Health Policy Final
How has assertive community treatment (ACT) been evaluated
'superior for improving clinical status and reducing hospitalization"
Four major historical shifts in thinking, theorizing and treating mental health issues in Canada: 1) Pastoral Asylum and 'Moral Therapy' (Mid-1800s to Mid-1960s)
- 1st asylums were in Ontario, Quebec, Atlantic Provinces - Approached treatment from systematic, scientific perspective - Intended to be humane, protected environments based on comfort and care - Expenses, serious undertakings. By WWII conditions were grim and funds diverted to pay for war effort
Four major historical shifts in thinking, theorizing and treating mental health issues in Canada: 2) Deinstitutionalization (Mid-1960s to Mid-1980s
- By early 1960s the pop of psychiatric hospitals across Canada had risen to their highest levels; facilities beyond repair - Civil Rights movement and its impact on thinking about mental health (relationship between mental health and human rights) - Development of drugs alleviated need for labour-intensive therapeutic treatment; emphasis on releasing patients to community - "More for the Mind" report (1963) called for transfer of patients to both community care facilities and general hospitals - From 1965 to 1981, the population of mental asylums in Canada fell by 70% and rather than community reintegration, the result was segregation of the mentally ill in smaller institutions, in poor-quality housing or on the streets.
What was the result of the refugee health cuts after the response by stakeholders?
- Federal court in July 2014 ruled the cuts to be a form of "cruel and unusual treatment" and ruled them unconstitutional and reversed the cuts - In this case, the government argued that it had the right to try to deter bogus claimants from coming to Canada, or overstaying, by denying them medical care, except where they had diseases that could spread to others. It said the cuts would save $80-million over four years, and those denied care could turn to charity, emergency rooms or private insurance - Until this point, several provinces broke with the Federal government and started to put in place contingency plans to cover the cuts. - The refugee and medical advocacy groups that challenged the policy documented for Justice Mactavish 40 cases in which the denial of medical insurance created hardship. Hanif Ayubi, a rejected claimant from Afghanistan, was denied insulin and other medication for severe diabetes. As a dishwasher earning $10,000 a year, he could not afford private insurance. Daniel Rodriques, a failed claimant from Colombia, was denied an emergency operation after his retina detached. A doctor waived his fee and Mr. Rodriques had the operation shortly afterward.
Public health *Exam
- Health of the public; focus is on the population; highly politicized - Health Canada: health of a population as measured by health status indicators, and as influenced by social, economic, and physical environments, personal health practices, and individual capacities/coping skills, human biology, early childhood development, and health services
Challenges associated w/ health human resources
- Planning of supply of and demand of HHR is often neglected and when they do exist they assume the existing health care system are efficient. - How staff is distributed between specialities and fields - Training of health care professionals and globalization
Liberalism and Public Health
- Political ideology and health policy - Because liberalism stresses individual autonomy as a keystone of political organization, there is always a tension between those who view health as primarily an individual responsibility and those who see it as a consequence of social organization.
Why talk about governance (4 reasons)?
- To make reasoned policy choices Canadians must understand how their health care system works, and what the reform options are. - To engage fully in the debate over health care Canadians must comprehend how the system works dynamically in both its policy and political environments. - Health care system = a large mechanism with various parts, but also as a battlefield of competing ideas and interests with varying levels of influence. - Even the most sensible health policy will not be enacted if there are powerful agents who don't like it!!!!
What is health policy's role in governance and accountability?
- Working towards redressing social and health inequities and toward social justice, requires social change - Health inequities cannot be resolved without addressing the structural conditions that produce inequities in the first place - Researchers need to engage with both the biomedical and intersectional understandings of equity and justice - Social policy research has tended to focus on analyzing public policies themselves, to the neglect of analyzing governance systems in which policy processes are embedded.
