WEEK 7 Flashcards
what are the four determinants of health
physical/social environment, individual characteristics, health behvaiours/lifestyle, and access to health services
what is a health care system?
Following the definition of the World Health Organization, a health system consists of all organizations, people and actions whose primary intent is to promote, restore, or maintain health
what are the goals of a health care system
improving health and health equity in ways that are responsive, financially fair, and make the best, or most efficient, use of available resources
what are the components of a health care system
Agencies that plan, fund and regulate health care
The money that finances health care
Those who provide preventive health services
Those who provide clinical services
Those who provide specialized inputs into health care, such as the education of healthcare professionals and the production of drugs and medical devices
what are the three functions of health system financing
revenue collection, funds pooling, purchasing
what are the two functions of health system service provision
personal health services and non personal health service
what are the structures of a health system
Human resources
Facilities
Know-how
Information
Organization
Finance
Legal norms
Technology
what are the outcomes of a health care system
Decline in disease and health
Increase is quality and equity
Increase is economy (e.g., cost/effectiveness)
Increase in scientific knowledge
Increase in prestige
Social peace
what are the three levels of health care?
Primary, secondary, tertiary
what is primary health care?
first point of contact, speaks of health as a human right, outlines content as care that is essential and socially acceptable
what is secondary health care?
care provided by some specialist physicians and general hospitals
what is tertiary health care?
provided by an array of specialists physicians and specialized
how are levels of health care organized
geographic area
what is PPP
public private partnerships
what is public sector
national, state/province/regional or municipal level
what is a private sector
for profit and non-for-profit
what is a NGO
nongovernmental organization that is a large of small, local, national, or international health system
what are the roles of public health systems
Stewardship of the system
Raising and allocation of funds
Establishing approaches to health insurance
Managing key public health functions
what are the roles of private for profit health systems
Provision of services including non-licensd “medical practitioners”
Operation of health clinics, hospitals, services, and laboratories
Can partner with the public sector or work under contract to the public sector
what are the roles of NGO, and private not for profit health care systems
Community based efforts to promote better health through education, improved water and sanitation
Carry out health services
Can partner with the public sector or work under contract to the public sector
which category has the highest private expenditure
poorer countries
what is total health expenditure
a share of GDP varies across countries
what has made health care spending double?
aging, population growth, inflation, increased use of services
how much did U.S health care spending grow in 2016?
4.3%
what is Germany’s health system
Social insurance scheme
Organized around insurance funds financed employers and employees
Funds serve as an intermediary to organize and pay for services
Funds have contracts with associations of physicians and hospitals
Government regulates health system
what is the U.S health system
Combination of public and private financing
Overwhelmingly private provision of care
50% of financing comes from Medicaid, Medicare, Veterans Administration and Worker’s compensation remaining of 50% of financing comes from individuals and their employers
Types of health insurance vary greatly
Many people lack insurance
Affordable care act (Obamacare) signed into a law in 2010
what is Costa Rica’s health system?
Federal government controls most of the health sector directly
Country is divided into health areas served by health teams
Social security
Administration owns most hospitals
Financing provided by taxes
Participants receive most services for free
what is brazils health system?
