The Canadian Healthcare system Flashcards
What is the WHO definition of health? is it realistic?
Health is the state of complete physical, mental and social well being. No one has it all, this is based on individuality. (WHO definition)
- Not just the absence of disease.
not realistic
What does a good healthcare system require (5)
- Financing mechanism
- Well maintained facilities
- Well-trained and adequately paid workforce
- Reliable information (to base decisions)
- Logistics to deliver quality medicines and technologies
Would more money fix our healthcare system? why?
No. Fixing the system should be through data and outcomes first
What is Medicare? Who is covered?
Canada’s publicly funded healthcare system
All citizens and permanent residents
What is the provincial government responsible for
Management, organization, and DELIVERY of healthcare
What is the federal government responsible for
- set national standards
- provide funding support for provinces
- Support delivery of healthcare
What are the 3 characteristics of Medicare
- Curative system
- works to cure illness rather than prevent
- Fragmented
- Some part of private with mostly public system
- Shared responsibility between federal and provincial
- Mixed funding
- 75/25% split for public/private. used to be 50/50
- Works by public payment to private providers
Where is money being spent in Canada?
25% hospital
13.9 % drugs
13.5 % physicians
How much do we spend as % of GDP
12.7%?
How were hospitals in the 17th century funded?
Catholic charities, religious groups, and wealthy donors
How were doctors working in the 18th century working
The Hudson’s Bay company employed doctors on the prairies and across BC during this period
How were hospital funds in the 19th century operating
Funds to operate large hospitals were in short supply
Explain the British North American act
1867
- stated that healthcare is a PROVINCIAL responsibility
- however federal were still in charge of marine and military hospitals
- Ontario passed an act that provided them with annual grants to the hospitals
- CMA + college of physicians and surgeons founded
What was pre-confederation like? (1867-1914)
Lack of funds and quality was bad.
What happened in 1910-1914
- Government discouraged patient-MD relationships and said that healthcare is a responsibility of the government
- CMA wanted a fee-for-service model
What occurred in 1914-1918
What happened on black tuesday (1929)
- A lot of veterans came back injured, lots of babies and cannot afford health
- Cannot pay medical bills and doctors could not afford a wage
- CMA wanted a publicly funded HC
What was the BC project in 1935
They proposed a plan to have. a capitation model ( a per-patient payment for rostered patient) rather than a FFS model
- was denied by the CMA
What was the 1948 National health Grants Program
1st stage to develop a comprehensive health insurance
What occurred in the Saskatchewan story in 1944
Tommy Douglas was brought into power
- Implemented a plan that’s fee-for-service but eventually switched to an insurance system
- His five principles:
prepayment, universal coverage, quality care, public administration (non-profit entities for health) and acceptability.
- Doctors didn’t like the change and went on strike.
- Eventually he gave those who wanted a chance to OPT out and bill patients directly
First province to implement universal healthcare insurance
What did the 1957 Hospital insurance and Diagnostic Services Act entail
What was covered and what was not?
the FEDs cover 50% of provincial costs for hospitals and diagnostic services.
Covered
- Acute
- Convalescent
- Chronic care of patients Diagnostic services
- In-patient drug administration in hospital
Not covered
- Hospitals for tuberculosis
- Mental hospitals
- Nursing homes
- Capital expenditures
- Administrative costs
What was The Royal Commission on Health Services (1961-1964) (Hall Commission #1)
What were the issues and barriers?
What were the 3 main areas they focused on in HC
“Assess readiness for national system of medical services insurance” (a delay tactic by CMA and SCPS) and a call for “Health Charter for Canadians”
Issues
- Financing methods
- Requirements for health services
- Costs of health services
- Methods of improving the services
Barriers
- Increasing Quebec nationalism
- Alberta & Ontario opposed to federal intrusion
3 main focus areas
1. Health Services
2. Health personnel, facilities, research
3. Financing and priorities
What happened in the Medicare Act in 1966
National healthcare plan for all provinces.
- 50/50 cost share between FED and public with an opt-out option for doctors
- opt out option means physicians can charge patients directly and they can get reimbursed from the province
- became unsustainable since doctors were now overbilling privately (MD income increased)
What did the Hall commission #2 recommend in 1979 after the Medicare act
Needed to review “hospital insurance and the diagnostic services act”
- Goal was to eliminate overbilling by MDs and review the opt out plan
- Doctors did not want this
What happened during the Canada Health Act in 1984
It brought both acts together
- the hospital insurance and diagnostic services act (1957)
- Medical care act (1966)
- Establishes conditions and criterias for insured health care services (national standards that provinces must meet in order to get federal funding)
- Universal coverage for surgical, dental, and physician services
