Module 1 Outcomes 5-9 Flashcards
The __________ is the main source of revenue for hospitals.
Province/territory
_________ are the leading health expenditure in Canada
Hospitals
Hospitals collect a significant amount of revenue from the private sector through chargeable services, like:
Parking, food services
List problems facing hospitals.
- Cuts to services
- Reductions in hospital beds
- Closures or merging of hospitals
- Rationalization of services
- Insufficient and demoralized staff
- Long wait lists
Improving efficiency by relegating certain types of care to one facility
Rationalization of services
T or F. Hospitals are expected to act like businesses, ending the fiscal year with a balanced budget
True
What type of funding does a hospital get if they receive money to complete a designated number of hip or knee replacements
Service based funding or case mixed approach
Funding pays hospitals in accordance with the number and types of services the facility provides to each patient
Activity based funding
T or F. Every hospital must be accountable for the funds it requests.
True.
The hospital negotiates with the _________ after completing budget, assessing financial needs, and preparing documentation for appropriate funding
Minister of health
When a hospitals reports its financial status as in the black it means
They are posting a surplus
When a hospitals reports its financial status as in the red it means
They are posting a deficit
What are the costliest things for hospitals?
Staff > infrastructure > diagnostic services > therapeutic services
T or F. Medical staff like doctors residents and interns represent the highest hospital costs.
False. Most of them operate individually of the hospital. Floor inpatient doctors bill their provincial plan for services. Salaried positions or contract positions like the chief of a department, hospitalists are exceptions.
Decreasing ______ is an important way to reduce costs and make beds available to those who need them.
Length of stay
Provinces determine the cost of an insured bed to a hospital by estimating the __________ required by the person occupying the bed.
Services
T or f. A long term care bed costs the hospital more than other beds.
False. The person occupying the bed usually requires less care.
T or F. The use of semi-private and private rooms generates income for a hospital.
True.
T or F. The cost of poor health is what Canada has to pay doctors and their services to treat sick people.
F. The cost of illness, injury and premature mortality is staggering to the Canadian economy. Disease prevention, health promotion, early diagnosis and prompt intervention are effective approaches to fix this.
What are some strategies to decrease LOS?
- Same day ADMISSIONS
- TECH and DAY Surgery
- COMMUNITY services and community health centres
- Timely DISCHARGE
- POSTOP pt discharge
- PALLIATIVE CARE patients
- HOME CARE
T or F. Provinces charge hospitals for an additional 24 hour period if a patient is not discharged by a certain time.
True.
Organizations that return surplus revenue (profits) back to the facility for purposes of maintaining or improving the facility and its operations. Usually managed by a board and not private owners.
Nonprofit Organizations (NPOs)
Costs can be cut by restructuring, downsizing, merging care, etc. also known as ____________
Rationalizing hospital services
What is the purpose of rationalization
- Prevent the DUPLICATION of services
- Provide care at the necessary level within the COMMUNITY
- Better use of RESOURCES
What are the advantages of preventing duplication of services?
- Saves MONEY
- Higher level of CARE
- More sophisticated equipment can be purchased and operated by highly SKILLED professionals
What are the 2 ways hospital mergers occur?
- The horizontal model
2. The vertical model
The _________ model merges several hospitals under one administration—one board, one CEO, one budget—but maintains several sites.
Horizontal. Greys Anatomy
The _________ model merges specific programs within a single organization; however the administration of various programs may remain independent of one another, this not be under the direction of one board.
Vertical
What are the advantages of merging
Reduced duplication of services, higher level of efficiency, lower admin and management costs, more services with better results for patient care and recovery.
What are the cons to merging?
Effects on staff, disruption in a hospital’s culture, lost seniority, displacement of staff members through layoffs
Merging of ______ hospitals appear to be more successful because the resulting facility broadens its service base while retaining staff and improving care.
Smaller
Impatient care in a facility or part of a facility in which the level of care provided meets the physical, mental, and emotional needs of the patient.
Alternate levels of care (ALC)
The ________ govt controls the number of long term beds, so all beds must be approved by the government
Provincial government
The patient must pay a flat rate for basic accommodation that covers the cost of a room and board, etc, a fee called ___________
Copayment
Those unable to pay copayment will be denied accommodation and care.
False. All jurisdictions have alternate funding options for those unable to pay, and no one can be denied accommodation or care.
Next to hospital services, ____ represent the second largest health care expense, the largest portion of which are _______.
Drugs, prescription drugs.
T or F. Canada is one of only a few developed countries without a national drug plan.
True.
T or F. Once a drug has been removed from the list of prescription only drugs, insurance will no longer cover the drug.
True.
