health care in canada - history

Question 1

what is US perspective on Universal HC?

Answer 1

name: opportunity cost of socialism.
debating socialism even tho socialized med =/= socialism.
believe that universal will reduce short + long term longevity.
-single-payer more efficient, similar to communist regimes - nationalizing + ethnic genocide. not at all what modern socialized medicine.

Question 2

types of healers in 1800s

- how to do this?

Answer 2

barber-surgeon, apothecaries, midwives
allopathic doctors
homeopathic doctors
eclectics
-> apprenticeship. get informal training otherwise.

Question 3

what are allopathic doctors?

Answer 3

cure by opposites: opposite reaction to cure. fever - cool body.
heroic measures: do something rather than wait around

Question 4

what are homeopathic doctors

Answer 4

like cures like
stimulate sick person’s natural defences by using small amounts of natural substance that in larger amounts would cause the same symptoms. = mimick sign that body is feeling + do same. fever - give something that causes fever to facilitate opposite?
allow natural defense = give small dose.

Question 5

what are eclectics?

Answer 5

botanical medicine

dontt exist today.

Question 6

what are efforts of allopathic docs to organize profession

Answer 6

1975/5: license + control admittance to practice medicine

distinguish allopathic medicine from other healing practices

Question 7

2 big questions?

Answer 7

what is history of Canada’s HC system

what role did allopathic doctors play in formation of Canada’s HC system

Question 8

professions legalized = what year?

Answer 8

homeopath = 1859
eclectics = 1861
allopaths =1869
-> canada not large. restricted to 2 provinces. ontario medical act + college = control who is “physician” bc achieved professionalism, others wanted this too.

eclectctics + homeopaths included in college. eclectics pushed out.
1960 - college cuts out homeopaths

Question 9

why did allopaths take a long time to regulate?

Answer 9

elite, school trained - gonna be allopaths.
but a lot of allopaths trained thru apprenticeship = hard to know which way this will occur then.
needed united front, seat at table with 1 voice.

Question 10

what is flexner report? findings? result

Answer 10

connected hs teacher. evaluate medical school that existed at time.
80% of schools closed bc poor quality of medical education.

Question 11

what are 5 recommendations of flexner report?

Answer 11

recommend: abolish apprenticeship; affiliated with uni; standardized entry for best doctors; scientific method; hospitals - learning (not warehousing)

Question 12

what happened in 1912

Answer 12

Canada Medical Act

• > licensing procedures standardized.
• > medical dominance : freedom from control by other occupations + groups
• > ability to control other health occupations

Question 13

what happened in 1919?

Answer 13

liberal govt propose universal med. insurance.
- pension, unemployment insurance + health care.
- docs oppose, but didnt think it was a real threat.
=> start talks but nothing happens.

Question 14

why did docs no think universal medical insurance was a big deal?

Answer 14

docs were politically connected: few years earlier, won + saw selves at top of heap.
free-market philosophy: cost of HC should operate on free-market philosophy.
BNA Act situated health as provincial matter = canada is new country, feds no influence on HC (or education)

Question 15

what happens in 1930?

Answer 15

Great Depression. physician change mind - feel impact of GD. see benefits of universal system.

• report acknowledges that in favour of national universal. worried about losing control/power of system
• economy recovers, docs change mind again, free market is better.

Question 16

what happened in 1945

Answer 16

dominion-provincial conference on reconstruction

• > how to rebuild country. invest in future of country
• • medical insurance discussed - disagreement across provinces. broken down talks

Question 17

what happened in 1947

Answer 17

tommy douglas - premier of Saskatchewan.
-> hospital insurance plan. services in hospital.
-$5/person annual fee.
93% of popln covered.
= country says they dont want it. popularity of it says they do.

Question 18

what happened in 1957

Answer 18

hospital insurance and diagnostic services act
-> fed govt and provinces agree to share costs.
fed pays 50% and province pays other half.

Question 19

what happened in 1959?

Answer 19

tommy douglas introduces medical insurance in Sask.
-> 5 components
insurance for outside of hospital too.

Question 20

what are 5 medical components of medical insurance in Sask

Answer 20

available to everyone
annual fee
public control
improvement to HC system
legislation satisfy doc + patient

Question 21

what happens in 1962

Answer 21

medicare is law in saskatchewan = without physician aagreement.
-> doctors on strike. 23 days, public opinion against doctors. public against physicians. public want it. medicare becomes template for other provinces

Question 22

what happens in 1966?

Answer 22

medical care act.

fully implemented by 1972.

Question 23

four principles of Medical Care Act

Answer 23

universal (available to all Canadian citizens)

portable: reciprocal recognition of coverage between provinces.
comprehensive: cover all medically necessary services. who decides medically necessary?
administration: health insurence administered by public authority on non-profit basis. public. no financial interest for physician

Question 24

1984 Canada Health Act

Answer 24

replaced Medical Care Act + Hospital Insurance and Diagnostic Services Act = harmonize
5th principle
eliminated extra-billing and user fees

Question 25

what is 5th principle in CHA

Answer 25

accessibility: access to medically necessary hospital and physician services must be unimpeded by financial or other barriers.

Question 26

describing Canada’s health care system

Answer 26

first dollar coverage, publicly-funded (revenue/tax pay for docs), privately provided, provincially administered, national health care plan

Question 27

what does first-dollar coverage mean?

Answer 27

third-party payer (province) assumes liability for covered services as soon as first dollar of expense is incurred

Question 28

docs payment plan?

Answer 28

paid on fee-for-service