Unit 8 Flashcards
discuss the rationale behind the shift in focus of the health care system from institutions to community‑based service delivery models.
Governments are interested in shifting the focus of the health care system from institutional services to community‑based or primary health care services for a variety of reasons:
Services provided in institutions tend to be more expensive than comparable services provided in community settings. This is due to the higher level of technology associated with institutional care, especially hospital care. Increasing levels of technology now surround hospital beds and require specialized personnel and greater expense to operate the technology. However, this higher level of technology does not necessarily mean better health.
Services provided in institutions tend to be geared towards sickness, as opposed to health. This emphasis does not fit with an overall strategy of encouraging people to stay healthy. As the “determinants of health” framework suggests, many of the factors that affect our health are outside the scope of the health care sector. To improve the health of the population, we need to create healthy and natural social and economic environments. Hospitals and other health care institutions have relatively little influence on these environments. The focus of health care institutions is largely to deal with people after these environments have adversely affected them. If we intend to encourage people to take more responsibility for their health, we need to place more emphasis on prevention and promotion services in communities and workplaces.
The length of time that a patient remains in an institution does not equate with improved health. In other words, many patients do not need to stay in institutions for long periods of time. They usually recover faster when they are at home. In fact, some research suggests that the longer a patient remains in hospital, the more likely he or she may develop other ailments.
A “determinants of health” framework implies that the health of individuals and communities is affected by a wide range of factors, many of which are beyond the traditional boundaries of health care organizations and programs. Therefore, there is a need for a multidisciplinary, multi‑sector approach to address the health requirements of the population. This means increased coordination, if not integration, among health care providers, organizations and programs. In addition, this approach will require increased links between the health sector and other sectors that provide services with the potential to have an impact on the health of the population (i.e., social services, education, housing, transportation, environment).
identify the major elements of an ideal primary health care system.
One common element is that primary health care involves the first contact an individual has with the health system.
Primary health care, while recognizing the importance and need for intervention and care components of health, is also consistent with a strong emphasis on determinants of health and population health strategies, disease and injury prevention, health promotion, and the active involvement of communities and individuals, in partnership with providers, regarding decisions that affect their health.
compare some current examples of primary health care.
Community Health Centres are non profit health corporations controlled by locally elected boards. Centres provide a range of primary health and social services to geographically or culturally distinct populations. The range of services that CHCs provide include primary health care, health promotion, health prevention, community development, community outreach, chiropody, dental care, social services and legal aid
Primary Health Care Transition Fund to support provinces and territories in reforming their primary care systems and to help their transition to new models of primary care delivery. A number of national initiatives undertaken through this initiative helped the federal jurisdiction move forward with primary health care reform.
Primary Care Networks (PCNs) in which groups of family doctors and local health authorities coordinate services for patients. The intent is to place more emphasis on health promotion, disease and injury prevention, chronic disease management, and taking care of patients who have medically complex problems.
examine the evidence surrounding examples of primary health care.
All of the many other factors that influence health become important in a primary health care system, e.g., housing, education, employment and income, support groups, transportation and the environment. Such a system includes health promotion and illness and injury prevention. It also more comprehensively includes alternative health care providers and health care givers that are not prominent in the current acute-care focused system. Primary care services are, therefore, provided by a variety of professionals and reach beyond the current health sector’s breadth.
examine possible future directions for the development of a health care system focused on primary health care.
The major challenges for health care policy makers and providers include
trying to make available health care services in rural and remote communities. trying to supply health care services that meet the needs of special communities. attempting to predict and manage the supply of health care providers.
compare and contrast the challenges associated with the provision of health services to rural and remote communities,
X‑ray machines, MRIs, CAT scanners, high technology surgical suites, and technology for monitoring patients before and after surgery are major elements in the collection of tools employed by health providers to treat illness. All these technologies are costly and need to be used frequently to be cost efficient. In rural areas, often there are not enough patients to generate sufficient volume to justify high‑tech equipment in local hospitals. The same can be said about certain surgical procedures.
A second factor is the need for government to place limits on the amount of money devoted to health care. In the past, government built hospitals in many small communities, often based on political considerations. These hospitals, in addition to representing a source of comfort in times of medical emergencies, also symbolized security and prosperity for local residents.
A third factor to consider is the availability of the highly trained personnel necessary to provide services in rural or remote communities. The further away from a major urban centre a community is, the harder it becomes to attract health care providers.
A final factor is nursing support. The majority of nurses are trained to work in hospitals, and the relative lack of rural or remote hospital facilities of a sufficient size to employ large numbers of nurses makes it difficult to attract nurses to these locations.
understand the rationale for regionalization of health services in provinces.
In addition to hospitals, health services were provided through institutions and service organizations. There were local public health departments that were responsible
For example, the Premier’s Advisory Council on Health for Alberta (2001) recommended consolidating the more than 200 existing governance structures in health into nine Health Authorities. In Saskatchewan, the Commission on Medicare (2001) recommended creating 15 comprehensive Health Service Divisions to replace over 400 local boards.
To begin with, it was expected that regional authorities would help integrate services and provide continuity of care. Whereas in the past, patients may have had to navigate their way through entirely separate systems in a single province, in the “new world” of regional health authorities, the navigation from acute hospital care to cancer services, home services and, perhaps, palliative care would be connected.
Through the regional health authority program, governments also felt they were responding to greater demands for increased accountability of the health care system to the public, and requesting more public input. They felt they were devolving and decentralizing decision making in health care as a whole to the community.
Inuit and indigenous Communties compare and constrast
Many Inuit and First Nations communities are located in remote areas of the country and, because of this remoteness, the problems associated with providing health services are often greater.
There are also cultural barriers. As Europeans settled in Canada, the approach of the Canadian government to First Nations peoples was to segregate them on reserves and provide for their needs in a paternalistic fashion. The result of this approach has been to both isolate First Nations people from the mainstream of Canadian society and retard the natural growth of their culture.
Of the treaties signed with First Nations in Western Canada, only Treaty Six specifically mentions medical care (the medicine chest clause). First Nations organizations have taken the position that the spirit and intent of the treaties provides a right to medical care. However, the federal government’s position has been that it provides medical care as a matter of policy, a position that has been supported in several court decisions.
One explanation for the health problems is that services tend to be delivered based on the medical model. That is, intervention usually occurs after illness.
compare and contrast the challenges associated with the provision of health services to multicultural populations
Although located primarily in major urban centres, visible minority populations face a host of linguistic, cultural and economic barriers.
Immigrants may find that health providers in hospitals speak only English. This language barrier makes two‑way communication about a medical problem difficult, especially if it involves discussing complex medical issues and procedures. Moreover, some medical interventions considered appropriate by the standards of Western industrialized countries may not be considered appropriate by other cultures, and vice versa.
Newcomers to Canada often face significant economic barriers to accessing health services.
