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HofMed165 > Medicare > Flashcards

Medicare Flashcards

1
Q

When was the western context welfare state roughly characterized as what time period?

A

1945-1976

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2
Q

What did politicians claim they wanted to be committed to during the welfare period?

A

1) full employment
2) social security (with redistribution)
3) enhancement of social consumption and social services (education, health, housing)

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3
Q

What were welfare policies inspired by? (3 points)

A

1) economic depression during the 1930s
2) trans-national experience
3) growing faith in modern medicine (and science) to fix social problems

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4
Q

What did the depression influence?

A

People’s attitudes towards helping each other

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5
Q

Which was the first country to introduce a National Health Service? When?

A
  • UK

- first step in 1911, fully implemented in 1948

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6
Q

What did the USA introduce in the 1960s?

A

Medicare (age) and Medicaid (income)

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7
Q

What the the BNA Act of 1867 say about matters relating to health?

A

Provincial responsibility

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8
Q

What were Roosevelt’s four freedoms?

A
  • freedom of speech
  • freedom for conscience
  • freedom from want
  • freedom from fear
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9
Q

What outlined the social and political necessities to ensure Roosevelt’s four freedoms?

A

Medicare and Medicaid

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10
Q

What developed as health care programs became national in Canada?

A

tensions between who had power (provincial and federal)

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11
Q

Prior to healthcare, what were most hospitals run by

A

religious denomination-based institutions (catholic and protestant)

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12
Q

What was the Charity Aid aCt of 1874 (ON)?

A

Obliged the religious-based institutions to admit and treat all patients irrespective of their ability to pay

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13
Q

What did a 1916 amendment in Saskatchewan allow municipal legislation?

A

Allowed municipalities the right to offer doctors retainers, in the form of a yearly salary, as a way of ensuring health services.

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14
Q

What was the first place in Saskatchewan to implement the 1916 legislative changes with salaried employment of doctors?

A

Sarnia, SK

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15
Q

What was the result of the 1920s AN and BC commission to examine public health insurance possibilities?

A
  • AB reported that the cost to the public treasury was too high; did not recommend state health insurance
  • BC recommended income tax supported scheme; failed to gain ascent
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16
Q

What forestalled any provincial efforts to enact any form of public health insurance from the period of 1929-1929? Why

A

The Great Depression because there were more pressing and disastrous concerns.

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17
Q

Demands for what grew in the period of 1929-1939?

A

Demands for healthcare services as unemployment reached unprecedented levels and fewer Canadians had the ability to pay for health care services.

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18
Q

What was the significance On-to Ottawa Trek in 1935?

A

Exposed the severity of the economic depression and forced a federal response

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19
Q

Describe the On-to Ottawa trek?

A

As the Depression wore on the men became dissatisfied with the provisions of work camps for unemployed men and they began a trek to Ottawa where they intended to negotiate with PM R.B. Bennett. The trek started in Vancouver and men rode the rails towards Ottawa. However, when it reached Regina the men were met by RCMP officers and a riot broke out. One trekker was shot and killed and the trek effectively ended.

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20
Q

What did the On-to Ottawa trek serve as?

A

An important turning point in the federal government’s relationship with the provinces and in establishing a precedent for intervening in local or provincial affairs.

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21
Q

What did RM McKillop introduce in SK in 1939?

A

A new ‘health insurance plan’ based on Norwegian model

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22
Q

What stalled further action on health insurance at any level after 1939?

A

WWII

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23
Q

What did PM McKenzie King promise to revisit after the war?

A

the issue of health insurance as part of social reconstruction policy

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24
Q

What took place at the 1945/6 Dominion-Provincial Reconstruction Conference?

A
  • Federal government agrees to provide 60% of public hospital and medical care insurance
  • Rejected by provinces
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25
Q

Who is the ‘father of Medicare’?

A

Tommy Douglas

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26
Q

What was the hardest region hit during the Great Depression?