Health human resources
- all people engaged in actions whose primary intent is to enhance health - core building blocks of a health system - i.e. doctors, nurses, midwives, allied health pros - those who deliver services directly and those who don't but are essential to the effective functioning of a health system (i.e. medical secretaries)
Lessons learned from Hurricane Katrina
- communications knocked out, physical access to certain areas was blocked, civil disorder - prevented aid delivery. Hospitals unable to sustain operations - critically injured patients sent to triage centers that were overwhelmed, coordination of volunteers was a challenge
Four major historical shifts in thinking, theorizing and treating mental health issues in Canada: Coordinated Community Services (Mid-1980s to Mid-1990s)
- developed a body of literature to address gaps in community care - series of "best practices" in mental health reform - Two predominant aspects were "case management" and "assertive community treatment"
Primary health care is the foundation for high-quality mental health care. Mental health services integrated into primary care include...
- identification/treatment of mental disorders - prevention/promotion of mental health - attention to mental health needs of ppl w/ physical problems - referrals to other levels when necessary
Situated knowledge
- knowledge specific to a particular situation - the truth always had to be moderated and filtered through complex social relations, and would therefore reflect the particular power relations of that context
Pharmaceutical drug
- medicine or medication - any substance that's compounded or formulated as a single active ingredient or in combination of other active substances
What makes pharmaceutical policy different from other types of health policy?
- require regulation and sometimes prescription-only designation to help reduce the risk of serious harm - medicines are commodities sold on a global scale by multinational companies who often hold patents - In Canada, pharmaceuticals used outside hospitals are not covered by the Canada Health Act
2 lessons learned from SARS outbreak
-highlighted issues with public health system in Canada. -highlights need for intergovernmental cooperation
Because there has been no centralized political control over health policy in the United States, the country has been singularly incapable of addressing many of the social and economic challenges in the provision of health care. What are 3 flaws?
1. A large portion of the population is uninsured 2. Health care costs are considerably higher in the US than any other OECD 3. Inequity in coverage
5 effects of the refugee health cuts
1. Confusion/anxiety for refugee claimants 2. Confusion of HCPs about their entitlements 3. People left without health coverage, including those waiting for an appt to make refugee claim 4. People left without means to pay for medication 5. Loss of psych surpport services for refugees who survived trauma, violence, rape
Looking at comparative data, there is little to direct correlation between the number of physicians and the health outcomes of a given country. Why is there a clear perception that Canada is experiencing a shortage of doctors? (3 reasons)
1. Distribution of funding: cutting back the number of days a surgeon practices in a particular area to save money (real issue: wait times, not number of doctors). 2. Geography: How are doctors distributed? Over what areas? 3. Demographics of Doctors: Gender, women work less, GPs overall are billing fewer hours (personal and professional life balances)
What 3 things did the federal government consider to decide to implement the cuts?
1. Importance of cutting costs 2. Specific views of Canadian citizenship and its links to health 3. Historical processes and the importance of political context
What are the 3 goals of Obamacare?
1. Increase quality and affordability of health insurance 2. Decrease cost of health care for individuals and government 3. Decrease uninsured rates by expanding public/private insurance coverage
Three main reasons why pharmacare has remained on the political agenda for so long
1. Issues of cost 2. Issues of equity 3. Coordination of pharmaceutical policy
Why are health care costs so much higher in the United States than in any other OECD nation? (2 factors)
1. More disposable personal income than most other countries 2. Less capacity for the gvmt to control health care costs
Why is public health so politicized? (3 reasons)
1. Prevalence of modern pathogens - i.e. human travel exposes us to new diseases/pathogens 2. Complexity of systems - fragmented system makes it hard to monitor pathogens/organize a response 3. Extensive scope of issues
Fierlbeck identifies three major factors that have structured the evolution of mental health policy in Canada.
1. Psychotropic drugs; move toward deinstitutionalization 2. New public management theory (regionalization, quantifiable results, accountability) 3. Theories about social inequity, social identities, and locations (i.e. feminism, post-modernism, post-colonial)
3 different models of reform
1. Results-based management (i.e. statistical analysis - if you find out most Canadians are overweight, it makes sense to address that) 2. Citizen engagement 3. Regionalization (health concerns are different in different parts of Canada)
The Toronto SARS outbreak occurred in two waves—March to April and April to July 2003. In total, __ people in Canada died from SARS, approximately ___ became ill, and 25,000 Toronto residents were placed in quarantine. Approximately __% of all Canadian SARS cases occurred in Ontario.
