Health Services Organization and Policy Flashcards
What is Health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The mission of Health Canada
Be responsible for helping the people of Canada maintain and improve their health measures by longevity, lifestyle and effective use of public health care system.
How many systems of health in Canada
- 13 overall
- 10 provinces
- 3 territories
- Federal government has basic national standards/rules and contributes financial support.
What is Medicare
- 2 old historical agreements between federal and provincial governments to cover all hospital costs and doctor’s visit and nothing else
- Not Included: Prescription, Homecare, Long-term care, eye care and dental
National Stakeholders
- Governments
- Professional Associations
- Industries (Pharmaceutical, medical devices, service agencies)
- Canadians
4 Keys of Health System
- Health Canada/ Federal Government
- Provincial Governments
- Patients/Public
- Delivery Organizations
5 Pillars in Canada’s Health Act (UACPP)
- Universal
- Accessible
- Comprehensive
- Portable
- Public Administration
Universal
Everyone is entitled to public health insurance coverage on uniform terms and conditions.
Accessible
Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers.
Comprehensive
All medically necessary services provided by hospitals and doctors must be insured.
Portability
Coverage for insured services must be maintained when an insured person moves or travels within Canada or travels outside the country.
Public Administration
The administration must be carried out by a non-profit public authority.
3 models of Healthcare
- National Health Service (Beveridge)
- Social Insurance (Bismarck)
- Private Insurance (Consumer Sovereignty)
National Health Service Model
- Universal Coverage for residents
- Financed by general taxation
- England
Social Insurance
- Universal coverage within social security
- Financed by employer/employee
- Combination of public/private ownership
- Government has universal coverage but not covered by them
- USA Obama Care
Private Insurance
- Individual or employer-based purchase of private health care.
- Financed by individual or employer contribution.
- USA pre-Obama Care
3 Physician Payment Models
- Fee-for-Service
- Capitation
- Salary
Fee-for-Service
- Pay-based on service
- Pros: motivation to do more services (get more paid)
- Cons: could be more costly (physician might go for the more expensive procedure to get paid more)
Capitation
- Based on a patient list
- Community of patients that they are responsible for and will receive funding.
- “money follows the patient”
- Pros: Competition among physicians
- Cons: the sickest patients might not get chosen since more funding would go to them compared to healthy patients.
Salary
- Funder controls primary care directly
- Pros: easier to control cost, great collaboration among physicians
- Cons: Salary could be higher in certain location leading to an exit of physicians from a region to another.
Financing of Health Care in Canada
- General taxation
- Specific taxes
- Premiums
- User charges
- Charitable contributions
- Research & Development
In-Patient Procedures
- Base Budget provided annually
- Covers all in-patient care, diagnosis and procedures
- Organizations are responsible for providing identified services under their base budget (salaries, infrastructure, technology)
- No additional fee is given for the patient.
Out-Patient Procedures
- Additional funding
- Province will reimburse predetermined professional feel for physician
- Province will reimburse technical fee for operating costs, overhead, staffing, etc.
Specialized Care
- Heart Institute is mostly all specialized care
- Special funding to perform a number of predetermined procedures.
