The Canadian Health Care System

Chief Public Health Officer

The Chief Public Health Officer leads a team and many others to address the complex issues that negatively affect people's health. The mandate of Public Health Services in NS is to improve the population's health by working in partnership with communities, families and individuals to identify needs.

Why do we need to reflect on and understand the Canadian health care system?

This information contributes to our knowledge based practice, must understand the professional context in which you practice.. helps provide informed support thats what people expect coming in for treatment

social justice

a concept that concerns fairness in society and states that all people, regardless of financial, or social circumstances, ethnic origin, gender, religion, age, impairment and sexuality should have equal chances to succeed in life. Fair distribution of resources and responsibilities, helps us acknowledge the advantage that some individuals or groups have over others, root causes of inequities and need for action to eliminate inequities.

Socioenvironmental Approach

combines previous approaches with an exploration of possible other contributors to health beyond those impacting the individual ex. the social context as a contributer of health refers to family and community environment bring into consideration ex.Poverty and unhealthy physical and social environments linked to health.. i.e. air pollution and poor water quality...address the unacceptable

Quaternary Care

highly specialized (difference in type and availability)

social safety net

is a term used to describe a collection of services provided by the Government of Canada. Examples of these services are: - Welfare - Unemployment benefits - Universal health care (Medicare)* - Homeless shelters - Breakfast programs - Minimum wage

The Canada Health Act

is federal legislation , that puts in place conditions by which individual provinces and territories in Canada may receive funding for health care services provided they conform with certain specified criteria.

tertiary care

is specialized consultative care involving dedicated supports and resources usually based on a referral from primary or secondary hcp. Usually in a large research and teaching hospital

difference between primary care and primary health care

primary care: - Individual/family focused - Emphasis on treatment/cure - Health is available within given healthcare institutions - Professional role is as expert, provider, authority, team leader - Collaboration within health care team primary health care: - Community or some aggregate is the focus - Emphasis on health promotion and disease/injury prevention - Healthcare is available where people live and work Professional role is as facilitator, consultant and resource - Collaboration goes beyond the health care sector

socio- environmental: problems, causes of problems and treatment

problems - living conditions - working conditions - social isolation causes: - poverty - unemployment - stress - powerlessness - environmental pollution treatment: - policy change - advocacy - community mobilization - self-help

biomedical: problems, causes of problems and treatment

problems: - cardiovascular disease - cancer - stroke - diabetes causes: - hypertension - family history treatment: - drugs - technology - surgery

Behavioural: problems, causes of problems and treatment

problems: - smoking - poor eating habits - physical inactivity causes: - same as problems treatment: - health education - health communication - self-help - lifestyle changes

WW2 turn around for medical care

provincial and municipal governments became more involved with providing medical care and financial support widows, children and elder families who lost sons in the war. veterans looking for work - stimulated proposals for coverage

Primary health care

refers to an approach to health and a spectrum of cervices beyond the traditional health care system. it includes all services that play a part in heath, such as income, housing, education, and environment. at this first level of care, use supports and services to promote the health and well being of Canadians Primary care brings health care as close as possible to where people live and work.

secondary health care

Care-Involves diagnosis and treatment.. Referred by a primary care provider to specialized care at a hospital.

end of the 1960's

strong social safety net was in place for Canadians

Pre 1940

- private medicine was predominate - families had to pay for services

Behavioural Approach to Medical Care

- 1970's there was a shift in approach. - Health defined as the product of making healthy lifestyle choices. - Promoted individual responsibility for health. - Focus on health promotion, disease prevention and education

medical approach to health care

- Focus on health care is on curing disease and health problems. - Medical interventions for health restoration were emphasized, heavy reliance on in-hospital care. - Reactive approach was not proactive - Remember until the 1960's health care was paid for out of pocket, many could not afford life-saving measures - most predominant throughout the 20th century

barriers of primary health care

- Lack of accessibility to 24/7 care - Turf protection when one category of professional is considered gatekeeper to those entering health care system - Reluctance by some re multidisciplinary team based approach / collaboration - Inadequate monitoring of persons with chronic diseases (to prevent acute flair ups) - Confusion b/t Primary Care & Primary Health Care - Health Care seen as illness centered rather than health centered -Funding mostly Illness Centered not prevention & health promotion

5 pillars of the Canadian health care system

- Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the province or territory, and their records and accounts are subject to audits. MSI - Comprehensiveness: Cover all insured services provided by hospitals, physicians, or dentists* (essential health services, including hospitals, physicians and surgical dentists, must be insured). May vary across provinces and territories. Universality: All insured residents are entitled to the same level of health care. Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province during a minimum waiting period (3 months). This is true for temporary visits to another province or out of country (with conditions) Accessibility: All insured persons have reasonable access to health care facilities, regardless of location. Reasonable meaning access when and where they are available, as they are available.

1961: National Hospital and Diagnostic Services Act

- public insurance for hospital costs and diagnostic services - all provinces agreed to covering inpatient care - physicians were against have paid medical services outside the hospital

1966: medical care act

- universal availability of medical care services - by 1972 all provinces had joined Medicare - strong emphasis on medical interventions/treatments within the health care system at this time

Points of Care

1) Primary Health Care (primary care is an element of this) 2) Secondary Care 3) Tertiary Care 4) Quaternary Care

4 influences on health

1) human biology; 2) lifestyle; 3) the environment; and 4) health services.

