HLTA03: midterm prep

Health policy

decisions or non decisions taken by political actors in the public or private sector to achieve a goal.

Health policy - who

• Political actor(s)

• Public sector (e.g., governments)

• Private sector (e.g., industry)

Health policy - what

• Decisions, plans, actions

• Non-decisions, no plans, inaction

• Within the power of policy actors

Health policy - where

• Within society

• Healthcare system institutions, organizations, services, funders

• External to health care system (e.g., food, transportation, tobacco…)

Health policy - why

• Achieve health and healthcare goals

Health systems

set of institutions and rules to regulate, finance and pay for personal services called health care

eg of health system

Eg. Canada's single-payer health system ensures public funding for medically necessary services, but healthcare is delivered by private providers.

health system relationship to health policy

Works hand in hand with health policy to produce outcome

• Makes some health policy issues more relveant/ visible 

• Make some health policy efforts more possible

Policy objectives

The specific goals or outcomes that a policy aims to achieve. These are often set to address identified issues or challenges in a society or sector.

Policy objectives - boxes

• Fits into 4 boxes 

  • Security, liberty, equity, efficiency 

  • Trade-offs - need more than 1 of the boxes 

  • Not always compatible

Policy instruments

How can we accomplish our objectives? One way to classify tools:

degree of coercion (each increasing)

Status quo

Do nothing!

Eg. People should be free to eat what they want and decide not to act on obesity

Encourage activities without forcing it

Exhortation, persuasion

Eg. Developing public education programs to persuade people to eat healthy foods and exercise, Use symbolic gestures, like photos of politicians meeting student-athletes

Spending money

Expenditure or spending

Eg. giving money for healthy school lunches

Tax policy to encourage/ discourage activities

Taxation

Eg. Tax deductions for people who enroll their children in physical activity programs

Rules to encourage or penalize activities

Regulation

Eg. Manufacturers are required by law to list ingredients on their packaging to allow people to make more informed choices

Eg. Government ban on certain types of foods deemed to be unhealthy

Government-run activities

Public ownership

City-run public skating rink to encourage people to exercise

Lalonde Report

A landmark 1974 Canadian government report that introduced the "Health Field Concept," emphasizing that health is influenced by more than just medical care (including lifestyle, environment, and biology, health care org).

The Lalonde Report shifted focus from just treating illness to health promotion and disease prevention, influencing policies on smoking cessation, exercise, and nutrition.

Social determinants of health

 The non-medical factors that influence health outcome

Social determinants of health example

including income, education, employment, housing, and social support.

• Low-income individuals may experience poorer health outcomes due to limited access to nutritious food, stable housing, and healthcare services.

• Every sector is responsible for this 

Population health

A field of healthcare that focuses on the health outcomes of groups of people, including the distribution of health outcomes within a population. It considers social, economic, and environmental factors.

Health care

The organized provision of medical services to individuals or communities to promote, maintain, or restore health

Health care characteristics

Principal agent relationship

Asymmetry of information

Principal agent relationship

A situation where one party (the principal) delegates decision-making authority to another party (the agent) to act on their behalf.

In healthcare, this is often seen between patients (principals) and healthcare providers (agents).

Asymmetry of information

A situation where one party in a transaction has more or better information than the other, leading to an imbalance in decision-making.

In healthcare, doctors typically have more medical knowledge than patients, which may lead to unnecessary treatments or higher costs if not regulated.

Primary care

The first point of contact for individuals seeking healthcare services, including routine check-ups, preventative care, and treatment for common illnesses.

Focus on relationship

Specialist in Generalism

Primary care worker include

Primary care providers include family doctors, nurse practitioners, and community health clinics.

Not just clinical may include health promotion, disease prevention, and rehab

Primary care silo level

lowest

Coordinates and oversees care

Primary care focus

• Primary care focuses on comprehensive, continuous care for individuals, aiming to prevent serious illnesses by addressing health issues early.

Generalism

A healthcare approach focused on broad, comprehensive care rather than specialized treatment in one area.

Focused on undifferentiated disease

Primary silo - entry to health care

Generalism example

General practitioners (GPs) and family doctors are examples of generalists who provide holistic care rather than focusing on a specific medical specialty like cardiology or neurology.

generilism expense

Less expensive cuz less tech, tools are eyes, nose, ears

Undifferentiated disease

A medical condition with symptoms that do not clearly indicate a specific diagnosis, requiring further investigation

Primary care determines this

Refers to specialist

Undifferentiated disease example

A patient presenting with generalized fatigue, fever, and weight loss may have an undifferentiated disease, requiring additional tests to determine the cause.