Regulates the price at which pharmaceutical companies sell their patented medicines to wholesalers, hospitals and pharmacies or the factory gate price
The Patented Medicine Prices Review Board
PMPRB
T or F. PMPRB can ensure drug companies don’t charge excessive prices but has no jurisdiction over prices retailers charge.
True.
Program that provides physicians access to existing drugs not currently on the market that might prove effective for treating serious or life threading conditions when mainstream medications aren’t readily available
Health Canada’s Special Access Program
T or F. THE PMPRB regulates the prices of nonpatented drug products
False - drug products that were never patented or for which the patent has expired aren’t regulated by the PMPRB
Refers to all people work in the health care field, from doctors nurses lab techs RTs and chiropodists
Human Health Resources (HHR)
The largest of the regulated health care professions is _______ followed by ________
Nursing, medicine (physicians)
T or F. Although physician shortages in all sectors persist, a large number of specialists (orthopaedic surgeons, oncologists, etc) can’t find jobs in Canada
True
Why do a large number of specialists have trouble finding jobs in Canada?
Too many doctors in relation to resources such as operating room/hospital beds, facilities can’t afford to hire them, over abundance of physicians in some specialties, poor geographic distribution
It can take LPNs up to __ years to find a full time position and RNs and physicians up to __ years
10 years, 5 years
Provides a setting in which member governments compare policy experiences, seek answers to common issues, identify practices, and coordinate domestic and international policies
OECD Organisation for Economic Cooperation and Development
T or F. Compared with other countries Canada spends significantly more on health care but has fewer physicians and nurses than other countries
True
Most physicians are paid through the _________ method
Fee for service
The oldest and most widely accepted method of physical payment in Canada.
Fee for service
Doctors charge the provincial plan for every service they perform, the amount of which relates to the COMPLEXITY and LENGTH of the patient visit
Fee for service
Some primary health care reform models blend _____ funding with _______
Capitation based funding with FFS
Pays the doctor for each rostered patient in his or her practice, usually a primarily health care group. Rostered patients are asked to sign a form to say that they will seek medical none merging care only from their family doctor.
Capitation-based or population-based funding
The doctor receives a set amount determined by the age and health status of each patient
Capitation-based funding
Whether the patient visits the doctor once or 30 times per year, the doctor receives the same amount of money for that patient per year
Capitation-based-based funding
Doctors are paid extra for achieving certain milestones like doing routine Pap smears and Pap smears for women in high risk groups, encouraging doctor to be actively involved in disease prevention and health promotion
Capitation-based funding
List the fundamental concepts of capitation based funding.
- Payment based on ROSTERED patients
- Dr. received a GUARANTEED INCOME based on the defined population
- Dr. may enter OTHER COMPENSATIONS; portion of practice may still be FFS
- DISEASE PREVENTION and health promotion INCENTIVES result in better health outcomes
Funding model through which an organization such as a regional health authority receives a set amount of money to manage health care–including staff, services, admin costs, capital expenditures
Indirect capitation
Doctors practicing in underserviced areas are paid a certain fee for maintaining these practices. Also includes vacation time and educational leave
Global budget
Doctors receive a negotiated amount of money per time frame (usually per month). Larger hospitals, medical centres, clinics often employ this model
Salary
Most physicians in Canada who engage in a form of funding other than FFS also partake in another method of payment
Blended Funding
Specialists may have teaching responsibilities and receive a salary
Specialists’ Compensation
If a patient’s health problem recurs, the patient may call the specialists office directly and return for another evaluation
Repeat consultation
If a new problem occurs or if the same problem returns after the designated time period the patient will need another referral
Consultation request
Specialist visits through a primary care provider results in specialists seeing only those patients who have legitimate problems which creates ____________
Cost savings
Federally funded npo responsible for EHR implementation
Canada Health Infoway
Benefits of EHR
- Safety
- Coordination
- Continuity of care
- Substantial cost savings
- High return investments
Represent the top 3 health care expenditures in Canada
Hospitals, drugs and human health resources
Why are the cost of drugs continuing to rise?
- MORE PEOPLE using medications
2. More people using SEVERAL medications
The context and environment in which health care is delivered
Practice settings, includes hospitals, LTC, clinics, etc
A facility that provides support and compassionate care to people who are in the final stages of terminal illness
Hospice
Proposal to ensure that every Canadian has a primary care provider who is the hub of a TEAM of professionals
Patient’s Medical Home (PMH)
A setting in which multiple health care providers work collaboratively, usually in a similar field, to provide cost effective patient centred health care
Clinic
The organizational and physical environment in which a person receives POINT OF ENTRY care
Primary care setting
Multiple health care workers from a variety of professions working together to deliver evidence informed patient centred health care
Interprofessional collaboration
Care provided for the patient in the home or on an outpatient basis rather than in the hospital or another health care facility
Community based care
What is the purpose of community based care
- Reduced COST by shortening hospital stays
- Enhance patient RECOVERY
- Minimize risk for hospital based INFECTIONS
What makes community based care possible?
