PPHC: L2 How Does the Canadian Health Care System Work?

… is the organization of people, institutions, and resources that deliver health care to meet the health needs of target populations

Health care system

Organization varies from country to country, but in all a health care system requires:

• Well-… and … paid workforce (WHO)

• Well maintained … and … to deliver healthcare (WHERE)

• … mechanism (HOW)

• Reliable information on which to base … and … (HOW)

trained, adequately, facilities, logistics, Financing, decisions, policies

The … is the legislation (…) that defines national principles for provincial and territorial health insurance plans (‘health care systems’)

Canada Health Act, 1984

… and … are constitutionally responsible for the … and … of health care

organization, delivery

The Canada Health Act sets conditions for provincial and territorial health care systems to meet in order to obtain federal contributions via the …

Canada Health Transfer

In order to qualify for full federal funding through the Canada Health Transfer, provinces and territories must meet … requirements under the …

9, Canada Health Act

The 9 requirements under the Canada Health Act includes:

• … criteria of the Canada Health Act

• … conditions that apply to the insured health care services and extended health care services 

• … extra-billing and user charges provisions that apply only to insured health care services

5, 2, 2

What are the 5 CHA criteria?

Public administration, comprehensiveness, universality, portability, and accessibility 

CHA 5 criteria - public administration: the provincial/territorial health insurance plans must be administered and operated on a … basis by … authority

non-profit, public

What are 2 examples of public administration?

BC → Health Insurance BC through Medical Services Plan (MSP), Quebec → Regie de l’assurance maladie due Quebec (RAMQ)

CHA 5 criteria - comprehensiveness: provincial/territorial health insurance plans must cover … medically necessary health services provided by …, …, and …

all, physicians, hospitals, dentists when performed in hospitals

CHA 5 criteria - universality: the provincial/territorial health insurance plans mist cover all … on uniform terms

residents

CHA 5 criteria - portability: provincial/territorial health insurance plans must cover residents when they … within Canada

move

CHA 5 criteria - portability:

More practically

• Residents … away from their home provinces or territories must continue to be covered for insured health care services

• Residents … moving from one province or territory to another must continue to be covered for insured health services by the “home” province during any minimum waiting period, not to exceed … months, imposed by the new province of residence

  • After the … period, the new province or territory of residence assumes health care coverage

temporarily, permanently, 3, waiting

CHA 5 criteria - accessibility: the provincial/territorial plans must provide all residents … access to medically necessary services

• Access must be based on medical need and not impeded by the …, …, … status

reasonable, ability to pay, age, health status

The Canadian Heath Care System is not a … system, but … provincial/territorial health care systems working in parallel with differences 

single, 13

BC Health Care System (aka …) sets policies and budgets, and regulate health professional bodies (licensure and discipline)

Ministry of Health

Many provinces/territories have ‘…’ inpatient health care

• One or several regional entities

• Region is responsible for inpatient health care for residents through … and … care facilities 

regionalized, hospitals, long-term

Inpatient health care is funded by the … within the global budget

• Example: … → health authority → hospital 

province 

What are the 5 regional health authorities in BC?

Northern Health (NHA), Interior Health (IHA), Fraser Health (FHA), Vancouver Island (VIHA), and Vancouver Coastal Health (VCHA)

The … health authority (…) in BC coordinates and delivers  provincial programs and highly specialized health care services 

provincial, PHSA

… are predominantly fee-for-service

Physicians

In outpatient health care:

• Fee schedules are …

• Fee schedules are administered by the …

• Funded directly by the … (contrast with funding for inpatient health care)

negotiated, province, province 

Which of the following are elements of a health care system? Select all that apply. (Note: the rest are the criteria of the Canada Health Act).

a. Skilled providers to deliver health care services

b. Coverage for residents when they move within Canada

c. Institutions where health care services will be delivered

d. Provisions of medically necessary health care services

a and c

Which health care service listed below is the province legally obligated to provide as an insured service under the Canada Health Act?

a. Physiotherapy for a sore shoulder following a hockey game

b. Filling a prescription for an analgesic for shoulder pain following a hockey game

c. Visiting a dental clinic to repair a cracked tooth after being hit by a stick in a hockey game

d. Consult with an orthopaedic surgeon for a sore back following a hockey game

d

Which of the following represent(s) type(s) of health care?

a. Lower anterior resection surgery to remove colorectal cancer

b. BC Cancer Agency to deliver care for colorectal cancer

c. FOLFOX chemotherapy to treat colorectal cancer

d. Carcinoembryonic antigen laboratory test to detect response to treatment for colorectal cancer

a, c, and d