Secondary care

Specialized medical services provided after a referral from a primary care provider, typically involving specialists or hospital-based care.

Secondary care example

Seeing a cardiologist or orthopedic surgeon after being referred by a family doctor is an example of secondary care.

Basic hospitals

Abulatory care (outpatient services provided outside of hospital )

Secondary care silo level

2nd level of silo

Tertiary care

Highly specialized medical care that typically requires advanced technology and expertise, usually provided in specialized hospitals.

Highly specilized

May include research and teaching

Tertiary care example

Cancer treatment centers, neurosurgery, and organ transplants are examples of tertiary care, requiring complex interventions and expert teams.

Specific hospitals - eg sickids

Tertiary care silo

Must be referred as higher in the silo

Integration

The coordination of different healthcare services and sectors (e.g., hospitals, primary care, home care) to provide seamless and efficient care.

Integration in health care

Eg. Integrated care models connect hospitals with home care services, ensuring that discharged patients continue receiving necessary treatment at home without delays.

Integration in health care in canada

Minimal integration across the silos

Emergency services

Immediate medical care provided for urgent, life-threatening conditions, typically available 24/7 in hospitals and through emergency responders.

Emergency services example

Ambulance transport, trauma care, and emergency surgeries are examples of essential emergency services covered under Canada’s healthcare system

Long-term care

set of health, personal care, and social services required on a sustained basis

Not a emergency paid

Long-term care types

Ltc institutions

Home and community care

Long-term care institutions

Facilities that provide residential care for individuals with chronic illnesses or disabilities who need assistance with daily activities over an extended period.

More specilized facility however still not hospital

Long-term care institutions example

Eg. Nursing homes, assisted living facilities, and rehabilitation centers are examples of long-term care institutions that offer 24-hour care and support

Home and community care

Medical and non-medical services provided outside of hospitals, but community based

Home and community care example

In home services, community support activities, supportive housing

Extended health care services

Activities of daily living

Basic self-care tasks that individuals perform daily to maintain independence and well-being.

ADLs are used to assess the level of assistance someone may need, particularly in healthcare and elder care.

Activities of daily living example

Eg. bathing, dressing, eating, toileting, and functional mobility.

who provides Activities of daily living

PSW provides this

Instrumental activities of daily living

More complex daily tasks that allow individuals to live independently, such as managing finances, preparing meals, housekeeping, and transportation.

Instrumental activities of daily living example

A senior who can bathe and dress independently but needs help with grocery shopping and managing medications may require support with IADLs.

Adl vs iadl

Adl = essential for survival, iadl = important for independent living

Adl = basic task, iadl = more complex

Informal care(givers)

Unpaid care provided by family members, friends, or community members to individuals who need assistance due to aging, disability, or illness.

Informal care(givers) example

Eg. A daughter caring for her elderly mother with dementia at home, helping with daily tasks such as cooking, bathing, and medication management.

Profession

A specialized field of work requiring formal education, training, and expertise, often governed by ethical standards and regulations.

Alot of health care is delievred by nonprofessionala

Profession example

Healthcare professions include doctors, nurses, and physiotherapists, who must complete formal education and obtain licenses to practice

Professional association

An organization that represents and supports members of a particular profession by setting standards, providing education, and advocating for the profession.

Protects interest of its memebers

Professional association example

the Canadian Medical Association (CMA) represents doctors in Canada, setting ethical guidelines and advocating for healthcare policies.

Regulated health profession

A profession that requires practitioners to meet specific educational, ethical, and competency standards set by a governing body to ensure public safety.

Protects public interest

Issues certificates and overseas activities

Self - regulating

Regulated health profession example

Eg. college of physicians and surgeons of ontario

Skilled trade

may or may not be designated as a profession

Provides care

Can be paid or unpaid

Skilled trade example

psw

Health human resources

The workforce involved in healthcare delivery, including doctors, nurses, technicians, and support staff.

questions associated with Health human resources

How many health care providers do we need?

How to balance supply and demand?

How much should we pay different providers?

Retention

The ability to keep healthcare professionals in their roles over time, reducing turnover and ensuring a stable workforce.

