Module 4 Cda's Health Care System Flashcards
The federal govt’s transfer payment program in support of the health systems of the provinces and territories of Canada
Canada Health Transfer
Federal legislation that sets out the national principals for a “national” health insurance system.
Canada Health Act
Services provided at the first point of contact within the Health Care System. Ie DR, Nurse, Nurse Practitioner, Pharmacist, Dentist
Primary Health Care Services
Services that include specialized care at a hospital or services provided in the home or community (generally for short-term) or in long-term care facilities (generally for long-term and chronic care). Ie adult day care, chronic care in LT facility specialized nursing,
Secondary health Care services
Services that include prescription drugs outside of the hospital, dental care, vision care, medical equipment and appliances, and the services of other health professionals outside of the hospital.
Supplementary Health Care Services
Medically necessary hospital, physician, and surgical-dental services provided to insured persons
Insured Health Services
Residents of a province or territory who are eligible for insured services
Insured Persons
Serving members of the Canadian Forces or inmates of a federal penitentiary
Excluded Persons
Certain aspects of long-term residential care and the health aspects of home care and ambulatory care services.
Extended health Care Services
Medically necessary inpatient and outpatient services provided in a hospital
Insured Hospital Services
Medically required services rendered by medical practitioners. (not specialist)
Insured Physician Services
Services provided by a dentist in a hospital, where a hospital setting is required to properly perform the procedure
Insured sergical-dental services
Payments made directly by the user of the health care services.
Out-of-pocket payments
Services that are not considered medically necessary and are not insured by provincial and territorial health insurance plans. There are also referred to as non-insured services.
Excluded health care services
Something that is administered and operated on a non-profit basis by a public authority.
Public administration
Plans that cover all insured health services provided by hospitals, physicians, or dentists
Comprehensieness
All insured resident of a province or territory must be entitled o the insured health services provided by the provincial/territorial health care insurance plan on uniform terms and conditions
Universality
Residents moving from one province or territory to another must continue to be covered for insured health care services by the home jurisdiction during any waiting period.
Protability
Note: all prov participate in reciprocal agreements (hospitals & physicians) except QB (protability)
Have coverage for 3 mos under old prov if moved
insured residents in a province or territory have reasonable access to insured hospital, medical, and surgical-dental services on uniform terms and conditions
Accessability
When a medical practitioner or dentist bills for an insured service in addition to the amount paid by the provincial/territorial health care plan. Ie. office visit
Extra Billing
Any charges for an insured health care service other than Extra Billing that are permitted by a provincial/territoral plan and are not payable by the Plan. Ie facility fee
User Charge
Includes health services provided to individuals suffering from serious and sudden health conditions that require ongoing professional nursing care and observation
Acute Care
Care required by a person whose acute phase of illness is over or who has a functional disability and requires a range of services and medical management that can only be provided by a hospital
Chronic Care
Practitioners who do not participate in the public health system. They bill patients directly and patient pay them directly.
Non-participating practitioner
