Health Care in Canada Flashcards
Medicine in the 19th Century: Types of healthcare providers
- Today, when confronted with illness, we have a set of behaviours that we typically abide to
- However, in the 19th Century healthcare was provided within the private sphere
- Should an illness warrant other help, Canadians poorly respected and poorly paid health practitioners, including regular doctors and irregular practitioners
Medicine in the 19th Century: Regular Doctors
- Also known as Allopathic doctors
- Paved the way for contemporary doctors
- Treated illness with drugs selected to produce symptoms opposite to the illness symptoms
Medicine in the 19th Century: Irregular Practitioners
- Anything other than Allopathic
- Homeopathic doctors
- Eclectics
Medicine in the 19th Century: Homeopathic doctors
Treats illness with dilute solutions of drugs that if given at full strength, would produce similar symptoms to the illness; Aim is to stimulate the body’s natural healing process
Medicine in the 19th Century: Eclectic
Healers who used form of botanical medicine & relied on complex combos of concentrated plant extracts to treat illness; Relied on herbal remedies
Medicine in the 19th Century: Trust in allopathic doctors
- In the 19th C, the trust in allopathic doctors was no different than any other health pracitioner. The hierarchy of knowledge was not as strong in this period
- During this time, doctors in Canada were trained under apprenticeship lasting between 3 to 7 years. Apprentices should accompany doctors to assist in procedures such as teeth extraction, bleeding, dressing minor wounds, and how to pulverize bark and roots for certain ointments
Medicine in the 19th Century: First medical schools
- In 1823, Canada opened its first formal medical school in Montreal to later open a second school at King’s College in Toronto in 1842
- bith schools atarted private, but later become affiliated with universities to ensure students got accredited degrees
- Opposite ti Canada, the US medical schools were private and therefore, many of the schools were left uncertified, for-profit institutions
- During this time period training was minimal & almost all training was relayed in lectures, so by the time students graduated they had little to no practical experiences (including specialty doctors)
Medicine in the 19th Century: Knowledge for allopathic doctors
- Lacking
- Resulted in the reliance of clinical experiences with their patients or extrapolating from abstract and/or untested theories
- Heroic Medicine was common during the 19th Century
Medicine in the 19th Century: Heroic Medicine
Aggressive form of treatment that emphasized curing illnesses through bloodletting - which caused extreme vomiting and/or excessive laxatives and diuretics; in most cases, example of how body attempted to heal itself after immense trauma, which convinced doctors that they themselves cured the patient
Medical Dominance
By the late 19th century and the early 20th century, restrictions and curriculum changes were made in medical schools, including the tightening of entrance requirements, increases in academic standards, emphasis on research & the inclusion of clinical experience
Medical Dominance: The Flexner Report (1910)
- A report on the state of American and Canadian medical education
- Written by a high school teacher of the name Abraham Flexner and commission by the non-profit Carnegie Foundation
- Used to pass the Canadian Medical Act (1912)
Medical Dominance: 4 Main recommendations included in the Flexner Report
1) Abolishment of apprenticeship
2) Minimum two years of clinical experience
3) Accredited medical medical schools be affiliated with a university (eliminating private schools)
4) Formally link medical schools and hospitals
Medical Dominance: Medical dominance of allopathic doctors in the 20th C
Medical Dominance refers to hierarchical nature of the HC field and allows those in power to make decisions, gain legitimization and organize the institution
History of HC: Discussions about public HC
- Started in 1919 and continued to debate for several decades
- In the beginning, public HC threatened the newly established medical dominance
- Many medical professiobals were in opposition of govt health insurance, except during a brief period in the 1930s
- Free-market philosophies were embedded w/in the field, which rejected govt intervention; however, the British NA Act constructed health as a provincial responsibility
History of HC: Tommy Douglas
- In 1947 he introduced the Hospital Insurance Plan in SK, including an annual fee of $5 (capping off at $30 per household), for citizens to receive hospital-based services w/o cost
- Other provinces followed soon after
- Insurance & pharmaceutical companies became the biggest opposition
History of HC: Hospital Insurance and Diagnostic Services Act (HIDSA)
- Following suit, the federal minister of Health and Welfare launched the HIDSA in March 1957
- The bill proposed a joint funding arrangement between the federal and provincial govts to provide HC services
- It passed and became law in April of 1957, and over the next few years, hospital services were provided and funded by both the federal and provincial govts
History of HC: Five fundamental principles of medical insurance proposal (1959)
1) The plan must be offered to all citizens w/o concern for age, cost, race or physical disability
2) Funding fir program would be through prepayment programs
3) Program must be publicly administered
4) Must be commitment to high-quality Medical Care (included making necessary investments to technology, ppl & infrastructure)
5) Govt would not proceed w/o backing of HC providers & general public
History of HC: Medical Care Insurance Act
- Was introduced into legislation in 1961, w/o the support of HC providers (going against the 5th criteria); Although the bill included a fee-for-service compensation, which would pay doctors for each of their HC services that they provided, SK doctors still profusely opposed the bill and shut down their practices in summer of 1962 and garnered national and international media attention
- Worldwide media coverage condemned the strike
- Communities in SK rallied support with govt lead HC
- After 23 days of negotiations, doctors ended their strike & ensured several of their conditions were met; this included autonomy to make medical decisions
History of HC: Canadian Medical Association
At this time, was lobbying for the federal govt in hopes that they would stick with private HC services; the Liberal party did in fact win the federal election and Prime Minister Pearson gathered the provinces to discuss federal and provincially driven HC, with 2 provinces opposed: QC & AB
History of HC: New Proposal for Medical Care Act
In 1966, a new proposal was submitted for this act, with four key principles:
1) Provided universal HC
2) Publicly administered
3) Comprehensive coverage
4) Applicable to those moved out of province
History of HC: The Canadian Health Act
- Introduced in 1984 to replace the Medical Care Act, but also to address physicians charging additional fees to their patients
- Extra-billing was widespread across the country in clinics
- User-fees were also spreading, which was a fixed charge for those who used hospital care after the 61 days
History of HC: Two-tier HC system
- Those who can afford vs those who cannot
- Those who cannot afford additional costs were treated as inferior for their inability to pay, as it was associated with morality and based on individual responsibility
Evaluating HC Systems: Sociologists interests
- Interested in comparing HC systems both cross-nationally, but also globally; sociologists seek to examine relationships between health and economic politics, while also paying special attention to social powers
- Drawing contextual descriptions of successes & failures of varying Hc systems & illuminate health & illness distribution
- Drawing on impact of indiv & group behaviour when Hc system changes
Evaluating HC Systems: Convergence Hypothesis
- Argues that the similarities between global HC systems (which seems to be growing) is due to similar scientific, technological, economic, and epidemiological pressures
