Module 2 Flashcards
Canada’s HCS is primarily under the control of….
Provinces and Territories –> British North America Act
How are national objectives achieved?
- Financial incentives –> Carrots and sticks by the federal Gov’t
- Voluntary and collaborative action
Define canada’s health care system
-a predominately publically funded, privately delievered system of 13 interlocking independent health care systems
Macro Components
Drugs, Hospitals and other facilities, HCP, Funding
Hospitals
- 95% of hospitals operate on non-profit basis
- Global Spending Budget –> Must operate within this budget
Physicians
- often first point of contact
- systems gatekeepers - control access to specialists, diagnostic testing, etc
- reimbursed by public funded sources
- fee-for-service based on quantity of services provided rather than quality of care
Community HCP paid by….. and hospital paid by…..
- Private, work related insurance, or out of pocket
- Medicare
Is drug therapy often covered by medicare?
No
Do most canadians have drug coverage?
yes
federal drug plans, provincial, private, worker compensation boards
Primary Care
First contact
Pharmacists, nurses, physicians
Doctors office, out-patient clinics, pharmacies, etc
Secondary Care
- Psychiatric medicinal and surgical care
- Network of regional hospitals provide basic acute care and emergency services
PA, North Battleford, Swift Current, etc
Tertiary Care
- Highly sophisticated diagnostic and tx
- Often by referral from secondary care
- Neurosurgery, oncology, etc.
- Regina, Saskatoon, PA
Rehabilitation
- Major emphasis on teamwork and collaboration
Rehabiltation Covered by….
Medicare, Private Insurance or out of pocket, WCB and SGI
Two-tiered healthcare/medicine
Hospitals have global funding. Not included is SGI and WCB. If get WCB and SGI in, get more money
Public –> Longer wait times
personal Care Home
- light needs not covered by community-based services
- cover the cost
Special care homes
- facility that provides institutionalized long term care services to meet:
- People with heavy needs that cannot be appropriately met through home/community based services
Public Health Involves
a) Population health assessment
b) Health promotion, monitoring and surveillance
c) prevention and protection
Define Medicare
- a public-funded single-payer system that provides through hospitals and physician services deemed medically necessary without financial cost to insured persons
HIDS
Hospital insurance and diagnostic services act
- fifty-fifty cost sharing agreement between Feds and Provs
MSA
Medical Services Act
- National medical service program to compliment HIDS
What two acts make medicare?
HIDS and MSA
What are the principles of Medicare?
Publically adminstered
Comprehensive
Universal
Accessible
Portable
Publically Adminstered
The health plan of each province or territory must be administered and operated on a non-profit basis by a public authority accountable to the provincial government.
Comprehensive
must cover all medically necessary services provided by hospitals and physicians. Includes drugs administered in hospitals and a range of out-patient services.
Universal
The plan must entitle 100 percent of the insured population to all insured services based on uniform terms and conditions
Accessible
Must provide reasonable access to insured services without barriers.
Portable
Residents are entitled to coverage when they move to another province, or when travelling within Canada or abroad.
Private Insurance in Medicare
Medicare does not allow for private insurance for health services covered by Medicare.
As a result, private insurance is only available for services not covered by Medicare such as prescription drugs, and services provided by non-physician HCPs in the community
Chaoulli Decision
a right to private insurance where the public system is inadequate
if the public system fails to deliver care within a reasonable time (access), individuals have the legal right to purchase/use private insurance.
Rule of Exclusivity
Doctors are not required to participate in Medicare.
If not participating in Medicare physicians are free to charge patients for covered elective services; but cannot concurrently receive payments from Medicare for some patients and privately for other patients for the same covered services.
Attributes of Quality in Canada’s HCS
Accessible - avilable when and where care is needed
Effective - tx that work
Safe - Low risk of harm
Patient-centered - reflect pts preferences
Equitable - to each according to need
Efficient - best bang for buck
Properly resourced - appropriate funding
Integrated - organized and connected to reduce waste
Population health focus - prevent illness and enhance health
ASEEPP
Stereotype
- a generalized conception of people that results in a concious or unconcious categorization of the members of the group
Prejudice
- beliefs, feelings, opinions and actions directed toward partcular individuals or groups based on stereotypical generalizations
Discrimination
- the denial of equitable treatment, civil liberties and or oppurtunities to individuals or groups
- education, acess to services, employment, etc.
Cycle of Discrimination
- Observed practice/behaviour of entire group
- Stereotype “They are”
- Prejudice “They can’t”
- Discrimination “We won’t”
- Reaction “They will” –> frustrated by attempts to overcome exclusion, group members focus efforts on permitted roles and cativities
Are additional charges allowed in Medicare?
Additional charges for insured services are not allowed; but must also provide a ‘reasonable’ level of compensation to the health care facility or provider
