Module 1 HISTORY HCS

Question 1

BNA Act

Answer 1

-1867
-British North Act
-Explained how the newly formed Canadian government would work under the new confederation
-Federal government (National) umbrella over the smaller provincial governments

Question 2

BNA FEDERAL government responsibilities

Answer 2

-Health of indigenous people
-Health policy and contagious diseases
-Pharmaceutical and Food safety

Question 3

Pharmaceutical and Food Safety became ..

Answer 3

The department of health in 1919

Question 4

BNA PROVINCIAL & TERRITORIAL government responsibility

Answer 4

Public health
-hospitals
-mental health facilities/asylums
-education
-Social services

Question 5

Following the BNA act all provinces passed legislation

Answer 5

“Insanity act”

Question 6

Asylums

Answer 6

-Were first introduced as “retreats from society”
-Built the hope that with early intervention and several months of rest people with mental illness could be cured

Question 7

Asylums “Bedlam”

Answer 7

In the eighteenth century, Europeans used to travel to bedlam to watch the people who lived there as holiday entertainment

Question 8

History of Mental Health “causes”

Answer 8

-Demonic possession, sin, or biological causes

Question 9

History of mental health early care

Answer 9

-included a variety of treatment forms; mostly inhumane
-1700’s began more humane treatment due to french physician Philippe Pinel

Question 10

Philippe Pinel

Answer 10

-Cause for more humane treatment for mental health in 1700’s
-Began social and psychological approaches = Moral Therapy
-first to start talking to patients, no chains =social and empathy psychological therapy (not successful)

Question 11

Canadian Asylums

Answer 11

-Early asylums began in Quebec and the Maritimes
-Eventually each province opened an asylum
-Moral therapy lacked access
-Overcrowding in asylums
-1900th century began radical therapies

Question 12

20th Century Canadian Asylums

Answer 12

-Electroconvulsive Therapy
-Lobotomies
-Psychotherapy

Question 13

Dorthea Dix

Answer 13

-Advocate in the 1800’s for more humane treatment (Canadian asylums)
-Met with Pope

Question 14

Changes to Canadian Asylums

Answer 14

-Late 1950’s-1960 = introduction of psychotropic drugs
-Provincially funded psychiatric hospital
-Changing values
-New philosophies in mental health care
-Promise of deinstitutionalization

Question 15

Deinstitutionalization

Answer 15

-1950’s-1980’s
-Canadian Mental Health Association (CMHA) published a framework for mental health reform (1963)
-Recommendations “mental health should be dealt with in the same organizational, professional framework as physical illness”
-“Receive the same excellence of medical care”

Question 16

Deinstitutionalization =

Answer 16

Dehospitalization

Question 17

Deinstitutionalization/Dehospitalization

Answer 17

-A shift from the institution to the community
-More humane
-Less expensive
-The use of psychotropic medication
-Community based services
-Community housing
-Canadian Mental Health Association

Question 18

Deinstitutionalization outcome

Answer 18

-Not as successful as planned
-Limited resources in place
-Trans institutionalizations
-Policy changes continue = The mental health strategy for Canada and the 2007 Senate report “Out of the Shadows at Last”

Question 19

Provincial & Territorial Government responsibilities

Answer 19

-First hospital Hotel Dieu de Quebec in 1637 =relied on financing from the wealthy & organizations
-1900’s -Governments started providing some funds for hospitals
-Religious and charitable agencies

Question 20

In the 1920’s Majority of health services were delivered by:

Answer 20

-Volunteer agencies

Question 21

1920’s Volunteer Agencies

Answer 21

-Order of St. John (St John Ambulance)
-The Canadian Red Cross Society
-Victorian Order of Nurses (VON)
-Children’s Aid Society
-Canadian Mental Health Assoc