44 400 85
In a 2013 Bloomberg ranking of nations with the most efficient health care systems, the United States ranks __th among the 48 countries included in the study
46
__% of drugs in Canada are bought with private insurance or out of pocket (2010). As drugs are increasingly prescribed, as costs increase, and as outpatient treatment is emphasized, there is a creeping of privatization of health care in Canada
62%
What is a drug patent?
A patent is a set of rights granted by a government that gives the patent holder the exclusive right to make and sell an invention. In Canada, patents are governed by the 1987 Patent Act, are issued by the Commissioner of Patents, and are typically valid for 20 years from the date of filing.
Financial influence: Six different funding relationships that pharmaceutical companies target
Academic Centres Medical/Health Professional Students Physicians and Health Care Professionals Industry Run Education Seminars Academic or Professional Journals Patients' Advocacy Groups
Why is a strong system of accountability and governance important?
Acts as a check and balance system that holds decision makers accountable for their policy decisions. (Health policy is never neutral. Policy makers have particular views and beliefs that influence the policy they develop)
Who does Obamacare require insurance companies cover?
All applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or gender
If a new drug looks promising after pre-clinical trials, what do developers have to do?
Apply to Health Canada to conduct a clinical trial involving humans. - Must be properly designed and subjects not exposed to undue risk - Must be conducted in accordance with international ethical and scientific quality standards
What happens after a patent expires?
Approved generic versions can enter the market - results in a substantial decrease in prices because generic manufacturers do not have to go through the same development process that the original manufacturers did + there is potential for competition in generic products
In Canada many major developments in health care policy have actually been detrimental to mental health care. Why is this?
Attempts at health care reform is very political - policy makers seldom consider the effects of reforms on mental health care when developing new policies (HCS works at cross-purposes to mental health)
3 dimensions of equity in health care
Availability of services - How services are provided to communities, the differences in geography, the availability of health care workers, affordable services, cultural norms, language barriers etc. Accessibility of services - How is a health system designed to meet the needs of patients? Are patients informed, can they make educated choices and decisions? How does gender or race effect a patient's ability to communicate with a health care worker? Acceptability of services - Are services provided in a way that meets the needs of distinct cultural, social and ethnic groups?
When do drug manufacturers file a patent?
Before clinical trials start - average time that a drug can be sold under patent (20 years minus time for trials and Health Canada approval) is generally about 7-9 years.
What does it mean to be accountable?
Being able to evaluate results and improve on past performances
3 classifications of natural disasters
Biological (i.e. disease, infection), climate-related (i.e. flood, storm, drought), geophysical (i.e. volcano, earthquake)
Why do pharma companies have the influence they do?
Can threaten to take their business elsewhere - "mobility threat" (these large multinational companies have more resources to engage in behaviours such as threatening to go elsewhere, that small ones do not have)
What was the response to refugee health cuts?
Canadian Council for Refugees (CCR) - Anyone who resides in Canada should be entitled to health care - The CHA enshrines the principle of universality - Preventative health care is humane and more economical - UN Covenants recognizes everyone's right to health * Example of the public and health professionals holding the Federal government accountable for their actions! Questioning 'bad' governance. * Canadian Medical Association and 7 other prominent health care groups (i.e. Canadian Association of Nurses, Optometrists) as stakeholders agreed with the CCR -> became an issue of human rights
Four major historical shifts in thinking, theorizing and treating mental health issues in Canada: Recovery and Empowerment (Mid-1990s to the Present)
Challenge to traditional epistemology (third wave feminist thought)
Mental health policy is also highly political and largely neglected. It involves issues of what 3 things?
Citizenship (inclusion in and exclusion from social communities), selfhood (the capacity to make autonomous choices), and political autonomy (the legal status of self-governing behaviour).
