of these two professions remain entrenched in images of the female nurse and male physician
gender - societal expectations in nursing
-As nursing continues to be a predominately female profession, social issues that have affected women have also been reflected in nursing, including:
-Lack of women in positions of power.
-A history of oppression.
-Biomedical curative model of health care.
-Lower salaries then other comparable professions.
-However medicine is predominantly male
men in nursing
-7% male vs 4.6% in 2008 (growing)
-Attrition from nursing school (50% vs. 20% for females) and job dissatisfaction are higher for nurses who are male
-Some areas of nursing have more male nurses than others: mental health, ICU, OR, ER
sexism in nursing
-Sexism is the assumption that members of one sex are superior to those of the other
-Sexism may manifest itself in power struggles for equal pay, access to opportunities, or recognition
-The text refers to a study conducted in 1995 (note this is >20 years ago…) which found physicians view male nurses as being more competent and value their opinions above those of female nurses