Strategies for healthcare worker retention

include offering competitive salaries, professional development opportunities, and work-life balance programs.

Recruitment

The process of attracting, selecting, and hiring individuals for a specific role.

Subsector, geographical region, organization

Stickiness

probability that someone working in a job will stay there

where is Stickiness high and low

Hospitals = high stickiness

Home care = not sticky

Ideology: egalitarian

Maximize social and economic equality; minimize social and economic inequalities through state intervention

Ideology: egalitarian example

Eg. The Canada Health Act (CHA) reflects egalitarian principles by ensuring universal access to healthcare regardless of income or social status.

Ideology: libertarian

Maximize individual autonomy and political freedom; minimize state involvement

Ideology: libertarian example

A libertarian approach to healthcare would advocate for more privatization, allowing individuals to pay for faster access to medical services

Federation

A system of government in which power is divided between a central (federal) government and regional (provincial or state) governments, each with its own responsibilities.

section of Federation

• National government (federal government)

• Sub-national jurisdictions (provinces and territories)

National government

federal government that has overarching authority over a country, with powers to make national laws and policies, including healthcare.

Sub-national jurisdiction

The level of government below the national level, such as provinces or states, that has authority over specific policy areas, including healthcare.

Balancing act

What should be standard across the country vs local?

year of Constitution Act

1867

Constitution Act

The legislation that established Canada’s federal system, defining the division of powers between the federal and provincial governments, including responsibility for healthcare.

Constitutional responsibilities of feds

• Section 91, “Quarantine and the Establishment and Maintenance of Marine Hospitals”

• Territories

• First Nations living on reserve

• Armed services

Federal jurisdiction over pharmaceutical regulation, public health, provision of services for Indigenous peoples, armed forces, veterans, inmates, refugees

Constitutional responsibilities of provinces

• Section 92, “The Establishment, Maintenance and Management of Hospitals, Asylums, Charities and Eleemosynary Institutions in and for the Province, other than Marine Hospitals”

Provinces in Canada are responsible for running hospitals, mental health facilities, and charitable institutions within their borders, except for federal marine hospitals.

• Professional licensure

Provincial jurisdiction over health service delivery and financing

Canada Health Act (CHA) year

1984

Canada Health Act (CHA)

 The federal legislation that sets the principles for Canada’s publicly funded healthcare system, ensuring universal coverage for medically necessary hospital and physician services.

Provinces and territories must comply to receive federal health funding.

The CHA establishes five key principles:

public administration, comprehensiveness, universality, portability, and accessibility.

CHA: Accessibility

ensuring all insured persons have reasonable access to medically necessary healthcare services without financial or other barriers.

Patients should not face extra charges, and services should be provided based on medical need rather than ability to pay.

CHA: Comprehensiveness

Requires that provincial and territorial health insurance plans cover all medically necessary hospital, physician, and surgical-dental services.

While basic healthcare is covered, services like prescription drugs, dental, and vision care often require private insurance or out-of-pocket payments.

Insured person = resident, insured health service = medicaly nessecary

CHA: Portability

Ensures that Canadians maintain their healthcare coverage when moving between provinces or traveling within Canada.

Some provision for out of country care

CHA: Public administration

Requires that provincial and territorial health insurance plans be operated on a non-profit basis by a public authority accountable to the government.

Not delivery, but management of insurance plan

CHA: Universality

Guarantees that all eligible residents of a province or territory are entitled to the same level of insured healthcare services.

Every Canadian citizen and permanent resident has equal access to publicly funded healthcare, regardless of income or employment status.

Extended health services

Healthcare services not covered by the Canada Health Act but often included in private insurance plans or employer benefits.

example of Extended health services

• a) nursing home intermediate care service

• b) adult residential care service,

• c) home care service, and

• d) ambulatory health service

Insured health services

Medically necessary hospital and physician services covered under the Canada Health Act (CHA) and funded by provincial/territorial health plans.

Insured health services examples

• Hospital services

• Accommodation and meals; nursing; diagnostics; drugs; operating facilities; equipment and supplies; radiotherapy; physiotherapy; other providers remunerated by hospital

• Physician services

• Medical doctors and surgeons

• Surgical-dental services (performed in hospital)

Medically necessary services

Healthcare services required to diagnose or treat a medical condition that are essential for maintaining health and functioning.