What is one of the biggest gaps when talking about stakeholders?
Communication (stakeholders communicating w/ each other would really help the health care system)
The two barriers to a national pharmacare program
Cost and politics - Shifting from provincial to federal = giving up sovereignty - When pharmaceutical firms are seen as good corporate citizens by governments (providing jobs, taxes and publicity) there is much less willingness to step on their toes by implementing a program that would disadvantage such strategic corporate allies
Under the Canada Health Act, a "near-universal" system of coverage has evolved that is remarkably similar in scope across the provinces. What is one exception?
Coverage for prescription pharmaceuticals - Drugs needed for treatment in hospitals are free - Outpatient prescriptions or prescriptions written in doctor's offices are not universally covered - The type and level of outpatient drug coverage is determined by provincial legislatures and therefore varies by province
How were intersectionality and equity relevant to the refugee health cuts discussion?
Created a rhetoric of Canadian citizens vs. refugees - Impact of race on health policy - A program that wasn't relevant to many Canadians or people that voted for them - bc refugees can't vote - Conservative government is starting to place more importance on White Canadians and less on others (like Refugees) - racialization i.e. designated country of origin list - Impacts Canadians if refugees can't get treated for things like infectious disease (only ~ 5 cents per taxpayer)
Who is Assertive Community Treatment (ACT) designed for?
Designed for 'intensive users' of the health care system: generally those with serious and persistent illnesses or functional impairment.
Experiential knowledge
Despite their lack of specialized, scientifically orientated knowledge, consumers of mental health care nonetheless have a sense of what is important to them, what is necessary to maintain a sense of dignity and self-respect, and what kind of treatment would fit well with their lives - also stakeholders like Canadian Mental Health Association (designing new policies about mental health)
Equity in health care refers to...
Distribution of health resources - allocation of services to reflect need - provision of services that reflect values and cultural beliefs of distinct system users (i.e. importance of context/intersectional analysis to evaluate equity)
The system of federalism on which Canadian health care services are provided is also responsible for the fragmentation of health human resource planning. How so?
Each province is responsible for training its own personnel, and each province does so in conjunction with an autonomous professional regulatory agency.
An example of how we hold stakeholders accountable?
Election every 4 years
How does the WHO model encourage patient's participation in care?
Emphasizes health worker-patient partnerships and collaboration
The discussion of governance has strongly been informed by new public management principles and been informed by what three overarching principles?
Evidence-based care, integration, and accountability
Why is there greater competition due to federalism?
Expansion of the types of health professionals and their duties
PHARMACEUTICAL POLICY IN CANADA IS SET AT both the federal and provincial levels of government. What are they each responsible for?
Federal -> patents, initial approval and labelling, overall market competitiveness Provincial -> responsible for funding of all HCS including pharmaceuticals
What were the refugee health cuts (June 30, 2012)?
Federal government implemented cuts to its Interim Federal Health Program (IFHP) which covers basic health care for refugees, refugee claimants, and other non-citizens (Said Canadian taxpayers shouldn't pay for the "bogus claims of bogus refugees")
The two variables that distinguished Canadian mental health policy, and that determine the parameters of any potential attempts at reform are:
Federal political structures (division of power) The CHA (ambiguous)
Four main strategies that pharmaceutical companies use to maintain their influence
Financial, political, commercial, and scientific
Who regulates pharmaceuticals?
Government - regulate what can be marketed, how they can be marketed, and in some jurisdictions, drug pricing
What functions of the health system can we improve, as evidenced by Hurricane Katrina?
Health information, health workforce, health financing, service delivery, leadership and governance, medical products and technologies
2 functions of public health
Health protection Health promotion
What are usually the first response to natural disasters?
Health systems (focus on public health - getting victims food, water, shelter, sanitation)
How did Fierlbeck describe the US health care system prior to the Patient Protection and Affordable Care Act (PPACA) in 2010?
Highly decentralized & unregulated, dependent on private markets *Canada has a very centralized and regulated health system. We live in a social welfare state, whereas the US doesn't. US citizens want less government involvement and regulation than Canadians.
