week four- budgets Flashcards
who
WHO is the directing and coordinating authority for health within the United Nations system
To achieve the highest level of health for all people
Federal Jurisdiction
Establishes and delivers national principles for health care through the Canadian Health Act (CHA)
Provides financial assistance for provincial and territorial health care services (done by transferring tax money to share costs of health care services)
Deliver health care to First Nations, Inuit people, military veterans, federal inmates and RCMP
Promotion of health and prevention of disease (public health programs and consumer safety)
Provincial and Territorial Jurisdiction
• Implementation of insurable health care in accordance with the principles of the Canada Health Act
• Allocation of hospitals and long-term care facilities
• Determines employment of health care professionals for hospitals and long-term care facilities (determines the health care mix)
• Distributes money to various health care services
• Reimburses physicians and hospital expenses
Unique plan coverage i.e. drug coverage, ambulanc
Private Health Insurance
- Canadians can buy private insurance coverage or can participate in an employee benefit plan offered by the employer
- Dental plans
- Vision care
- Pharmaceuticals
- Therapies (physio, speech, massage)
Canadian National Health Care System
Designed to ensure Canadians have a reasonable access to medical treatment, hospital &physician services on a uniform prepaid basis (Health Canada, 2006)
1947:
Saskatchewan initiates provincial universal public hospital insurance plan (known today as OHIP)
1962:
Saskatchewan introduced a universal, provincial medical insurance plan to provide doctors’ services to all its residents
Tommy Douglas is the ‘Father’ of medicare in Canada
In subsequent years the remaining provinces and territories follow suit
1984:
Canada Health Act, Federal Government combines both hospital and medical acts; to establish 5 basic principles for health care:
– Universality available to all eligible residents of Canada
– Comprehensive coverage for hospital and physician services
– Accessible without financial and other barriers; available to all Canadians on the basis of need
– Portable within the country and during travel abroad
– Publicly Administered public authority administers and operates the plan on a non-profit basis
The Canada Health Act establishes principles & criteria:
provincial & territories health insurance in order to receive full federal cash transfers in support of health
Canada Health Transfer (CHT)
Federal government provides cash & tax transfers to provinces & territories in support of health through the Canada Health Transfer (CHT)
The CHA establishes criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer (CHT).
Canada Health Act imposes:
- financial penalties that prevent physicians from charging more than provincial schedule of fees.
- bans user fees and extra billing
- Establishes a provincial/territorial reciprocal billing agreement for out-patient hospital services provided out-of province/ territory
Canadian Institute of Health Information (CIHI)
Independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians
CIHI’s data and reports focus on:
- Health care services
- Health spending
- Health human resources
- Population health
Canadian Health Services Research Foundation (CHSRF)
Canadian Health Services Research Foundation (CHSRF)
– Independent non profit corporation
– Funded by federal government
– Promotes and funds management and policy research in health services and nursing
– Collaborates with health system decision makers to support and enhance the use of research evidence
Example:
– Research in the 1970s indicated that patient outcomes and costs varied significantly in different parts of the country
– Studies related to unnecessary surgeries and outcomes for patients impacted on physician practice
Annual Conference of Ministers of Health discuss a broad range of issues.
– Advisory Committee on Governance and Accountability
– Advisory Committee on Health Delivery and Human Resources
– Advisory Committee on Information and Emerging Technologies
– Advisory Committee on Population Health and Health Security
Primary Health Care
is the foundation of the health care system: first point of contact people have with the health care system
The first encounter with a health care provider (nurse/ doctor/pharmacist/telephone advice line)
Health care services include:
- insured primary health care (ie: physicians and other health professionals services)
- care in hospitals (account for the majority of provincial and territorial health expenditures)
Canadian Federal Government (2000) –
Invested $800 million in Primary Health Care Transition Fund (support provinces/territories to improve and expand primary health care delivery in Canada)
Primary Health Care has five guiding principles
Equitable access (health and health services)
Public participation
Appropriate technology
Intersectoral collaboration
Reorient health system to promote health and prevent disease and injury
Canada’s health care system is public but not nationalized
-Each province/territory manages its own insurance system includes own healthcare identification cards
-Once care moves beyond the services required by the Canada Health Act - inconsistency from province to province in the extent of publicly-funded coverage: Out-patient drug coverage Rehabilitation Dental Eye care, as well as vision care Mental health Long-term care
-substantial portion of such services being paid for privately, either through private insurance, or out-of-pocket
Services Not covered by OHIP
- Ambulance services.
- Routine eye examinations for people aged 19-64;
- Some Physiotherapy )may be partially covered or not at all.
- Regular dental exams; only some dental surgery that is done in a hospital will be covered.
- Podiatrists are only partially covered by OHIP.
- Chiropractors.
- Necessary emergency medical tx obtained outside of Canada is only covered on a very limited basis
Ontario Ministry of Health and Long Term Care (MOHLTC)
In 2006, the MOHLTC divided the province into 14 regions or Local Health Integration Networks (more succinctly known as LHINs)
Thought was… people living locally were better able to plan, fund and integrate health services in their own communities than people in Toronto
By April 1, 2007, LHINs took on full responsibility for health services in their communities.
Main roles of the Local Health Integration Networks (more succinctly known as LHINs)
:
- plan, fund and integrate health care services locally in communities
- Development Integration of Health Service Plan
LHINs Funds:
- the health service providers
- allocates local health dollars based on community priorities.