Publicly owned services at the federal, state, and municipal levels, as well as the military
Private sector services contracted by the public sector
Private sector services paid for by individuals or corporate health insurance
what groups are affecting by problems with quality
low, middle, and high income
how are health systems financed
by rationing services
what is Canada’s healthcare system
Publicly financed and privately delivered
14 interlocking systems: healthcare service delivery is the purview of the individual provinces and territories, the federal government provides fiscal support
Health support for indigenous people is seen as the federal government’s responsibility as outlined in the “indian act” (1876)
The canada health act (1984) lays out the rules and a national “minimum standard” for the provinces to follow
The defining feature of Canada’s healthcare system: it is universal and publicly financed health insurance for medically necessary hospital and physician service
No user fees or extra billing
what is the role of the federal government
Legislation - canada health act
Funding - canada health and social transfer
Program delivery - direct provider of healthcare services for certain groups (e.g., first nations and Inuit, veterans and members of the military, and royal canadian mounted police)
Population and public health programs
Health protection and regulatory activities
Health research
what is the role of provincial and territorial government
Management and delivery of health care services insured health care services (e.g., medically necessary hospital and physician services) supplementary programs (e.g., prescription drugs, home care)
Funding health care services
Health research
Public health and health promotion
Health services delivery and management
Managing prescription care (e.g., Pharmacare in BC) and some areas of public health (e.g., BC CDC)
Hospital care planning, financing, and evaluating, physician hiring and management, and allied health care services
what is the accessibility pillar of the Canada health act
the provincial and territorial plans must provide all insured persons reasonable access to medically necessary hospital and physician services without financial or other barriers
what is the comprehensiveness pillar of the Canada health act
the provincial and territorial plans must insure all medically necessary services provided by hospitals, medical practitioners and dentists working within a hospital setting
what is the portaility pillar of the Canada health act
the provincial and territorial plans must cover all insured persons when they move to another province or territory within Canada and when they travel abroad. The provinces and territories have some limits on coverage for services provided outside Canada and may require prior approval for non-emergency services delivered outside their jurisdiction
what is the public administration pillar of the Canada health act
the provincial and territorial plans must be administered and operated on a non-profit basis by a public authority accountable to the provincial or territorial government
what is the universality pillar of the Canada health act
the provincial and territorial plans must entitle all insured persons to health insurance coverage on uniform terms and conditions
what is the goals of Canada health act coverage
Covers “medically necessary” physician and hospital services
Dependent on federal government transfers
Accountability
sustainability
what are services outside of the Canada Health Act coverage
Dental care
Home care
Long-term care
Prescription drugs
physiotherapy
what is the Canadian system funded by?
general tax revenue (25-50% federal)
how is the price of pharmaceuticals determined?
varies by province and formularies are set up at the provincial level
what must a doctor have in order to bill in Canada
must be registered as a practitioner in the province, must have a billing number, and must be eligible and qualified to bill for the specific code indicated
how are bills submitted
electronically on forms online through the web or via a direct connection to the MSP office
what are the categories of health care providers
regulated, or non-regulated, unionized or non-unionized, employed, self-employed or volunteer
what category do most doctors work in
independent or group practice are not employed by the government
what category do nurses work in
in hospitals, they also provide community health care, including home care and public health services
what category do dentists work in
independent practice
what is included in allied health professionals
dental hygienists; laboratory and medical technicians; optometrists; pharmacists; physio and occupational therapists; psychologists; speech language pathologists and audiologists
what did the 1876 Indian act state
that indigenous services are a federal responsibility
what did the 1979 Indian health policy state
The policy outlines the roles of the federal government as public health activities on reserves, health promotion, and the detection and mitigation of hazards to health and in the environment
what was Bill C-31
it allowed women who regained status to pass on their status to only one generation; leaving grandchildren unable to obtain status
what does Jordan’s principle ensure?
that first nations children can access all public services when they need them. Services need to be culturally-based and take into full account the historical disadvantage linked to colonization that many first nations children live with. The government of first contract pays for the service
what is NIHB
non-insured health benefits
what is the NIHB program
provides eligible first nations and inuit clients with coverage for a range of health benefits that are not covered through other social programs, private insurance plans, provincial or territorial health insurance
what does NIHB cover
Vision care
Dental care
Mental health counseling
Medical supplies and equipment
Prescription and over the counter medications
Medical transportation to access medically required health services that are not available on reserve or in the community of residence
how does Canada’s health spending compare?
Canada is above the OECD average in terms of per-person spending on health care, the public-sector share of total health expenditure is below the OECD average
why does the US and Canada differ as to health system preferences
Culture, History, form of government
what are wait times a result of in Canada?
budget cuts in 1990’s
what are wait times a result of in USA?