Public health care
How a system is funded and how certain important services are free or subsidized at the point of delivery for the general population
What do health care stakeholders share an interest in?
How the health system performs, how it's governed, and its accountability - Each organization has individual interests, expectations, capacities, and perspectives Example: 3 levels of government distribute funds to pay for a health system that individuals contribute to through taxes and out-of-pocket spending
When comparing health care systems what do we want to know to find out how we can do better?
How they function, what they produce, and thus, we should focus on measuring outcomes of healthcare systems for patients, insurers, and citizens
Issues of accountability in public health are not restricted to governmental jurisdictions but...are also influenced by ideological perspectives. What are ideological perspectives?
How we see our relationship with the government - Public health is the one area of health that we all are interested in because it affects all of us
What was healthcare coverage like prior to 2010?
Like Europe, health insurance is generally employment related. The US doesn't mandate individuals to carry health insurance. Americans over 65 are covered by Medicare and the poor are covered by Medicaid (a public health insurance program but eligibility is difficult and not uniform, and cost sharing issues) Veterans are covered by VHA and CHIP (Children's Health Insurance Program) offered assistance to children not covered by Medicaid
Case management
Looks at mentally ill people in the context of their own community including housing, employment, education, legal matters and other services + issue of proper medical treatment
How would a national pharmacare plan change drug costs?
Lower drug costs A system of private insurance (many buyers = competition for goods) keeps prices high and has high administrative costs. A single buyer system can keep costs low by demanding better prices, better performance from companies, and is more rigorous in the drugs it selects
60-65% of healthcare provision and spending in the USA comes from what programs?
Medicare Medicaid TRICARE Children's Health Insurance Program Veteran's Health administration * socially or publicly funded insurance systems
The move to set up a shared-cost system of health services that excluded community treatment put in motion a set of political decisions that would disadvantage mental health services as other health policies developed. What does this mean?
Mental health is a community treatment so it's not "medically necessary" even though it is - but because of stigma it's not picked up
What changed after SARS?
National Advisory Committee on SARS and Public Health in 2003 - highlighted disadvantages of a fragmented system and issues around accountability, lack of communication across different jurisdictions, inadequate resources, and capacity disparities
if a clinical trial shows that a drug has potential therapeutic value that outweighs the risks, the manufacturer has to file what?
New Drug Submission (NDS) contains information from pre-clinical research and trials about the product's safety, efficacy and quality, as well as how the drug will be packaged and labeled. If Health Canada approves the submission, the manufacturer is issued a Notice of Compliance (NOC) and is allowed to sell the drug in Canada.
The WHO model of mental health is based on the principle that...
No single service setting can meet all population mental health needs (need collaboration, info-sharing across different levels of care). People with mental disorders need to be involved in their own recovery from mental disorders.
Does the recovery model replace the coordinated community service system?
No, it simply presents a different approach to the provision of these same services
How do we balance financing, service delivery and health human resources?
Ongoing negotiation, reallocating services
How did SARS originate?
Originated in Hong Kong, an infected individual exposed hotel travellers to the disease. Upon returning home to Toronto on 23 February, the woman started to develop symptoms, and on 5 March 2003 she died of unrecognized SARS. Transmission to a family member who was later admitted to a community hospital in Toronto led to a large nosocomial outbreak.
How did health policy change after SARS? (what network was created)
Pan-Canadian Public Health Network - attempt at central coordinating body (which was needed during SARS) like the CDC - governed and co-chaired by provincial and federal representatives. Reports to provincial and federal ministers of health.
What act represents the most significant regulatory overhaul of the US healthcare system since the passage of Medicare and Medicaid in 1965, providing major changes in health insurance?
Patient Protection and Affordable Care Act (Obamacare) - March 23, 2010: became law
The more that psychiatric treatment focused on pharmacological therapy, the more treatment costs were shifted onto whom?
Patients also negatively impacted the provision of human resources in mental health care
Inequity in health systems is often created by...
