PPHC 02: Health – How does the Canadian Health Care System work?

Question 1

What is a health care system?

Answer 1

organization of people, institutions, and resources that deliver health care to meet the health needs of target populations

Question 2

What do health care systems require? (4)

Answer 2

• well-trained and adequately paid workforce (WHO)
• well maintained facilities and logistics to deliver healthcare (WHERE)
• financing mechanism (HOW)
• reliable information on which to base decisions and policies (HOW)

Question 3

Describe the structure of the Canadian health care system.

Answer 3

not a single system – 13 provincial/territorial health care systems working in parallel with differences

Question 4

What is the Canada Health Act (1984)?

Answer 4

legislation that defines national principles for provincial and territorial health insurance plans

• provinces and territories are constitutionally responsible for the organization and delivery of health care
• sets conditions for provincial and territorial health care systems to meet in order to obtain federal contributions via the Canada Health Transfer

Question 5

What is the Canada Health Transfer?

Answer 5

federal transfer payment program to support provincial and territorial health care systems

• ## provides long-term funding for health care and supports principles of the Canada Health Act

Question 6

What are the 9 requirements under the Canada Health Act that provinces and territories must meet to qualify for full federal funding through the Canada Health Act?

Answer 6

• 5 criteria of the Canada Health Act – public administration, comprehensiveness, universality, portability, accessibility
• 2 conditions that apply to insured health care services and extended health care services – information, recognition
• 2 extra-billing and user charges provisions that apply only to insured health care services (ensure no patient charges)

Question 7

What are the 5 criteria of the Canada Health Act?

Answer 7

• public administration
• comprehensiveness
• universality
• portability
• accessibility

Question 8

What is the public administration criteria of the Canada Health Act?

Answer 8

provincial/territorial health insurance plans must be administered and operated on a non-profit basis by a public authority

• ie. BC → Health Insurance BC through Medical Services Plan (MSP)
• ie. Quebec → Regie de l’assurance maladie due Quebec (RAMQ)

Question 9

What is the comprehensiveness criteria of the Canada Health Act?

Answer 9

• provincial/territorial health insurance plans must cover all medically necessary health services provided by physicians, hospitals, and dentists when performed in hospitals
• provincial/territorial insurance plans decide on what are medically necessary for health care insurance purposes

Question 10

What is the universality criteria of the Canada Health Act?

Answer 10

provincial/territorial health insurance plans must cover all residents on uniform terms

Question 11

What is the portability criteria of the Canada Health Act?

Answer 11

• provincial/territorial health insurance plans must cover residents when they move within Canada
• residents temporarily away from their home provinces or territories must continue to be covered for insured health care services
• residents permanently moving from one province or territory to another must continue to be covered for insured health services by the ‘home’ province during any minimum waiting period (not to exceed 3 months) imposed by the new province of residence – after the waiting period, the new province or territory of residence assumes health care coverage

Question 12

What is the accessibility criteria of the Canada Health Act?

Answer 12

• provincial/territorial plans must provide all residents reasonable access to medically necessary services
• access must be based on medical need and not impeded by ability to pay (socioeconomic status), age, and health status

Question 13

What is the responsibility of the BC Ministry of Health?

Answer 13

to ensure quality, appropriate, cost-effective, and timely health services are available for all British Columbians

• set policies – definition of insured health care services
• set budget
• regulate health professional bodies – licensure, discipline

Question 14

Describe inpatient health care organization.

Answer 14

• many provinces/territories have ‘regionalized’ inpatient health care – region is responsible for inpatient health care for residents through hospitals, long-term care facilities
• funded by the province within the global budget (ie. province → health authority → hospital)

Question 15

What are the 5 regional health authorities?

Answer 15

• Northern Health (NHA)
• Interior Health (IHA)
• Fraser Health (FHA)
• Vancouver Island (VIHA)
• Vancouver Coastal (VCHA)

Question 16

What is the 1 provincial health authority?

Answer 16

PHSA

• coordination and delivery of provincial programs and highly specialized health care services

Question 17

How are physicians paid?

Answer 17

predominantly fee-for-service

• fee schedules are negotiated
• fee schedules are administered by the province
  funded directly by the province (contrast with funding for inpatient health care)

Question 18

What are the 2 types of outpatient health care?

Answer 18

• physicians
• prescription drugs