Health Services Organization and Policy

Question 1

What is Health?

Answer 1

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Question 2

The mission of Health Canada

Answer 2

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.

Question 3

How many systems of health in Canada

Answer 3

• 13 overall
• 10 provinces
• 3 territories
• Federal government has basic national standards/rules and contributes financial support.

Question 4

What is Medicare

Answer 4

• 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

Question 5

National Stakeholders

Answer 5

• Governments
• Professional Associations
• Industries (Pharmaceutical, medical devices, service agencies)
• Canadians

Question 6

4 Keys of Health System

Answer 6

1. Health Canada/ Federal Government
2. Provincial Governments
3. Patients/Public
4. Delivery Organizations

Question 7

5 Pillars in Canada’s Health Act (UACPP)

Answer 7

1. Universal
2. Accessible
3. Comprehensive
4. Portable
5. Public Administration

Question 8

Universal

Answer 8

Everyone is entitled to public health insurance coverage on uniform terms and conditions.

Question 9

Accessible

Answer 9

Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers.

Question 10

Comprehensive

Answer 10

All medically necessary services provided by hospitals and doctors must be insured.

Question 11

Portability

Answer 11

Coverage for insured services must be maintained when an insured person moves or travels within Canada or travels outside the country.

Question 12

Public Administration

Answer 12

The administration must be carried out by a non-profit public authority.

Question 13

3 models of Healthcare

Answer 13

1. National Health Service (Beveridge)
2. Social Insurance (Bismarck)
3. Private Insurance (Consumer Sovereignty)

Question 14

National Health Service Model

Answer 14

• Universal Coverage for residents
• Financed by general taxation
• England

Question 15

Social Insurance

Answer 15

• 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

Question 16

Private Insurance

Answer 16

• Individual or employer-based purchase of private health care.
• Financed by individual or employer contribution.
• USA pre-Obama Care

Question 17

3 Physician Payment Models

Answer 17

1. Fee-for-Service
2. Capitation
3. Salary

Question 18

Fee-for-Service

Answer 18

• 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)

Question 19

Capitation

Answer 19

• 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.

Question 20

Salary

Answer 20

• 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.

Question 21

Financing of Health Care in Canada

Answer 21

• General taxation
• Specific taxes
• Premiums
• User charges
• Charitable contributions
• Research & Development

Question 22

In-Patient Procedures

Answer 22

• 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.

Question 23

Out-Patient Procedures

Answer 23

• Additional funding
• Province will reimburse predetermined professional feel for physician
• Province will reimburse technical fee for operating costs, overhead, staffing, etc.

Question 24

Specialized Care

Answer 24

• Heart Institute is mostly all specialized care
• Special funding to perform a number of predetermined procedures.

Question 25

How is Canadian Health Care Funded?

Answer 25

• 75% Public (provincial and territorial government)
• 25% Private (private insurance, out of pocket)