Module 1 Flashcards
What is Canada?
- 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
True or false * The Canadian system is centrally planned and funded, so
that all Canadians receive the same services, no matter
where they live
False
True or false * We have more doctors per capita in Canada than ever
before
True
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.
False
True or false * Canada has among the highest out-of-pocket costs for
health care among OECD nations
False
True or false * Health care is fundamental to Canada. Canada’s publicly funded health care system dates back to confederation in
1867
False
What is Health?
- 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.”
4 categories of determinants of health
- human biology
- environment
- lifestyle
- health care organization
What is a system?
A set of principles or procedures according to which something is done; an organized scheme or method
PRIMARY prevention
intervention before
there is evidence of disease or injury
SECONDARY prevention
Intervention
after a disease process has begun but
before it is symptomatic
TERTIARY prevention
interventions after
disease or injury occurs
Canadian healthcare systems?
- 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
Federal or provincial/territorial? Administration of health insurance plans
P/T
Federal or provincial/territorial? Prescription drug regulation and safety
F
Federal or provincial/territorial? Public health
F/P/T
Federal or provincial/territorial? Planning/funding hospitals and other health facilities
P/T
Federal or provincial/territorial? Provision of medically necessary hospital and doctors’ services
P/T
Federal or provincial/territorial? Planning/implementation of health promotion/public health initiatives
P/T
Federal or provincial/territorial? Services for First Nations peoples living on reserves
F
Federal or provincial/territorial? Services for First Nations peoples living on reserves
F
Federal or provincial/territorial? Negotiating fee schedules with health professionals
P/T
PRIMARY care
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.
SECONDARY care
Services provided by medical
specialists (e.g. cardiologists, urologists), and
acute care for brief but serious conditions - injury, childbirth)
TERTIARY care
More specialized consultative care
usually in-hospital (e.g cancer treatment,
neurosurgery, cardiac surgery)
About what percent of Canadians use primary
care each month?
-25%
-important provincial variation
-most of health care resources go towards tertiary, quaternary
What does primary care look like?
- 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
Primary care - Access, continuity, coordination, comprehensive
- 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
Primary care or primary health care?
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)
Public Health
- 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
Emergency care
- 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
Specialist physician
and hospital care
- 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)
Rehabilitation/
intermediate care
- 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
Pharmaceutical care
- 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
Mental health care
- 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)
Home and long-term care
- 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
Informal caregivers
- 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
Dental care
- 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
Canada Dental
Care Plan
- 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