Question 22

Medical and Hospital Care 1800’s-1900’s - Poor

Answer 22

-No health care
-Family provided
-Received health care in crowded hospitals

Question 23

Medical and Hospital Care 1800-1900’s -Wealthy

Answer 23

-Avoided hospitals
-Hired Dr’s privately
-HC provided by nurses in homes

Question 24

Medical and Hospital Care 1800’s-1900’s -Middle class

Answer 24

Somewhere in between

Question 25

Historical Indigenous Health Services

Answer 25

-Provided by Shamans, Medicine men or women -Indigenous philosophy of health -Four sacred medicines

Question 26

WW1

Answer 26

-WW1 was a global war originating in Europe that lasted from July 1914-November 11 1918

Question 27

WW2

Answer 27

World war 2 also known as the Second World War was a global war that lasted from 1939-1945

Question 28

Influences of the World Wars -Medical Advances

Answer 28

-Between 1919 and 1939 improved medical care -Triage was introduced -The traumatic injuries required advanced anesthesia, infection control and surgery -Stored blood (blood banks) -X ray machines improved -Powerful electron microscopes were invented -Oximetry was developed during WW2 -Penicillin

Question 29

Canadian Medical Discoveries (1922)

Answer 29

Advent of insulin

Question 30

Canadian Medical Discoveries (1936)

Answer 30

Hans Selye = Father of the field of stress research

Question 31

Canadian Medical Discoveries (1948)

Answer 31

First artificial kidney machine

Question 32

Canadian Medical Discoveries (1950)

Answer 32

Introduction of lumpectomy for treatment of breast cancer

Question 33

Canadian Medical Discoveries (1951)

Answer 33

First device to deliver radiation in the treatment for breast cancer

Question 34

Canadian Medical Discoveries (1961)

Answer 34

Discovery of blood forming stem cells

Question 35

Canadian Medical Discoveries (1965)

Answer 35

First artificial knee joint

Question 36

Evolution of Social Safety Net: The Great Depression

Answer 36

-Formerly independent people joined public welfare -Assistance was granted in the form of food, clothes, and fuel -This aid was money left from 19th century poor relief systems of municipal aid and supplemented by charitable donations

Question 37

Evolution of Social Safety Net

Answer 37

-As a result of the Great Depression, Canadian social-political philosophy changed -Governments through tax dollars, should play a role insuring an acceptable standard of living and access to services for all

Question 38

Nationally Legislated Social Safety Net (1942)

Answer 38

McKenzie King (PM) unemployment insurance

Question 39

Nationally Legislated Social Safety Net (1944)

Answer 39

Family allowance (now called child tax benefit)

Question 40

Nationally Legislated Social Safety Net (1948)

Answer 40

National Health Grants Program

Question 41

Nationally Legislated Social Safety Net (1952)

Answer 41

Old age security (70 yr and older)

Question 42

Prior to Medicare

Answer 42

-Before WW2 health care in Canada was privately delivered -Doctors often went without payment -People suffered and or died without medical care -Financial ruin

Question 43

Tommy Douglas

Answer 43

-1904-1986 -Believed health was a basic human right available to anyone on the basis of need -Leader of first socialist party in North America -As premier of Sask. introduced government insurance for hospitalization and later, medical doctor visits -Led way for social reforms in the rest of Canada

Question 44

Tommy Douglas Growing Up

Answer 44

-Born in 1904 -Born in Scotland -Immigrated to Winnipeg -Was diagnosed with osteomyelitis in leg -Couldnt afford surgery, surgeon donated care to save -Witnessed beatings of workers in Winnipeg general strike -Became Baptist minister and went to Brandon College -First posting as minister in 1930 in SK during economic depression

Question 45

Evolution of Medicare: First Stage

Answer 45

-To remove money as a barrier to access to care -Government of SK under tommy Douglas -Municipal & Hospital Services plan (1947) guaranteed residents of Sask hospital care in insurance premiums

Question 46

Evolution of Medicare

Answer 46

-1957 hospital insurance and diagnostic services act -50/50 -Sharing cost

Question 47

Evolution of Medicare: Next step

Answer 47

-1966 Medical Care act (based on Hall commission) =cost sharing of hospital and medical services -All provinces -No one would be denied health care for economic reasons