- New PROCEDURES
- Increased community SUPPORT for home care
- MULTIDISCIPLINARY TEAMS in primary care settings
What three categories have health care providers been divided into
- Health professionals (doctors, nurses and specialists)
- Allied health professionals (osteopaths, psychologists)
- Complementary and alternative practitioners (aboriginal healers, naturopaths)
Allied health professionals are now being classified along with core health one professionals in one overarching group called ________
Conventional health professionals
A person who has graduated from a health related college or university program and is accredited by a professional or regulating body. Person must be licensed by the provincial govt
Health care provider
Health are provider other than a doctor, nurse, pharmacist and dentist who provides supportive health care including direct patient care, technical care and support services
Allied health professional
Prescribed methods or techniques
Modalities
Medicine that diagnoses health problems, treat predisposed health problems, and render technical therapeutic or supportive care with scientifically proven therapies medication and surgery
Conventional medicine
Medicine practised by all health care providers not considered mainstream or conventional
Complementary and Alternative Medicine (CAM)
What’s he difference between complementary and alternative medicine
As their names suggest, complementary medicine SUPPORTS or complements conventional medicine while alternative medicine typically provides an alternative that often excludes conventional medicine
Proven through high quality scientific studies to be effective
Evidence informed
Why do a significant number of people use CAM at some point in their lives
- Disillusionment with conventional treatment
- Difficult appointments
- Cultural influences
- Internet info
Why do people disregard conventional medicine
- Mainstream medicine may have nothing left to offer
- Patient suffered a bad experience with conventional practice
- Patient holds health belief system that contradicts conventional medicine
T or F. In general, the father apart the philosophies of practitioners, the less likely they are to understand and work with one another
True.
The majority of health care professionals are ______ meaning a professional body enters into an agreement with the government to exercise control over and set standards for its members
Self regulated
Regulatory authority is granted through _______ such as an act or statute that outlines the framework for behaviour and values for a given profession
Legislation
_________ legislation provides the legal framework for regulation most health cafe professions in Canada
Provincial and territorial
______ and _______ make up the largest groups of regulated care providers
Nursing and medicine
What are the characteristics of regulated profession?
- TITLE Protection
- CONTROLLED Acts
- DELEGATED Acts
- COMPLAINT Process
- EDUCATIONAL Standards
- LICENSE to Practice
- Provincial EXAMS
- SCOPE of practice
CEC DELTS
Complaint, exams, controlled, delegated, educational standards, license, title protection, scope of practice
Legal restrictions around and guidelines for the use of a professional title. Only properly trained persons can legally use that title
Title protection
A range of skills that a practitioner can perform competently and safely. Legal parameters dictate what a practitioner may or may not do based on the profession’s education, training, and licensure
Scope of practice
How does regulation protect a profession and the public?
By ensuring that their within a given profession are who they claim to be and do what they claim to do in a competent and safe manner. It proves a person has undergone training and gained a predetermined degree of knowledge skill or ability.
An act that may be performed only by authorized regulated health care providers, specified in the _______ Act
Controlled act or reserved act in BC, Regulated Health Professions Act
List controlled acts that can be performed in certain situations by competent yet nonregulated individuals
- First aid or assistance in an emergency
- Students learning to perform under supervision (as long as that act is within the scope of practice for that profession)
- Caregivers
- In accordance with a religion
A controlled act that a physician authorizes another health care provider, either regulated or unregulated, to do in his or her stead and under supervision
Delegated acts
Delegated act supervision can be ____ (physician physically present) or ______ (physician available by phone)
Direct or indirect
In health care orgs, the ____ and the ____ must agree to the rules and procedures for delegated acts
In health care orgs, the board of directors and the medical advisory committee must agree to the rules and procedures for delegated acts
T or F. The delegating physician, the delegate, and the facility in which the act is performed share responsibility for the act
True
The patient must give _________ to allow someone other than a physician to perform a procedure
Informed consent
What is the complaint process?
System where the public can launch complaints against a health care provider. Providers found at fault may face suspension, additional training, loss of license or even legal proceedings
T or F. Educational standards include theoretical and practical components of their training as well as examinations for entry to practice.
True
Professional bodies often use _____ to ensure continued maintenance of practise standard protecting both the health care provider and the public
Competency based assessment programs
List examples of competency based assessment programs
Self assessment tools, continuing Ed, keeping a record of professional activities, and a combo of these
T or F. Proof that educational standards have been met is a requirement for renewal of a professional’s license to practice.