because of cost
what are the catalysts for health policy
access, cost, quality
what is amenable mortality
defined as deaths from a collection of diseases, such as diabetes and appendicitis, that are potentially preventable given effective and timely health care
what is included when measuring cost of health care
fixed costs, variable costs, payment for services, payment for goods, losses from non-payment
what is excluded when measuring cost of health care
opportunity costs, costs of educating health professionals, expenditures on the determinants of health
what is the safety element of healthcare
ensure that the medical care intended to benefit patients is not causing harm
what is the effectiveness element of healthcare
medical treatments must be based on scientific knowledge, and must produce beneficial, measurable results
what is the patient-centered element of healthcare
care must be tailored to individual patient preferences, needs and values, patients should have authority over their own medical care, and their input must guide clinical decision making
what is the timeliness element of healthcare
patients requiring medical attention should have access to timely healthcare and follow-up care to avoid potentially harmful delays in treatment
what is the efficiency element of healthcare
quality health care avoids wasting finances, time, equipment, and energy. Efficiency maximize the impact of global health organizations
what is the equitability element of healthcare
the quality of medical care must be consistent across all patients, irrespective of gender, ethnicity, socioeconomic status, and other personal characteristics
what are the Characteristics of Indigenous Primary Healthcare Service Delivery Models?
accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment
what national commission occurred in 1961-64
Justice Emmett Hall led the commission recommended comprehensive health coverage for all Canadians and development of national policy in health services, health personnel, and healthcare financing
what national commission occurred in 1973-74
led by Marc Lalonde, Canadian minister of national health and welfare, this paper introduced the public health imperative and called for the prevention of illness and promotion of good health. It called for the expansion of the healthcare system beyond disease-based medical care
what national commission occurred in 1979-80
Led by Justice Emmett Hall, this review reported on the progress made since the 1964 commission and sought to determine whether provinces were meeting the criteria of the medical care insurance act. This inquiry identified widespread extra billing and user fees and served as a catalyst for the Canada Health Act
what national commission occurred in 1991-96
Royal Commission on Aboriginal peoples: the commission investigated the evolution of the relationships between aboriginal and non aboriginal people and governments in Canada. Major recommendations included the training of 10,000 health professionals over a ten year period
what national commission occurred in 1993-97
commission of inquiry on the blood system in Canada (Krever inquiry). Led by Justice Horace Krever, the commission investigated the use of contaminated blood products that infected 2000 transfusion recipients with HIV and 30,000 with hepatitis C between 1980 and 1990. This commission led to the creation of Canadian Blood Services in 1998
what national commission occurred in 1994-97
National forum on health: commissioned by Prime Minister Jean Chretien, this group of experts from across Canada focused on broad determinants of health and the need for enhanced emphasis on evidence-based care
what national commission occurred in 1999-2002
standing senate committee on social affairs, science and technology study on the state of the health care system in canada (Kirby Committee). Led by senator Michael Kirby, this committee conducted a comprehensive review of Canadian health care. Recommendations included a call for enhanced federal oversight to ensure effective care and efficient resource use, and highlighted poor health human resource planning as a cause of geographical inequities
what national commission occurred in 2001-02
commission on the future of health care in Canada (Romanow Commission): led by former Saskatchewan Premier Roy Romanow, the commission called for a renewed commitment to the values of equity, fairness, and solidarity. The report was the catalyst for the 2003 accords and the establishment of the health council of canada (defunded in 2014) to monitor progress on key objectives
what national commission occurred in 2003
national advisory committee on severe acute respiratory syndrome (SARS) and public health: led by David Naylor, this committee was established to review the circumstances of the 2003 SARS outbreak. The report identified significant issues with public health in Canada and led to the creation of the public health agency of Canada
what national commission occurred in 2008-2015
Truth and Reconciliation Commission of Canada undertaken as part of holistic and comprehensive response to the systemic abuse suffered by indigenous Canadians under the Indian Residential School system, the commission identified calls to action to advance reconciliation. Although not specifically focused on health care, the report highlighted substantial gaps in health care for indigenous people and outlined the substantial impact of the trauma on mental and physical health
what national commission occurred in 2015
Advisory Panel on Healthcare Innovation: led by David Naylor, the panel’s unleashing innovation report highlighted the need for enhanced patient engagement, workforce modernisation, technological transformation, and improved scale-up of existing innovations
what is one view on romanow?
one view is based on the premise that healthcare is a commodity - that medical needs ebb and flow with markets and they determine who gets care, when, and how
what is another view on romanow?
strong belief that health care is a public good, emphasis on fairness, equity, compassion and solidarity
