Week One Flashcards
Who is Tommy Douglas?
Invented Medicare and Is from saskatatchwan
What did the Hospital Insurance and Diagnostic Services (1957) entail?
it was apart of the development of health care system
Provided universal public hosital insruance and cost share specific healthcare services with provinces & territories for publicly funded inpatient hospital and diagnostic services.
What is the medical act? (1996)
-Addiontally cost share one half the provision of insured phsyician services with the provinces and territories
Principles needed to be made, cause they wanted equity
Started the CANADA HEALTH ACT
What is the Canada Health Act?
to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.“
– Federal legislation for publicly funded health care insurance
What are the 5 criteria for health care to recieve funding?
- Public Administration
- Comprehensiveness
- Universality
- Portability
- Accessibility
What are the 4 conditions to receive funding B
- Give Information to anyone
- Needs to recognize the funding given
- Absolutely no user fee’s by physicians
- No extra fee’s by physicians
True or False:
The provinces have primary jurisdiction in the administration and delivery of health care services.
True
True or False:
The federal government sets the health care priorities and resources for the provinces.
False- the provinces do
The federal government sets out the criteria and conditions that must be satisfied by the provinces and territorial health plans to qualify for the federal Canada Health Transfer
True
Who is Covered by the Canadian Health Act?
Insured People: a personal lawfully entitled to be or to remain in Canada & have their home in Canada
Who are the excluded people from the Canadian Health Act?
Excluded people: Serving members of the Canadian forces and inmates in federal prison
• They have coverage through a separate federal program
What are the Insured Health Services?
Medically Necessary Services: hospital, physician and surgical dental services( performed in the hospital) are provided to insures persons
Medically Necessary means: Act does not define, “medically necessary”
It differs between individuals
There is no definition of what is medically necessary, nor is their universal definition around provinces
What does the medical necessary Services focus on?
Services provided by physicians and not other health care professionals; and
Services provided in hospitals versus other settings.
The Accord is?
• Expired March 31 2014 after the Harper government refused to renegotiate it
• Starting in 2017-18, a major cut to the Health Transfer Tax of $36 billion over 10 years
We Don’t have a Health Accord
• Lack of agreement has left provinces to develop their own plans
• Provinces want a 6% annual increase in health care transfers to the provinces
• Large budgetary demand on federal budget
• Jane phlipt states new accord with address issues such as pharmacare strategy, home care and improved mental health and palliative care services.
What do people use their health care for? what brings up the costs
Dental Care Hearing Aids Glasses Drugs Mobilty Reno's Caregivers Assisted
Why is our health care at issues for sustainability
- Aging population;
- Advanced technology, procedures, diagnostic tests;
- Demanding consumers;
- Increasing prevalence of chronic disease
7 for Principles of Heath Reform
No perfect health care system
Adopting ideas from other countries
Simplicity trumps complexity
Place caps on spending and engage in strategic rationing
Fairness in finance and acess
Higher spending does not correlate with quality care
Micromanagement is suboptimal
How do we pay for healthcare?
Increase revenue through taxes to pay for healthcare;
Aggressively reduce the costs of healthcare; and/or
Reduce spending in other areas such as education, social services, infrastructure
What are the Four Basic Models of Health Care Delivery?
Beverdige
Bismarck
National Health Insurance
Out of Pocet
What is the Beveridge Model?
Health care is provided and financed by the government through tax payments
Most hospitals and clinics are owned by the government
Lower costs per capita (gov’t controls what doctors can charge)
Close to total government control
Great Britain
What is the Bismark Model?
Health care is financed jointly by employers and employees through payroll deduction (“sickness funds”)
Non profit
Plans have to cover everybody (universal coverage)
Doctors and hospitals private
Tight regulation gives government much of the cost-control power
=== Germany,
The National Health Insurance Model
- This system has elements of both Beveridge and Bismark
- It uses private sector providers, but payment comes from a government – run insurance program that every citizen pays into
- Since there’s no need for marketing, no financial motive to deny claims and no profit
- Cheaper and much simpler administratively than American
- Canada, Taiwan
Out of Pocket Model
The Out-of-Pocket Model
• Plan” used by most nations which are too poor / disorganized to provide any mass medical care
• In these poor countries, only rich can afford medical care
– In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor
– Rely on ‘village healers’ and home remedies
– May pay a doctor’s bill with potatoes or other produce
Pro’s of Obama Care:
Pros: more people have health insurance, affordable, pre existing health coditions aren’t denied, more screenings covered, & low drug costs
Cons of Obama Care
higher insurance premium, mandatory to buy (fined), some tax are increasing, and business don’t cover now
Explain A grade of B—
why did Canada only get a B ???
- Limited availability of comprehensive health information systems;
- Wait times;
- Management systems that don’t focus on quality of health outcomes;
- Age of population, lifestyle choices, physical activity & eating habits;
- Dropped to 10th place from 5th place due to mental disorders, diabetes, musculoskeletal & cancer diseases and medical misadventure;
- Key issue is lack of physical activity, obesity & diet
The Cambie Surgical Centre in British Columbia is a private for-profit clinic offering standard surgical procedures covered by the province to those individuals willing to pay more, and not wait for care. This primarily contravenes what principle of the Canada Health Act?
a) Universality
b) Public Administration
c) Portability
d) Comprehensiveness
B) Public Administration
The concept of ‘medical necessity’ is poorly defined in the Canada Health Act, but often aligns with which statement?
a) Basic health needs are covered
b) Patients wanting surgery will be covered
c) Medical services delivered in a hospital by a health care provider are covered
d) Care provided in an emergency or for urgent circumstances are covered
C: Medical services delivered in a hospital by a health care provider are covered
• Mr. Kowalski is looking for a family doctor. He learns that he can obtain one by joining a family practice clinic, but will have to pay a $1,200 enrollment fee.
o Which Canada Health Act Principle does this violate?
Acessibility & they are charging a user fee
• Mrs. Gomes lives in Barrie, Ontario and is moving to an assisted living residence in Montreal to be closer to her daughter. She is worried about what will happen when she tries to access healthcare in Montreal.
o What will you tell her as a nurse?
Notify her about the portability principle