Poor design and delivery of health services Focus on acute rather than primary care * Inequality in health is usually a result of poor implementation -> benefits a certain group of people at the expense of others (overlooks certain groups)
Lack of collaboration and info sharing is a hot button issue in Canada. Simply having improved communication and timely laboratory testing to develop treatments is not enough. What else is necessary to prevent another SARS experience?
Preparation, communication, improved technologies
Federal government's role in pharmaceuticals
Primarily regulatory - Ensuring drugs are safe and effective - Not priced too high relative to other jurisdictions - Administrator of Non-Insured Health Benefits Program (public health/drug coverage to certain populations: First Nations and Inuit peoples, Canadian Forces members, veterans, RCMP members, and inmates of federal prisons)
Healthcare facilities in the United States are largely owned and operated by whom?
Private sector businesses
Accountability
Processes/procedures by which one party justifies and takes responsibility for its activities
Provincial government's role in pharmaceuticals
Provide public drug coverage to their residents - Not required to do so under the CHA like they are for hospital and physician care - make decisions relating to who is eligible for public coverage, how generous it should be, which medicines are covered under public plans, and how much the provincial drug plans will pay for generic (or non-patented) medicines and pharmacist dispensing fees
While the federal government is responsible for immigration, who set the standards for foreign-trained physicians?
Provincial colleges of surgeons and physicians - ¼ of Doctors are from UK, Ireland, India, and South Africa (all former British Colonies). - Residency positions in Canada are only available to Canadian-trained physicians
What is the Pharmaceutical Policy Research Collaboration (PPRC)?
Publicly funded network of university-based experts from across Canada. Conducting and communicate policy-relevant research with integrity.
How does the government make sure that drugs are safe?
Regulation of the manufacture, sale and import of therapeutic products is a federal responsibility in Canada. Drugs are monitored by Health Canada for safety, efficacy and quality in several stages throughout their development and after they are put onto the market.
_______ authority is the primary means that professional organizations have to control the way in which their disciplines are practised, but is also the source of these organizations' political influence and power.
Regulatory i.e. few changes to health systems in any province are made without consulting the college of physicians and surgeons.
Canada allows two kinds of direct-to-consumer advertisements: reminder ads and disease-oriented or help-seeking ads. How do they differ?
Reminder ads: state the brand name of the drug but do not make any health claims. Disease-oriented or help-seeking ads: do not mention a specific brand but they do discuss a condition and encourage consumers to ask their doctors for more information about treatments for that condition
What type of studies hold various stakeholders accountable to the public?
Research data and performance measurement studies - Provinces responsibilities to collect this information and this creates issues around how performance is measured and evaluated.
Policymakers
Researchers/professionals who frame the issue, pose questions, or define the policy problem/solution
Governance
Responsibility is defined w/in an organization Those persons responsible define, measure, and report the required outcomes and are judged accordingly
Prior to 2005, public health systems in Canada were very decentralized. What outbreak lead to reform of this system?
SARS (Severe-acute respiratory syndrome)
The second implication of the pharmaceutical revolution for Canadian health care is the balance of POLITICAL power held by pharmaceutical companies. What makes regulation so difficult?
Size and international mobility of pharma companies - Struggle between innovation, political oversight, and humanitarianism
Fierlbeck
Slides 39 and 40 - need to look at the readings
In Canada, formal institutions governing health at the national level began with the _________ and most recently were reformed in the wake of the epidemic of SARS in 2003
Spanish flu
What was one of the major gaps in services during SARS?
Technology (public health structures were not as technologically advanced - lots of time spent in the lab trying to identify the virus) Canada did not have the resources like a CDC for rapid response or the capacity for rapid turnaround to act on the real-time information. During SARS, many hospitals were by-passing the provincial lab and sending samples directly to Winnipeg or conducting testing themselves Investigators did not know what they were looking for, did not know the virulence and transmissibility of the organism, and many were taking significant risks to identify the pathogen."
In response to the Oklahoma City bombing, the terror attacks of 2001 and several serious natural disasters, Congress and the administration created new authorities, structures and plans to assure that government at all levels can respond well to disasters like Hurricane Katrina. Local and state governments are to be the first responders in a disaster. This is known as what?