True.
Only __% of Canada’s workforce works in regulated professions
20%
A program that meets standards requisite for its graduates; standards set by the profession’s governing body which may be national or provincial
Accredited program
HIM professionals hold the designation of _____
CHIM—Certified in HIM
Administers the national exam on behalf of CHIMA
Canadian College of HIM (CCHIM)
The national body representing approximately 5000 HIM professionals
Canadian HIM Association (CHIMA)
How does one be corn a CHIM
- Graduate from a CHIMA accredited diploma or degree program
- Successfully challenge the NCE
CHIMA members are required to earn ____ credits to maintain certification
Continuing professional education (CPE) credits
Four domains of practice for HIMs
Data quality
eHim
Privacy
HIM standards
What do HIMs do
Data and information collection Analysis Retrieval Destruction Of health info
Him professionals are trained in what 6 core competency areas
- BIOMEDICAL SCIENCES
- Health care systems in Canada
- Health INFO
- Info systems and tech
- Management aspects
- Professional practice
An association that provides direction support continuing Ed and networking opportunities for its professional members
Affiliating body
Why are clinics valuable
COST Effectiveness
TIMELY access
Patient FOCUS
What is primary health care reform
The most effective way to deliver high quality primary care to the greatest number of people was through aligning health professionals from varying disciplines into some sort of group practice
The newest and most comprehensive primary care model in Alberta
Family Care Clinics (FCC)
In Alberta, focuses on improving health outcomes in mental health, respiratory, hesrt health, emergence and critical care fields
Stratehiya Clinicsl Networks (SCNs)
In Alberta, improves general health outcomes by improving patients experience with the health care system, shortening wait times, ensuring care availability
Operational Clinical Networks (OCN)
The registering of a patient in a primary health care reform group. Patients sign a form stating they will seek care only from a specific doctor or primary care group
Rostering
Rostering is also called
Patient attachment or formal registration
What are the advantages of primary care networks
- Effective point of contact care
2. Applying knowledge and expertise from a variety of health care providers INDIVIDUALIZES health care
Similar to primary health care reform groups except that a third party receives and manages their funding
Health service organizations
What are the practice settings where health care is delivered
Hospitals, homes, clinics (urgent care, walk in, ambulatory care, outpatient, nurse practitioner clinics)
Challenges within mental health as a trend in healthcare can be divided into what three broad categories?
Homelessness
The Justice System
Employment
JES
What is the name of the 2012 national strategy for mental health (the first such strategy)?
Changing Directions, Changing Lives CDCL
What are the associated concerns related to Canada’s aging population?
Lower Taxation Base
Loss of Skilled Labour
Physicians Time
Acute Care Hospital Beds
TLTB
Taxation, loss of labour, time, beds
What are the reasons we have a regulated nursing shortage in Canada?
Funding cutbacks in 80s and 90s meant fewer nursing jobs > decreased graduating nurses > or nurses that left country to look for jobs which we are still trying to recoup. Working conditions contribute as well. Attrition is also a factor; nurses approaching retirement are continually increasing
What are some of the initiatives to continue to increase the number of family practitioners in Canada?
Medical schools increase enrolment
Easier entry to practice foreign physicians
Personal time and flexibility
Turnkey operations
What are the barriers encountered in home care?
Insufficient numbers of trained home care workers
Limited provincial insurances coverage for those services
Inconsistent, poorly coordinated and poor quality care
Scheduling/communication problems between caregivers
Workers, insurance, poor care, scheduling
WIPS
What has the Canadian Medical Association proposed to cover home care and other extended care services as an alternative to reopening the Canada Health Act?
Canada Extended Health Services Act (CEHSA)
What are the common issues that contribute to wait lists across the country?
Increase in number of people requiring services
Shortage of HHR
Limited access to diagnostic services, operating rooms, operating times for surgeons
Lack of service coordination
Patients, lack of Providers, Diagnostic services, Operating, Service coord
PPDOS
What are some of the issues related to emergency department wait times?
Visits for nonessential reasons, shortage of family doctors, shortage of ED staff, chronic conditions
NFEC
NONESSENTIAL, family doctors, emerg staff, chronic conditions
A person without a family doctor
Orphan patients
What are some of the issues challenges to aboriginal health care (related to the determinants of health)?
Unemployment Education Food Insecurity Housing Mental Health and Substance Abuse Chronic Diseases Sexual Health and Pregnancies Children Older Indiginous Morbidity/Mortality Rates
MHCC
Mental Health Commission of Canada
