Week 10-Canada Health Act (HCA) & Laboratory Specimen Collection Licensing

THE CANADA HEALTH ACT - Mandate

Primary Objective:

• “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate access to health services  without financial or other barriers”

• Purpose of the Act

  • is to ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without charges at the point of accessing services

• CHA

  • establishes criteria and standards related to insured health services 

  • extended health care services that the provinces and territories must fulfill in order to receive federal cash contributions.

is Canada's federal health insurance legislation

• established the criteria and standards related to

  insured health care services

• The provinces and territories of Canada are responsible for the administration and delivery of health care services

• The provinces and territories decide where their hospitals

  will be located, how many physicians they will need, and

  how much money they will allocate to the different health

  services.

The national standards and criteria of CHA must be met by the provinces and territories in order to receive the full federal cash transfer under the transfer mechanism, that is, the Canada Health and Social Transfer (CHST)

The aim of the national health insurance program is to ensure that all residents of Canada have reasonable access to medically necessary insured services without direct charges.

History of Canada Health Act

•  After the great depression and World War 2, men and women had made great sacrifices for this country, economy was not stable and Canada examined the importance of providing affordable health care to its citizens.

•  There was great debate as to which level of government should bear the financial burden, no consensus was reached

•  1946 – Tommy Douglas (premier of Saskatchewan) took up the affordable health care cause independently and started Canada’s first publicly funded Hospital Insurance Plan

Timeline

•  1947 - Saskatchewan - instituted compulsory public, universal hospital insurance scheme

•  1948 - National Health Program was established and comprised of 10 grant programs for public health care, tuberculosis, cancer, mental health, sexually transmitted diseases, crippled children... and hospital construction

•  1949 - Alberta and B.C joined national health program

•  1958 - Insurance was provided for diagnostic services offered in hospitals but not for nursing homes, mental institutions, etc.

•  By 1961-10 provinces and two territories have public insurance plans that covered in-hospital care

•  1962 - Saskatchewan - extends insurance to cover all physician services

•  1962-64 EMMETT HALL Commission Recommendations

  • 1. That federal government, in co-operation with the provinces should introduce universal health care.

  • 2. Recommends universal health insurance be guided by 4 criteria

    • a) Public Administration

    • b) Comprehensiveness

    • c) Universality

    • d) Portability

•  1966 - Medical Care Act was passed by Lester B. Pearson

•  1972 - physician fees were included

•  1979 - Justice Emmett Hall declared that the health care in Canada was among the best in the world

•  In 1984 - Canada Health Act was passed by parliament under Pierre Trudeau

Canadian Health Care System (Medicare)

•  Ensures all residents have access to hospital and physician services on a prepaid basis

•  National program is composed of 13 provincial and territorial health plans which cover common features and standards of health coverage

•  Principles governing the healthcare system are equity for all Canadians

•  Roles and responsibilities of the Canada ‘s Health care system are shared between the governments at the federal, provincial and territorial.

•  The provinces and territories must satisfy the criteria in order for them to qualify for the federal cash contributions under the Canada Health and Social Transfer (CHST)

•  Provincial and territorial governments are responsible for the management, organization and delivery of health services

CHA - THE CRITERIA

1. Public Administration

2. Comprehensiveness

3. Universality

4. Portability

5. Accessibility (added in 1984)

Public Administration (CHA criteria)

• applies to the health insurance plans of the provinces and territories (not to hospitals or the services hospitals provide).

• The health care insurance plans are to be administered and operated on a non-profit basis by a public authority, responsible to the provincial/territorial governments and is subject to audits of the accounts and financial transactions.

Comprehensiveness (CHA criteria)

• The health insurance plans of the provinces and territories must insure all insured health services and, where permitted, services rendered by other health care practitioners.

• Health insurance covers hospitals, home care, long-term care, mental health care, diagnostic services, surgery including dental surgery and out-patient services

Universality (CHA criteria)

•  One hundred percent of the insured residents of a province or territory must be entitled to the insured health services provided on equitable terms and conditions.

•  Provinces and territories generally require that residents register with the plans to establish entitlement.

Portability (CHA criteria)

•  Residents moving from one province or territory to another must continue to be covered for insured health care services by the "home" province, with a minimum waiting period, not to exceed three months, imposedby the new province of residence.

•  After the waiting period, the new province or territory of residence assumes health care coverage.

•  Residents who are temporarily absent from their home provinces or territories, or from the country (less than 6 months), must also continue to be covered for insured health care services.