A

Saskatchewan

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27
Q

What were the effects of the Great Depression on Saskatchewan (3 points)?

  • What percent dependent on wheat?
  • low grain prices for how many years?
  • What about doctors?
A
  • 60% rural population, dependent on wheat production
  • Drought and low grain prices for over 10 years
  • Lost 20% of doctors
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28
Q

What did the Great Depression instill in Saskatchewan?

A

Need for cooperation and community action

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29
Q

What did the Federal Liberals promise money for after the war?

A

healthcare initiatives

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30
Q

What did Tommy Douglas do upon election in 1944?

A

Established a commission to recommend how to set up a public system of health care services
-Sigerist Report

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31
Q

What was the Sigerist Report?

A

Recommended a form of public health care

-Henry Siegerin (John’s Hopkins University) surveyed province and reported findings to Douglas.

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32
Q

What was Sigerist known as?

A

Communist sympathiser

33
Q

What kind of gov’t was Douglas?

A

Socialist government

34
Q

What did Douglas invite Sigerist to SK to do?

A

To come to SK and advise on healthcare

35
Q

What is the 1946 Swift Curren model: ‘experiment’?

A

Health district was the first area to offer a comprehensive range of publicly-funded health services

  • hospital care, in-patient care, pharmaceuticals (in-hospital), choice of doctor
  • attracted doctors to the area who were pleased to have a regular, secure income
36
Q

What did Sigerist recommend to Douglas?

A

that the best way of delivering universal public health care was the first divide the province into health care regions or districts, and focus on building comprehensive health services for each region.

37
Q

What was the idea behind each health region in SK?

A
  • each region should provide basic sets of services
  • offer doctors salary to staying region
  • everything in hospital care should be covered
38
Q

What did SK introduce in 1947?

A

Universal hospital services plan or “Hospitalization Act”

39
Q

What is the first step towards our medicare today? Describe it.

A

“Hospitalization Act”

-Provincial government covered costs of hospital care

40
Q

How much did the Hospitalization Act cost? Why is this significant?

A
  • $7.6 million, 15% of provincial budget

- most spending in one area as ever before

41
Q

What did the Canadian Medical Association endorse in response to the Hospitalization Act?

A

Proposals for universal health care

42
Q

What was support like for the “Hospitalization Act” ?

A
  • Fairly favourable from physicians

- Saskatchewan Medical Association supported early initiatives

43
Q

What did physicians continue to control despite the “Hospitalization Act”?

A
  • Physicians continued to control a private insurance market, predominantly in urban areas
  • Doctors in Canada also maintained a private insurance fund on the side.
44
Q

What were physicians unhappy about with the “Hospitalization Act”?

A

They wouldn’t make money on insurance plan anymore

45
Q

What did SK become the model of?

A

Universal hospitalization scheme

46
Q

When did AB and BC try to implement similar schemes to SK universal hospitalization scheme?

A
  • 1949 BC

- 1950 AB (subsidies to municipalities that agreed to provide public coverage)

47
Q

What act did the federal government pass in 1957 in Parliament?

A

the Hospital Insurance and Diagnostic Services Act (HIDS Act)

48
Q

What is the HIDS Act?

A
  • Cost-sharing agreement

- Federal government pays 50% if provincial plans meet federal standards

49
Q

What are the 3 benefits to the HIDS Act?

A
  • universally available
  • portable (ex. if you live in SK you can get care in AB)
  • publicly administered
50
Q

What did Tommy Douglas do in 1960 with elections and medicare? Describe the election.

A
  • Called an election that serves as a referendum on the subject
  • “Medicare” a central election issue
  • A vote for the CCF is a vote for Medicare
  • SK Medical Association campaigns against Medicare
  • Raise $100 000 to support Liberals and stop Medicare
  • Use language of Communism as a scare tactic
51
Q

Who won the 1960s election?

A

-SK doctors’ plan backfires and CCF wins a decisive majority (seems doctors appeared greedy though claim only protecting professional freedom)

52
Q

What is the CCF mandate after the 1960 election include? Why?