Forces Influencing Health Care Delivery

1. Technological advancements-Expansion of continuum of care, need new treatment site for new Rx modalities, ethical dilemmas 2. Aging population-Increased demand for primary care and health promotion (among 65-75 year olds, chronic care management older than 75, managing ethical issues associated with prolongation of life Other demographic and social forces- immigration, incomes of populations, aboriginal population expected to grow at a rate of four times the non-aboriginal population...health disparities exist... diabetes is 3 times for prevalent in aboriginal populations, lack of health care service providers average stay is about 2 years 3. Ethnic/cultural diversity-Understanding and meeting client expectations, increasingly diverse work force. 4. Supply and education of health professionals- Creative approaches for meeting population needs associated with Disease Prevention, health promotion, Chronic care Management, compensate for shortages, effective teams across multiple sites. 5. Social morbidity- ability to deal with Unpredictable increases in demand, increased social support, work effectively with community organizations 6. IT-Training, Coordinate across sites, increased pace of change, confidentiality, certain technologies will make surgeries less invasive or completely unavoidable.. Pan Canadian electronic health record 8. Capitated payments, expenditure targets- Need for increased efficiency and productivity, redesign of client care delivery, strategic alliances, increased growth of networks. 9. Increased accountability- Effective clinical guidelines, continuous improvements in all functions and processes, public expectations

Five Guiding Principles of Primary Health Care

Accessibility: (a continued and organized supply of essential healthcare services that is available to all people with no unreasonable geographic or financial barriers) Public Participation: (individuals and communities have the right and responsibility to be active partners in making decisions about healthcare) Health Promotion: (healthy living, prevention, management, self care; process of enabling people to increase control over and to improve their health) Appropriate technology: (includes methods of care, procedures and equipment that are socially acceptable and affordable) Intersectoral Cooperation: (commitment from all sectors is essential for meaningful action on the health determinants)

Chief Public Health officer of Canada

Dr. Theresa Tam responsible for the Public Health Agency of Canada, reporting to the Minister of Health. Is the federal government's lead public health professional, providing advice to the Minister of Health and Government of Canada on health issues. Manages the Public Health Agency's day-to-day activities. Works with other governments, jurisdictions, agencies, organizations, and countries on health matters.

Provincial Jurisdiction

Each province is responsible for administration of their own delivery of health services Decide on how many physicians, nurses and other care providers are required

minister of health

Ginette Petitpas Taylor The Minister of Health is responsible for maintaining and improving the health of Canadians.

Health Authorities Act

Government passed the Health Authorities Act on, Oct. 3, 2014 that sets the groundwork to consolidate 9 district health authorities into two. Under the act: -- wages, pensions, health benefits and retirement allowances for workers will not change -- government will set a strategic, multi-year health plan for the province, with targets for improvement -- the IWK and provincial health board will be required by law to create annual public engagement plans, to ensure community voices are heard "Health-care workers, government, employers and Nova Scotians share the most important goal, to improve the health care we offer across the province," said Health and Wellness Minister Leo Glavine. "I encourage all sides to work together as we move forward, for the benefit of patients." too many health boards...local autonomy.. Centralize purchasing... when in doubt restructure

Tommy Douglas

Premier of Saskatchewan for 17 years; *Father of Canadian Medicare 1947 Public Insurance Plan implemented in Saskatchewan Legacy: A social policy innovator Pioneered many social programs that were later modeled & implemented by other provinces/countries Promoted - Social welfare - Universal Medicare - Old age pensions and mothers' allowances

Provincial Minister of Health & Wellness

Randy Delorey The organization and mandate of the department is set out in the Health Act. The department is responsible for all aspects of public health, including health services and insurance, health care institutions, community health services, psychiatric mental health and drug dependency rehabilitation.

federal jurisdiction

Responsible for the administration of principles for the health care system as defined by the Canada Health Act Responsible for financing provinces and territories - territories-transfer funding Delivers services to First Nations and Inuit, veterans, inmates of federal penitentiaries Government policy & programs -i.e............ approved drugs, assess environmental risks, and others

1947

Saskatchewan government ed by the leader tommy Douglas, introduced the first provincial hospital insurance programs. - hospital services only

Perspectives on Health: What causes heart disease?

You may get three different answers if you ask 3 different types of health professionals.... Nutritionist or a fitness professional may say: "Heart disease is caused by smoking, physical inactivity, excess alcohol consumption and a high fat diet." A Social Worker may say: "Heart disease is caused by stress, poverty, unemployment and social isolation." Cardiologist-"Heart disease is caused by hypertension, family hist0ry, and a build-up of arterial plaque."

Jurisdictional Boundaries

the official power to make legal decisions and judgments. - Indigenous health falls under the Federal Government - Acute care services are accessed provincially - Jurisdictional disputes ie: Jordan's Principle

British north american act of 1867

the provinces were given the responsibilities for health and welfare