  • can not be covered by 2 provinces at the same time

  • After 6 months leaving country must re-register with province 

Accessibility

• The Canada Health Act of 1984 added accessibility as the fifth criteria

• The health insurance plans of the provinces and territories must provide: reasonable access to insured health care services and access must not be impeded, directly or indirectly, by:

  • Charges (user charges or extra-billing)

  • Others (location, age, health status, social-economic status)

Accessibility in Rural and Remote Areas

•  Under the Canada Health Act, reasonable access in terms of physical availability of medically necessary services has been interpreted using the "where and as available" rule.

•  Residents in remote areas of a province or territory are entitled to have access to insured health care services that may be limited in a particular hospital, however these patients do have access to urban hospitals through transfers either by EMS or helicopter

•  Reasonable compensation up to a maximum ceiling will be made to physicians and dental surgeons for all insured health care services they provide and similarly, reasonable payment to hospitals to cover the cost of insured health care services.

Laboratory and Specimen Collection Centre Licensing Act

•  R.R.O. - Revised Regulations of Ontario 1990

•  Clearly identifies the individuals responsible for administration and operation of the Lab, the duties and responsibilities of the individuals

•  Lab Director – responsible for scientific and technical operation of lab, which includes testing and reporting of results. Director is a medical practitioner (physician)

•  Lab Supervisor –supervision of personnel, operations

•  Lab Technician – who under direct supervision performs lab tests that require limited technical skills.

•  Lab Technologist who under supervision of the Lab Director performs test that require independent judgment

•  License lists the classes of tests that a Lab can perform, sets limitations on classes of tests based on the qualifications, patient needs and programs

  • for each individual tests

Statue of the Laboratory and Specimen Collection Centre Licensing Actclearly defines a laboratory

• means an institution, building or place in which operations and procedures for the

  • microbiological, serological, chemical, hematological, biophysical, munohematological, cytological, pathological, cytogenetic, molecular genetic or genetic examination, or such other examinations

• as are prescribed by the regulations, of specimens taken from the human body are performed to obtain information for

  • medical diagnosis, prophylaxis or treatment

Specimen collection centre

means a place where specimens are taken or collected from the human body for examination to obtain information for medical diagnosis, prophylaxis or treatment, but does not include

• a place where a legally qualified medical practitioner is engaged in the practice of medicine or surgery

• In the case of a specimen collection centre, the Act limits the type specimens collected or class/classes of specimens collected

• In the case of a laboratory, the Act limits the classes(types) of tests or which tests within a class of tests that can be performed in a laboratory

Laboratory and Specimen Collection Centre Licensing Act

•  Only human specimens will be examined and processed

•  All Lab tests can be ordered or requested by qualified medical physician and dentists.

•  Physicians have delegated to Clinical Nurse Practitioners the ability to order only certain types of tests.

•  Midwifes can order test related to pregnancy

•  At request of an insurer, a medical physician orders the tests under the Insurance Act

•  All communicable disease identified must be reported to the Medical Officer of Health within 24 hours (Health Protection and Promotion Act)

•  Establish a quality control program

•  Maintain all records

•  Physicians who perform laboratory tests in their office are exempt from this Act.

  • they are not currently regulated

•  Ontario Medical Association is designated to monitor and inspect the laboratory’s operations and the quality management of the lab services

Lab Director (physican/biochemist)

qualified medical practitioner, certified by Royal College of Physicians and Surgeons, with at least 2 years of lab training

Lab Supervisor (administator/director/managment)

Qualified practitioner with post-graduate/doctorate degree and has one year experience in laboratories or with under-graduate degree with three years lab experience

Lab Technologist (encharge of technician)

Completed relevant course experience or has 6 years of experience and is acceptable to the Director or is recognized as a Lab Technologist

Lab Technician

Obtained School Graduation Diploma and has completed the relevant courses and together with experience is acceptable to the Director or Diploma and two years of experience as a technical trainee

Health Promotion and Protection Act

• pertain to health protection and promotion include the

  following

•  To develop, disseminate and advance public health knowledge, best practices, and research;

•  To develop, collect, use, analyze and disclose data, across sectors, that informs and enhances healthy public policy and public health planning, evaluation and action;

•  To provide education and professional development for public health professionals, scientists, researchers, and policymakers;

•  To establish, operate and maintain laboratory centres;

•  To facilitate collaboration between the areas of infection control and occupational health and safety