Health Policy, Systems, and Canadian Healthcare Delivery

Vocabulary practice flashcards covering health policy concepts, governance, economic classifications, healthcare delivery levels, the Canada Health Act, and Canadian federalism based on lecture notes.

Health (WHO Definition)

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, formulated by the World Health Organization in $1948$.

Health Care

Services intended to maintain or improve health, often referred to as 'sickness care' when focused on treating illness after it occurs, but also including preventative services such as screening and vaccinations.

Health Systems

The overarching institutions, organisations, resources, and people involved in delivering, financing, regulating, and governing health-related services and population health.

Health Policy

Authoritative decisions, plans, rules, and actions designed to achieve specific healthcare goals and balance core objectives such as equity, efficiency, access, and responsiveness.

Legislation

A legally binding rule enacted by government that formally mandates or restricts what institutions and individuals are permitted or required to do (e.g., Ontario Bill $7$).

Organisational Policy

A set of operational rules and commitments established within a specific institution (such as a hospital) that guides organisational action and internal accountability.

Policy Ideas

Conceptual frameworks, knowledge, and shared beliefs that shape how decision-makers define problems and which policy solutions they consider legitimate.

Policy Agenda

The formal set of broad priorities and directions established by decision-makers to guide future actions, resource distribution, and service design.

Policy Claim

A testable assertion proposing an explanation or predicting a specific outcome of an intervention that requires empirical evaluation rather than automatic acceptance.

Policy Trade-Off

A situation where pursuing one desirable policy objective (such as efficiency or cost containment) makes it harder to achieve another competing objective (such as equity or patient autonomy).

Public Good

A good that is both non-rivalrous (one person's use does not deplete its availability for others) and non-excludable (people cannot be prevented from benefiting from it, even without payment), such as clean air.

Private Good

A good that is both rivalrous and excludable, meaning consumption by one individual prevents another from using it and access is restricted to those who pay.

Merit Good

A good or service that does not meet the technical definition of a pure public good but is deemed sufficiently beneficial to individuals and society to warrant public funding, subsidies, or social support.

Free-Rider Problem

A market failure occurring when individuals benefit from a non-excludable collective good without contributing to its cost, creating an incentive to avoid payment.

Negative Externality

An uncompensated cost imposed on third parties by an individual or commercial action, such as secondhand smoke exposure or antimicrobial resistance resulting from overprescribing antibiotics.

Positive Externality

A social or collective benefit generated for third parties beyond the direct beneficiary of an action, such as population-wide protection resulting from vaccination against infectious diseases.

Lalonde Report (1974)

A landmark Canadian document that shifted health policy toward prevention by identifying four health fields: human biology, environment, lifestyle, and health care organisation.

Ottawa Charter (1986)

An international public health agreement emphasizing health promotion by creating supportive environments and addressing social determinants rather than focusing exclusively on clinical treatment.

Intersectoral Collaboration

Joint policy and planning initiatives across non-health sectors (including housing, transit, education, and employment) to improve population health and address social determinants.

Policy Instruments

The range of governance mechanisms arranged by degree of coercion used to implement policy, including doing nothing, exhortation/information, expenditure, taxation, regulation, and public ownership.

Policy Advocate

An actor who argues in favour of a preferred solution or policy position, focusing on why it should be adopted and emphasizing supporting evidence.

Policy Analyst

An actor who objectively assesses whether a proposed policy is feasible and likely to achieve specified goals by evaluating evidence, alternatives, uncertainties, and trade-offs.

Evidence-Informed Policy

A decision-making approach that uses empirical research alongside prevailing values, stakeholder interests, institutions, and contextual factors to guide health decisions.

3-I Framework

A political science model explaining health policy development through the continuous interaction of Ideas (understandings and values), Interests (affected stakeholders), and Institutions (rules and structures).

Path Dependence

The concept that established institutional arrangements, legal precedents, and policy legacies constrain future choices and make incremental change easier than systemic restructuring.

Concentrated Interests

Stakeholder dynamics where a specific group experiences substantial, direct, and immediate impacts from a policy change, motivating high political mobilization.

Diffuse Interests

Stakeholder dynamics where costs or benefits are spread thinly across a large population, resulting in lower individual incentives to mobilize or advocate.

Macro Level (Health Policy)

The system-wide tier of health policy that encompasses overarching paradigm shifts, national/provincial legislation, broad funding priorities, and structural system design.

Meso Level (Health Policy)

The organizational and regional tier of health policy where hospitals, regional networks, and clinics translate macro priorities into operational plans and coordination protocols.

Micro Level (Health Policy)

The clinical and frontline tier of healthcare delivery where practitioners implement clinical guidelines, care pathways, and direct operational practices with patients.

Primary Care

The first point of clinical contact for non-emergency healthcare needs, delivering comprehensive, ongoing care and coordinating referrals across other levels of the system.

