health care in canada - history Flashcards
what is US perspective on Universal HC?
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.
types of healers in 1800s
- how to do this?
barber-surgeon, apothecaries, midwives allopathic doctors homeopathic doctors eclectics -> apprenticeship. get informal training otherwise.
what are allopathic doctors?
cure by opposites: opposite reaction to cure. fever - cool body.
heroic measures: do something rather than wait around
what are homeopathic doctors
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.
what are eclectics?
botanical medicine
dontt exist today.
what are efforts of allopathic docs to organize profession
1975/5: license + control admittance to practice medicine
distinguish allopathic medicine from other healing practices
2 big questions?
what is history of Canada’s HC system
what role did allopathic doctors play in formation of Canada’s HC system
professions legalized = what year?
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
why did allopaths take a long time to regulate?
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.
what is flexner report? findings? result
connected hs teacher. evaluate medical school that existed at time.
80% of schools closed bc poor quality of medical education.
what are 5 recommendations of flexner report?
recommend: abolish apprenticeship; affiliated with uni; standardized entry for best doctors; scientific method; hospitals - learning (not warehousing)
what happened in 1912
Canada Medical Act
- > licensing procedures standardized.
- > medical dominance : freedom from control by other occupations + groups
- > ability to control other health occupations
what happened in 1919?
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.
why did docs no think universal medical insurance was a big deal?
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)
what happens in 1930?
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.
what happened in 1945
dominion-provincial conference on reconstruction
- > how to rebuild country. invest in future of country
- medical insurance discussed - disagreement across provinces. broken down talks
what happened in 1947
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.
what happened in 1957
hospital insurance and diagnostic services act
-> fed govt and provinces agree to share costs.
fed pays 50% and province pays other half.
what happened in 1959?
tommy douglas introduces medical insurance in Sask.
-> 5 components
insurance for outside of hospital too.
what are 5 medical components of medical insurance in Sask
available to everyone annual fee public control improvement to HC system legislation satisfy doc + patient
what happens in 1962
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
what happens in 1966?
medical care act.
fully implemented by 1972.
four principles of Medical Care Act
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
1984 Canada Health Act
replaced Medical Care Act + Hospital Insurance and Diagnostic Services Act = harmonize
5th principle
eliminated extra-billing and user fees
what is 5th principle in CHA
accessibility: access to medically necessary hospital and physician services must be unimpeded by financial or other barriers.
describing Canada’s health care system
first dollar coverage, publicly-funded (revenue/tax pay for docs), privately provided, provincially administered, national health care plan
what does first-dollar coverage mean?
third-party payer (province) assumes liability for covered services as soon as first dollar of expense is incurred
docs payment plan?
paid on fee-for-service