Question 48

Medical Care Act/Medicare

Answer 48

-Each province/territory was allowed to administer the plan independently within the guidelines set by the Federal government -The 5 pillars of healthcare must be met -Medicare covers hospital costs and medically necessary expenses -Fee for service -2nd stage of Medicare > Prevention

Question 49

5 Pillars of Healthcare

Answer 49

-Universality -Portability -Comprehensive coverage -Public administration -Accessibility

Question 50

Fee for Service

Answer 50

Oldest and most widely accepted method of physician payment in Canada

Question 51

1970’s

Answer 51

-Health system flourished -hospitals were built -Health spending increased -Provinces saw the need for health services within the community -Response: Federal Provincial Fiscal Arrangements/Established Programs Financing Act 1977

Question 52

Established Programs Financing Act

Answer 52

-Funding was reallocated to community services, long term care, ambulatory care, and some components of home care

Question 53

Alexander Fleming

Answer 53

Discovered penicillin

Question 54

Department of health now

Answer 54

Health Canada

Question 55

Asylum first opened in

Answer 55

Islamic societies Was meant to be peaceful until Europe religious view ruined it (different treatment)

Question 56

Type of patients sent to asylums

Answer 56

Those with: Learning disabilities Dementia Post partum

Question 57

1900th century radical treatments

Answer 57

-leaching, spinning chair, insulin shock therapy

Question 58

Trans institutional settings

Answer 58

Smaller Boarding homes Group homes Foster homes Nursing homes Prisons

Question 59

Health Care Reform

Answer 59

-Late 70’s-80’s -Block transfers - provinces paid more -Hospital cutbacks -Restrictions on MD fees -Extra billing -User fees

Question 60

Hall Report #2

Answer 60

-Canada’s National Provincial Health Program Report for the 1980’s -Extra billing - violated Medicare -Was a movement towards a 2-tiered health system -Recommendations: doctors could bill outside Medicare -National standards be set -Accessibility be added -Form a National Health Council

Question 61

1980’s Health Care Reform: Lobby for action

Answer 61

-Canadian Nurses Assoc -Nurse unions -Other health care agencies lobbied strongly for the maintenance and improvement of Medicare

Question 62

1980’s Health Care Reform - Lobby Against Action

Answer 62

-Physicians -Dr strike in Ontario -Banning extra billing violated their rights to contract directly with patients

Question 63

Health Care Reform of 1990’s

Answer 63

-Federal liberals significantly reduced funding to provinces -Hospitals had trouble functioning within reduced budgets -Closures, restructuring, downsizing, services cut and lay offs -Doctors and nurses left the country -Fewer nurses were needed, nursing education programs were cut

Question 64

History of Canada Overview 1950’s-1990’s

Answer 64

-1950’s-1960’s = Federal Government played a central role 50/50 cost sharing -1970’s = Federal Government began to withdraw from central role/less transfer of money, less restrictions -1980’s = increased costs lead provinces to introduce “extra billing” -1984 = Fed Gov concerned of encroachment of universality and accessibility = Canada Health Act 1984 -1990’s = no more money

Question 65

2000’s new report

Answer 65

-From Michael Kirby -2002 -Said Canada’s HC system was not sustainable as operated -Suggested new taxes or insurance based on income -Wanted privatization

Question 66

Evolution of our HC system (2002)

Answer 66

-Royal Commission = The Commission on the Future of Health Care in Canada -Purpose: to preserve Medicare’s survival -The Romanow Commission -Consultations across the country

Question 67

Romanow Commission Findings

Answer 67

-HC system was sustainable -Recommended polices and measured to improve the system and it’s long term sustainability (including reducing wait times) -Create a Health Council of Canada (monitoring body)

Question 68

Romanow’s Recommendations

Answer 68

-To create Rural and Remote Access Fund to improve timely access to care in rural and remote areas -To create Diagnostic Services Fund to reduce wait times for diagnostic services -To develop a Primary Health Care Transfer to remove obstacles to the renewal of primary care delivery (Health Canada)