Secondary Care

Specialized medical services and outpatient consultations typically accessed through a formal referral from a primary care provider (e.g., cardiology, endocrinology).

Tertiary Care

Advanced, highly specialized acute healthcare services provided in specialized hospital facilities for complex or severe conditions (e.g., advanced cardiac surgery, specialized cancer treatment).

Quaternary Care

An extremely specialized extension of tertiary care involving rare, highly complex, or experimental diagnostic and therapeutic procedures.

Horizontal Integration

Coordination between health services and organizations operating at the same or similar levels of care (e.g., collaboration among primary care clinics).

Vertical Integration

Coordination and continuity of healthcare across different levels and stages of service delivery (e.g., linking a family physician, hospital acute team, and cardiac rehabilitation).

Health Service Silos

The administrative, clinical, and financial separation of different healthcare services (such as dental, mental health, and pharmacy), creating barriers to coordinated patient care.

Regulatory College

A statutory body established by provincial legislation whose legal mandate is to regulate professional practice, enforce standards, and protect public safety.

Professional Association

An advocacy organisation representing the economic, workplace, and professional interests of its members (such as the Ontario Nurses' Association or Ontario Medical Association).

Controlled Acts

Clinical procedures restricted by provincial law to designated, legally authorized health professionals to prevent harm to the public (e.g., injections, operative surgery).

Health Human Resources (HHR)

The overall workforce required to supply healthcare services, including its size, training capacity, geographic distribution, working conditions, and composition.

Alternate Level of Care (ALC)

A clinical designation for a hospitalized patient who no longer requires the intensity of resources in an acute-care bed but remains hospitalized while awaiting an appropriate care setting.

Long-Term Care (LTC)

A sustained continuum of medical, personal, and social care provided either in residential facilities (nursing homes) or via community and home-care services.

Activities of Daily Living (ADLs)

Core self-care tasks essential for day-to-day personal functioning, including bathing, dressing, eating, mobility, and toileting.

Instrumental Activities of Daily Living (IADLs)

Complex daily activities required for independent living within a community, including grocery shopping, housework, transportation, and medication management.

Bill 124

The Protecting a Sustainable Public Sector for Future Generations Act in Ontario, which legally capped annual compensation growth for affected public-sector workers, including nurses, at $1\%$ per year over a $3\text{-year}$ period.

Federalism

A system of governance where authority is constitutionally shared between a national government and regional subnational governments (provinces and territories).

Constitution Act, 1867

The foundational Canadian statute assigning provincial jurisdiction over hospitals and healthcare delivery, while reserving federal power over quarantine, marine hospitals, armed forces, and reserve healthcare.

Established Programs Financing (EPF) (1977)

A fiscal federalism reform that shifted federal healthcare contributions from $50:50$ cost-sharing to block funding via cash and tax point transfers.

Canada Health Act (1984)

Federal legislation establishing five mandatory criteria that provincial and territorial health insurance plans must fulfill to receive their full cash contribution under the Canada Health Transfer.

Public Administration (CHA Principle)

The requirement that a provincial health insurance plan must be administered and operated on a non-profit basis by a public authority accountable to the provincial government.

Comprehensiveness (CHA Principle)

The requirement that a provincial insurance plan must cover all medically necessary health services provided by hospitals, physicians, and surgical-dentists.

Universality (CHA Principle)

The requirement that $100\%$ of insured provincial residents are entitled to insured health services on uniform terms and conditions without discrimination.

Portability (CHA Principle)

The requirement that insured residents maintain health coverage when temporarily absent or moving between provinces, with limited coverage for emergency care abroad.

Accessibility (CHA Principle)

The requirement that insured residents receive reasonable access to insured medical facilities and providers without financial impediment, barring user fees and extra-billing.

Jordan's Principle

A child-first legal principle mandating that when jurisdictional disputes arise between governments over funding for a First Nations child's health needs, the service is funded immediately and disputes resolved later.

Chaoulli v. Quebec (2005)

A Supreme Court of Canada ruling holding that Quebec's statutory prohibition on private health insurance, in the context of significant public wait times, violated the Quebec Charter of Human Rights and Freedoms.

Public Financing vs. Public Provision

The distinction in Canadian healthcare where services are predominantly funded using public tax dollars (public financing) but frequently delivered by private practitioners or independent non-profit institutions (private provision).

Local Health Integration Networks (LHINs)

Regional health administrative bodies established in Ontario in $2007$ to organize, integrate, and fund regional health services across hospitals, LTC, and community care.

Ontario Health Teams (OHTs)

Integrated care provider networks introduced in Ontario in $2019$ designed to deliver coordinated, patient-centred care across disparate healthcare sectors.

Subsidiarity

The governance principle stating that policy decisions should be made at the most decentralized or local level practical, provided that level has the capacity to implement them effectively.