Module 1

Question 1

What is Canada?

Answer 1

• Is a colonial country
• Is a constitutional monarchy
  ◦ The Head of State is a king or queen
  ◦ Elected Parliament passes legislation
  ◦ The Prime Minister is the head of Government
• Is a federation
  ◦ Central “federal” government
  ◦ Ten provincial governments, and three territories
  ◦ Both levels of government are constitutionally
  equal in power with different responsibilities

Question 2

True or false * The Canadian system is centrally planned and funded, so
that all Canadians receive the same services, no matter
where they live

Answer 2

False

Question 3

True or false * We have more doctors per capita in Canada than ever
before

Answer 3

True

Question 4

True or false * In order to receive national accreditation medical and
nursing schools must provide training in conflict resolution,
human rights, responding to racism, and working
effectively across cultures.

Answer 4

False

Question 5

True or false * Canada has among the highest out-of-pocket costs for
health care among OECD nations

Answer 5

False

Question 6

True or false * Health care is fundamental to Canada. Canada’s publicly funded health care system dates back to confederation in
1867

Answer 6

False

Question 7

What is Health?

Answer 7

• WHO definition of health: “a state of complete physical, mental,
  and social well-being, and not merely the absence of disease or
  infirmity.” (Affirmed in Alma-Ata declaration)
• The Ottawa Charter for Health Promotion affirms social,
  economic and environmental aspects of ‘health.’ In order to be
  healthy: “an individual or group must be able to identify and to
  realize aspirations, to satisfy needs, and to change or cope with
  the environment.”

Question 8

4 categories of determinants of health

Answer 8

1. human biology
2. environment
3. lifestyle
4. health care organization

Question 9

What is a system?

Answer 9

A set of principles or procedures according to which something is done; an organized scheme or method

Question 10

PRIMARY prevention

Answer 10

intervention before
there is evidence of disease or injury

Question 11

SECONDARY prevention

Answer 11

Intervention
after a disease process has begun but
before it is symptomatic

Question 12

TERTIARY prevention

Answer 12

interventions after
disease or injury occurs

Question 13

Canadian healthcare systems?

Answer 13

• People often refer to the “Canadian healthcare system” SINGULAR
• BUT:
  ◦ Each province and territory has its own healthcare system
  ◦ The federal government has separate responsibilities for First Nations and Inuit,
  prisoner, veteran health care
• So really we have15+ systems . . .
• Experiences of health care differ widely depending on who you are
  and where you live, as do issues and challenges for healthcare
  systems

Question 14

Federal or provincial/territorial? Administration of health insurance plans

Answer 14

P/T

Question 15

Federal or provincial/territorial? Prescription drug regulation and safety

Answer 15

F

Question 16

Federal or provincial/territorial? Public health

Answer 16

F/P/T

Question 17

Federal or provincial/territorial? Planning/funding hospitals and other health facilities

Answer 17

P/T

Question 18

Federal or provincial/territorial? Provision of medically necessary hospital and doctors’ services

Answer 18

P/T

Question 19

Federal or provincial/territorial? Planning/implementation of health promotion/public health initiatives

Answer 19

P/T

Question 20

Federal or provincial/territorial? Services for First Nations peoples living on reserves

Answer 20

F

Question 21

Federal or provincial/territorial? Services for First Nations peoples living on reserves

Answer 21

F

Question 22

Federal or provincial/territorial? Negotiating fee schedules with health professionals

Answer 22

P/T

Question 23

PRIMARY care

Answer 23

first point of consultation, often
with a general practitioner or family physician.
This could also include walk-in clinics and some
services in emergency departments.

Question 24

SECONDARY care

Answer 24

Services provided by medical
specialists (e.g. cardiologists, urologists), and
acute care for brief but serious conditions - injury, childbirth)

Question 25

TERTIARY care

Answer 25

More specialized consultative care
usually in-hospital (e.g cancer treatment,
neurosurgery, cardiac surgery)

Question 26

About what percent of Canadians use primary
care each month?

Answer 26

-25%
-important provincial variation
-most of health care resources go towards tertiary, quaternary

Question 27

What does primary care look like?

Answer 27

• Gatekeeper model
• Patient choice of physician . . . up to
  a point
• Limited “rostering”/ “empanelment”
• Usually (but not always) a family
  doctor
• Most physicians are contractors, not
  employees of government

Question 28

Primary care - Access, continuity, coordination, comprehensive

Answer 28

• Access - First-contact care for
  each health concern
• Continuity - Patient-focused
  (rather than disease focused)
  care over time
• Coordination – Follow-up when
  services are needed elsewhere
• Comprehensive – Broad range
  of services, referral to other
  services where needed

Question 29

Primary care or primary health care?