The Stafford Act - Federal assistance is provided under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) and other authorities.
Health insurance for public sector employees in the USA is primarily provided by whom?
The government
Issues with HHR recruitment
The recruitment of health professionals is tied in to the design of the health care system as a whole: any attempt to construct a comprehensive primary care, long-term care, or home care program would have to involve an evaluation of the numbers and types of health professionals available, as well as a long-term training plan to recruit individuals in the necessary areas.
Pharmaceutical policy
The rules, processes, and structures that are put in place by governments and public agencies to manage problems related to the availability of medicines and the role of medicine in health care.
Most of the population under 67 is insured by whom?
Their or a family member's employer, some buy health insurance on their own, and the remainder are uninsured.
The rise of pharmaceutical based medicine has had two considerable implications for Canadian health care. 1) COST
There has been a shift in treatment costs from the public to the private sector. The CHA was designed just before the pharmaceutical revolution and it reflects the way health care was provided in hosptials
T/F Mental health care sector is perhaps the area of health care most affected by political power struggles and the area in which thorough analyses of these dynamics of power have been least studied.
True
T/F The USA spends more on health care per capita and more as a percentage of its GDP than any other nation?
True
Although the challenges faced by health systems will vary, it is important to learn from the experiences of other health systems (comparison) - TRUE/FALSE
True (Using a lens that focuses on a comparative cross-national analysis of health care systems has many benefits)
The Canadian health system will be more effective and accountable if its major stakeholders (i.e. governments, governing bodies, managers, providers, etc.) do what?
Understand, share, and use a common set of overarching principles to guide their actions
Where does information on post-market safety come from?
Voluntary adverse reaction reporting by healthcare professionals and consumers. Health Canada collects these reports and decides on a case-by-case basis if they should notify healthcare professionals and the public about the possible adverse health effects of a product. Interventions range from issuing warnings to the public and health professionals to removing a drug from the market
The centre of the health care system is the Canadian Public. What is our role?
We have expectations of the system, and roles and responsibilities when using its services We're the primary users of the system - need for active engagement as the public provides the key to resolving difficult choices challenging policy makers
A good health care system is what 3 things?
Well-governed, high-performing, accountable to the public it serves
Where mental health is integrated into primary care, what are some of the benefits?
access is improved, mental disorders are more likely to be identified and treated, and comorbid physical and mental health problems managed seamlessly
To be fully effective and efficient, primary mental health care must be complemented by...
additional levels of care (i.e. secondary care components for supervision/referrals, links to community-based services)
Oppression is caused by...
categories and dualities (e.g. mental asylums)
This recovery/empowerment movement also address the power balance between consumers and providers of mental health care services. 'Mental Health' in a modern liberal social context means...
development of autonomy, assertiveness, and mental health care users must take an active role in the provision of care. They are participants, not subjects.
What are the 2 ways drug companies market and promote their drug?
directly to consumers, through advertising, and directly to doctors, through advertising as well as visiting physicians in their offices and providing drug samples.
The way a drug works when used in the population is called its _________
effectiveness
Bill C-5 (2006) established what?
federal Public Health Agency of Canada & a chief of public health officer - Collaborative federalism
Fierlbeck: The treatment of mentally ill patients in an environment segregated from other medical hospitals resulted in (1 good thing, 1 bad thing)
good: the professionalization of psychiatry bad: served as an enclave for mental health elites, often with their own agenda
The response to mass infection must be carefully coordinated, as a single weak link can compromise the coordinated efforts of other jurisdictions. Thus all governments have, at a national level, implemented strategies for dealing not only with infectious diseases, but also chemical, biological, and radiological disasters. The political dynamics underlying public oversight of disease control are especially unstable because...
governments loath to spend money on things that may not occur
New pharmaceuticals play an increasingly important role in the provision of health care spending on drugs and is the second largest category of health care expenditure in Canada. What is the first?
hospital costs
Speculation that SARS was spreading through Toronto community, even though transmission of SARS was limited primarily to...
hospitals and households of infected patients
Instead of investing in technology (because there's only so much science can do) what should we be investing in?
human resources in public health (making sure we have enough people, space etc.)