OPHA mission:
the mission of the Ontario Public Health Association is to provide leadership on issues affecting the public’s health and to strengthen the impact of people who are active in public and community health throughout Ontario
Our mission is achieved by providing education opportunities and up-to-date information in community and public health, access to local, provincial and multi-disciplinary community health networks, mechanisms to seek and discuss issues and views of members, issue identification and advocacy with a province-wide perspective, and expertise and consultation in public and community health.
Public Health Activities - current
- Immunization
- Alcohol Policy network
- Chronic Disease Prevention Projects
- Heart Health Resource Centre
- Injury Prevention Initiative
- Nutrition Resource Centre
- Youth Engagement Project
Community Care Access Centres (CCACs)
are local agencies that provide information about care options in your area.
Anyone can make a referral to a CCAC
— an individual requiring service, a family member, caregiver, friend, physician or other health care professional.
10 Year Plan to Strengthen Health Care
- Focus on improved access to quality care and reductions in wait times
- Additional reforms targeted
- Federal government increased healthcare cash transfers again and applied escalator (to provide predictable growth in funding) — expected to continue until 2014
Health can be categorized into four levels
1) Health Promotion
2) Disease and Injury Prevention (Protection)
3) Diagnosis and Treatment of Existing Health Problems (Primary, Secondary, Tertiary)
4) Rehabilitation
Canadian health care spending has increased three times amount since 1975
.
Newer developments for approach to health care in Canada
- Population Health
- Integrated Health Care Delivery
- Disease Management
Population Health is:
- An approach to health care that focuses on health determinants
- Aims to reduce inequities among different groups of population (the vulnerable)
Goal: to improve the health of the entire population
Focus: on strengthening health determinants through health care system
Determinants of health (i.e. education level/ income level) contribute to health
Canadian Health Services Research Foundation (CHSRF)
– Independent non profit corporation
– Funded by federal government
– Promotes and funds management and policy research in health services and nursing
– Collaborates with health system decision makers to support and enhance the use of research evidence
Accreditation Canada (AC) national organization
- Assists health service organizations across Canada to examine and improve quality of care they provide
- Qmentum (2009) new programme — looks at health system performance, client safety, risk prevention planning, performance measurement and governance
Accreditation (AC) has focused on patient safety:
1) Culture
2) Communication
3) Medication Use
4) Worklife/workforce
5) Infection Control
6) Falls prevention
7) Risk Assessment
Institute of Medicine (IOM) committee report 2001 identified six major areas.
• Health care should be: – Effective – Patient-centered – Timely – Efficient – Safe – Equitable
Identified four major areas to target for change: • Information technology • Payment • Clinical knowledge • Professional workforce
What structures must be in place to deliver quality health care?
- uses the elements structure, process, and outcome.
- quality patient care standards, environmental standards,
Two main acts govern privacy issues and must be considered in the context of health care delivery
- Privacy Act
2. The Personal Information Protection and Electronic Documents Act
Capitation
is a payment arrangement forhealth care service providers such as physicians or nurse practitioners. It pays a physician or group of physicians a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
Budgets
- Help define services (costs)
- Require forward thinking (planning)
- Serve as benchmarks
- Typically are monitored monthly
- Foster collaboration between departments
types of budgets
Operating Budgets
• account for income & expenses associated with day-to-day activity within a department or organization- NUSES, MEDS, STAFF, SUPPLIES
Capital budgets
• account for the purchase of major new or replacement equipment –MRI MACHNIES
Construction budgets
• are developed when renovation or new structures are planned-
Operational budgets
• financial tools that outline anticipated revenue & expenses over a specified period.- EXPENSES OF CARE, MORE SPECIFIC LIKE AN DEPPARTEMENT
Accounting
• an activity that managers engage in to record & report financial transactions and data.
Balanced Scorecards
- Snapshot view in a point in time that identifies finances, costumer satisfaction and services, internal operating efficiency and learning and growth
- Helps organization focus on strategies and improvement activities
- May influence decision-making process
budget prep
- Budgets are generally developed for a 12-month period, or yearly cycle
- Fiscal year is determined by the organization
- Shorter- or longer-term budgets also may be developed
Fundamental information gathered to prepare a budget:
– Demographics (volume increases or decreases) —determine client characteristics & health care needs
– Regulatory influences—Accreditation Canada (AC) accredits health facilities to ensure they meet standards — their recommendations can affect operating budgets
– Strategic plans—map out the direction for the organization over several years
– Consumer willingness to pay—some items no longer covered and are out of pocket expenses for patients
cost centers
Hospital systems are frequently divided into subsections or units, commonly called cost centers
Each cost center defines its own scope of service
Departmental goals may include the introduction of new technology, facilities, or services, which may result in additional expenses for staff, equipment, & supplies
Revenue
is income generated through a variety of means, e.g., billable patient services, & investments in & donations to the organization
Third-party payer affects revenue & can change from year to year (e.g. accommodation rates semi or private)
Expenses
the cost associated with the delivery of service
Expenditures
resources used by an organization to deliver services –include labour, supplies, equipment, space, utilities, & miscellaneous items
Human Resources
Salaries & benefits account for 80% health care budgets
Calculations are made according to amount staff time required to complete a service
Staffing
—staffing models outline the number of staff required (based on the procedures or clients) most cost effective combination of staff important to consider
Supplies
Zero-based budgeting is a process used to drilldown into expenses by detailing every supply item & quantity of items used
The five criteria that provincial health insurance plans must meet are:
- Public administration:
- Comprehensiveness:
- Universality:
- Portability:
- Accessibility:
OHIP Eligibility
- Canadian citizen, landed immigrant AND
- Make your permanent residence and principal home in Ontario AND
- Be physically present in Ontario 153 days in a twelve month period