Answer 29

PRIMARY CARE
◦ “Family doctor-type” services
delivered to individuals (Muldoon
2006)
◦ First-contact access
◦ Long-term continuity
◦ Coordination
◦ Comprehensiveness (Starfield 1998)

PRIMARY HEALTH CARE
◦ Approach to health policy and
service provision that includes
population-level public health
functions as well as individual
patient care
◦ May also include additional
principles articulated by the WHO
◦ Universal access
◦ Commitment to health equity
◦ Community participation (WHO)

Question 30

Public Health

Answer 30

• Public health programs and policies generally
  target populations rather than individuals
  ◦ Population health assessment
  ◦ Health promotion
  ◦ Disease and injury control and prevention
  ◦ Surveillance
  ◦ Emergency preparedness
  ◦ Epidemic response
• Primary care has role in individual-level
  prevention
• Cancer agencies oversee dedicated screening
  programs
  ◦ Breast cancer, cervical cancer, colorectal cancer

Question 31

Emergency care

Answer 31

• Emergency Department (ED)
  ◦ Staffed by specialist Royal College of
  Physicians and surgeons of Canada
  (RCPSC) fellows or specialist family
  physicians
  ◦ ED also serves as primary care (especially
  after hours) for many patients
• Emergency medical services (EMS)
  ◦ Transportation (road or air ambulance)
  ◦ Pre-hospital or inter-hospital patient care
  ◦ Some out-of-pocket payment

Question 32

Specialist physician
and hospital care

Answer 32

• Specialist physician ambulatory services
  ◦ Generally provided in outpatient departments of
  hospitals, some provided in private doctors offices
  ◦ Variety of payment models (will come back to this in
  later modules)
  ◦ Some specialist and diagnostic services may be
  provided in for-profit clinics
• Hospital services
  ◦ Mostly organized by regional health authorities
  ◦ Some hospitals run by health authorities, some
  privately administered (not-for-profit)

Question 33

Rehabilitation/
intermediate care

Answer 33

• Inpatient rehabilitation
  ◦ Orthopedics – e.g. joint replacement surgery,
  amputations
  ◦ Stroke, brain dysfunction, spinal cord injury
• Outpatient rehabilitation (often
  physiotherapy and occupational
  therapy)
  ◦ Also covered by:
  ◦ Workers compensation
  Private health insurance
  ◦ Out-of-pocket payments

Question 34

Pharmaceutical care

Answer 34

• Prescribed by physicians, nurse practitioners, midwives, dentists
  (limits on classes of drugs for non-physician prescribers)
• Inpatient (in hospital) drugs covered by public provincial
  insurance
• Outpatient prescription drugs covered by some combination
  of
  ◦ Private insurance
  ◦ Public insurance:
  ◦ Every provincial and territorial government has a prescription
  plan that covers outpatient prescription drugs for designated
  populations (e.g. seniors and social assistance recipients.
  ◦ Coverage under Non-Insured Health Benefits (NIHB)
  Program for First Nations and Inuit peoples
  ◦ Out-of-pocket
• Over-the-counter drugs also have a role to play!
  ◦ Covered for inpatient care
  ◦ Outpatient out-of-pocket plus private insurance

Question 35

Mental health care

Answer 35

• Treatment now largely on an outpatient
  basis
  ◦ Episodic treatment in the psychiatric
  wings of hospitals
  ◦ Pharmaceutical therapies overseen by
  psychiatrists
• Family physicians provide majority of
  primary mental health care
• Services by non-physician providers
  (psychologists, counselors) largely
  private (health insurance or out-ofpocket)

Question 36

Home and long-term care

Answer 36

• Serve older adults, as well as individuals
  of any age with physical or learning
  disabilities or chronic diseases. Also
  home supports available to people with
  short-term needs.
• May be offered in a range of settings
  (home, assisted living, chronic care
  institutions)
  ◦ Mix of public, non-profit, and for-profit
  institutions
• Referrals can be made by doctors,
  hospitals, community agencies, families
  and patients themselves

Question 37

Informal caregivers

Answer 37

• Care provided by friends and family
  members plays a substantial role in health
  care
• Some estimates suggest up to 75% of
  healthcare is delivered by informal
  caregivers, totaling 5.7 billion unpaid hours
  per year
• Some financial support in the form of:
  ◦ Tax credits
  ◦ Compassionate Care Benefit (paid leave)
• Direct support for caregivers vary widely

Question 38

Dental care

Answer 38

• Delivered by independent practitioners
  operating their own practices
  ◦ Private health insurance (~54%) or outof-pocket
• Much lower public support than almost
  all wealthy countries
• Wide socioeconomic inequities

Question 40

Canada Dental
Care Plan

Answer 40

• Covers most basic
  dentistry for uninsured
  Canadians with net
  household income
  <$90,000
• Open to seniors over
  87, then applications
  for other age groups
  phased in by 2025