A
  • Mandate to expand health care plans and promises to include physicians in the administration of the plan
  • They did not want to wage a battle with the medical profession
53
Q

How many doctors’ strikes in advanced industrial countries in the 1960s amid the expansion of the welfare state after WWII?

A

8

54
Q

Where were the most prolonged and bitter doctors’ strikes?

A

Belgium and Canada (SK)

55
Q

What did the doctors’ strikes have an impact on?

A

future of health care

56
Q

What were the four areas with doctors strikes?

A

Western Europe, Canada, Australia, and New Zealand

57
Q

How long was the doctors’ strike in SK? Belgium?

A
  • 23 days

- 18 days

58
Q

What was the moral dilemma that the doctors strike presented?

A
  • Withdraw services in support of self-regulation of the profession?
  • Defy the oath in favour of political resistance
59
Q

When was the SK Medical Care Insurance Act passed?

A

November 1961 with implementation planned for April 1 of 1962

60
Q

Why was the SK Medical Care Insurance Act delayed?

A

College of Physicians and Surgeons refused to negotiate.

61
Q

What did the medical profession oppose?

A

Expansion of state-intervention

62
Q

How many of SK doctors went on strike on July 1 of 1962 opposing the CCf/NDP plan?

A

725

63
Q

What is the legacy of the doctors strike?

A
  • Preserved fee-for service feature

- Commitment to ‘medical liberalism’

64
Q

What is ‘medical liberalism’

A

-Individualistic philosophy that opposed collectivist character of the welfare state

65
Q

what does ‘medical liberalism’ include?

A
  • doctor-patient confidentiality
  • free choice of doctor by patient
  • non-interferene by state re: clinical judgement, feeds set by doctors )not state)
66
Q

What was the wedge issue in both cases of the doctors’ strike?

A

fees

67
Q

Who favoured fee for service?

A

doctors

68
Q

What is fee for service?

A

doctors paid according to services performed

69
Q

Why didn’t Premier Douglas like fee for service?

A

He feared that this method encouraged seeing as many patients as possible, assembly-line service, use of expensive techniques and procedures, and less emphasis on education and prevention

70
Q

Who favours the salary system in the doctors’ strike?

A

government

71
Q

Why didn’t doctors like the salary system in the doctors’ strike?

A

Doctors feel it reduces them to state employees, discourages initiative, interferes with the doctor-patient relationship and dilutes the quality of medical care

72
Q

When was the end of the doctors strike?

A

July 23, 1962 as an agreement was reached between the SK government and the College of Physicians and Surgeons

73
Q

What were the two agreements reached with the doctors strike?

A
  • accepted fee-for-service payment scheme–gov’t would assume these costs and physicians would set the price for health care services
  • ensure physicians retained control of profession by issuing medical licenses and sitting on administrative boards
74
Q

What was the 1964 Royal Commission on Health Care Services, aka Hall Commission? Who proposed it?

A
  • Recommended national system of health insurance based on SK model
  • Justice Emmett Hall
75
Q

What did the recommendations of the Hall Commission give rise to?

A

The 1966 Medical Care Act

76
Q

What are the 4 Medical Care Act principles?

A
  1. Universality
  2. Public administration
  3. comprehensiveness
  4. Portability
77
Q

What replaced the Hospital Insurance Diagnostic Services Act (1957) and the Medical Care Act (1966)? Why?

A
  • 1984 Canada Health Act
  • Double billing issue: extra billing and user fee (this act made into law the federal government’s responsibility to deduct funding n a dollar-for-dollar basis of any additional fees charged to patients)
78
Q

What are the Canada Health Act Criteria (5)?

A
  1. Public Administration (non-profit basis)
  2. Comprehensiveness
  3. Universality
  4. Portability
  5. Accessibility (dealt with extra-billing issue)

HofMed165 (21 decks)

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