What is a mental health system?
i- set of interconnected parts that must function together to be effective - often crucial aspects of mental health systems are poorly functioning or missing altogether - results are inefficiencies, service gaps, and compromised health outcomes
How can sudden infusions of outside aid and expertise compromise existing community public health operations? (i.e. Haiti)
imposing different systems w/ different norms and revenues (not a long-term solution; people stop giving money when they stop caring)
Canada can never have a 'national' mental health policy; the best it can achieve is an _______ mental health policy
integrated
It is important to note that at country level, mental health and overall health system planning and development must be...
integrated to the greatest extent possible - otherwise it may result in fragmentation (inequities/inefficiencies)
The SARS experience demonstrated our lack of ________ capacity
laboratory - the lab sector is underfunded, under regulated, and doesn't have the resources to deal with infectious outbreak.
We will be thinking about how comparative analyses of different health systems can be used as tools to discuss the issues of equity. Using the idea of equity as a way to ________ the successes and failures of different health systems
measure
Canada is one of the only developed countries without a national mental health strategy. The main reason for this is...
mental health is under provincial jurisdiction and legally, the federal government is not allowed to regulate policy in this area.
Health equity means building...
on the current successes within a health system and raising awareness about health inequity and the social determinants of health
Where do assertive community treatment (ACT) teams visit mental health users?
on their own home base in order to provide necessary supports or to assist in the acquisition of skills
How are academics rewarded professionally for grants they receive?
pg 167
Public health insurance in Canada was achieved only by ceding professional self-regulation to physicians. What did this mean for physicians role in health policy?
physicians retained a more direct role in health policy making at the provincial level (more influence) Reinforced the model of 'medical dominance' within the mental health system (not good for mental health workers - if it can be treated by a pill rather than thereapy, doctors will go that route
A high-quality mental health system requires forethought and planning long before a health worker engages with a patient. For policy-makers and health planners, the challenges are great:
providing mental health services to all who need them, in an equitable way, in the most effective manner possible, and in a fashion that promotes human rights and health outcomes.
The call to establish a national pharmacare program was sounded in 1997 by the National Forum on Health and 2002 by the Romanow Commission Report. While the _________ governments attempted to call on Ottawa to commit to pharmcare, the _______ governments refused on the grounds of cost.
provincial federal
According to the WHO model of mental health, integrated mental health services...
reduce stigma, address health worker shortages, and improve access to services.
The CHA fragmented mental health services by...
segregating the regulation of mental health providers . i.e. the remuneration of physicians but not other mental health professionals
For all the activity, little attention has been focused on the _______ barriers for change underlying attempts at mental health reform for the past half century
structural
Case managers act as....
system navigators for mental health care users, coordinating care on an ongoing bases as necessary for each particular case (i.e. social workers).
The ways in which health systems are designed and administered (governance and accountability) have important implications for...
the extent to which different populations are able to access health services
What is one key failing of the pharmaceutical system?
the federal government is almost completely insulated from the impact of its policies because, although it regulates drug prices, it does not buy any drugs. In contrast, provincial governments have no jurisdiction over market competitiveness or pricing, yet end up paying for most of the drug expenditures incurred
As an approach population health focuses on...
the interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations
Intersectionality
the intersections between aspects of social difference and identity as related to meanings of race, ethnicity, gender, class, sexuality, age, ability etc. and forms of systemic oppression such as racism, classism, sexism, homophobia, ableism).
In Canada, Sweden, UK, France and Germany, there are negotiations between government and providers on fees set on health care services. In the US, this is determined by
the market
How well people fared after Hurricane Katrina reflects....
their situation before the storm and their ability to connect w/ assistance after the storm (vulnerability based on race, location etc.)
Federal government policies also affect the pharmaceutical sector indirectly, for example..
via federal taxes and tax credits
