Healthcare in Canada: Comprehensive Study Notes

Agenda and Learning Outcomes

• Agenda:
  • Learning Outcomes
  • Healthcare in Canada
  • Wrap Up / Questions
• Learning Outcomes:
  1. Evaluate the influences on, and the history of, the nursing profession.
  2. Appraise the roles and responsibilities of the RN and associated healthcare providers.
  3. Critically examine healthcare and the healthcare system in Canada.
  4. Identify and define the principles of the Canadian Healthcare Act.

The Healthcare System in Canada

• Overview: Often depicted by a municipal hospital, highlighting its community-based nature.

Funding - History

• Early System:
  • Initially, people had to pay for care received in hospitals.
  • Individuals who could not afford care relied on charity.
• Post-Great Depression and WWII:
  • Many people could not afford necessary healthcare, leading to severe financial hardship.
• Introduction of Universal Healthcare:
  • Tommy Douglas, Premier of Saskatchewan, introduced the idea of universal healthcare in Saskatchewan in $1947$.
  • This was the first universal hospital care program in North America.
• Federal Involvement:
  • $1957$ – Hospital Insurance and Diagnostic Services Act: The federal government agreed to cost-share provincial hospital insurance programs.
  • By $1961$, all provinces and territories had universal hospital coverage for the costs of all inpatient services.
• Expanded Coverage:
  • In $1966$, the Medical Care Act was created, extending healthcare coverage to inpatient and outpatient services.
• Current Funding:
  • Today, many healthcare services are still publicly funded, meaning funding comes from taxes rather than individual payments.

Canada Health Act

• Creation: Established in $1984$.
• Goal: To create principles and law that every part of Canada must follow.
• Consequence of Non-Compliance: Provinces or territories may not receive full federal funding for healthcare if they do not adhere to these criteria and conditions.
• Principles of the Canada Health Act:
  • Public Administration:
    • Healthcare must be non-profit (i.e., it does not aim to gain money).
    • A public authority must lead all administration of provincial health insurance (non-profit).
  • Comprehensiveness:
    • Covers 'necessary' services, including inpatient and some outpatient expenses, and the cost of seeing a doctor.
    • The scope of 'necessary' services can differ in each province.
  • Universality:
    • Healthcare must be free of any form of discrimination (e.g., based on race, gender, income).
  • Portability:
    • If eligible for insured care, individuals can receive necessary care anywhere in Canada for free, regardless of their location.
  • Accessibility:
    • Insured residents should have reasonable access to healthcare facilities (e.g., hospitals) and providers.

Governance

• Federal Jurisdiction (Role/Responsibility of the Federal Government):
  • Ensuring each province and territory follows the Canada Health Act.
  • Transferring funds to each province and territory.
  • Helping to deliver services for certain populations.
  • Creating national policy and programming to promote health and prevent disease.
• Provincial and Territory Jurisdiction:
  • Deciding how health insurance plans are administered.
  • Providing funding and planning support for hospitals.
  • Paying for services by doctors and other healthcare professions (e.g., nurses are government employees).
  • Planning and implementation of health promotion and public health initiatives.

Cost of Healthcare

• How Canadians Pay:
  • Indirectly: Through taxes.
  • Directly: For services not covered by the provincial or territory healthcare plan.
• Equity vs. Equality: The cost an individual pays through taxes does not equal the hypothetical cost if it weren't shared across Canada.
• Total Spending:
  • In $2021$, Canada spent approximately $308$ billion on healthcare, which is about $8000$ dollars per Canadian.
• Majority of Spending Areas: The majority of healthcare spending falls into three main areas:
  • Paying for hospital care ($25$%)
  • Paying for drugs ($14$%)
  • Paying for physicians ($13$%)

Private vs. Public Costs

• Split Costs: The cost of all types of healthcare services is split between private and public costs.
• Private Healthcare:
  • Needed for services not publicly funded (e.g., most prescription medications, massage therapy, additional homecare nursing).
  • Funding Sources:
    • Private insurance plans (often employer-provided, but can be purchased separately).
    • Direct out-of-pocket expenses (if no insurance, or if insurance doesn't cover needs).
  • Choice: Some services are available both publicly and privately; individuals may choose to pay privately for faster access.
• Public Healthcare:
  • Any services provided 'for free' by the provincial/territory government (e.g., inpatient hospital care, surgeries, cancer care).

Settings for Healthcare Delivery

• Two Main Areas:
  • Institutional Settings:
    • Hospitals
    • Some long-term care settings
    • Mental health facilities
    • Rehabilitation centers
  • Community Sector:
    • Public health
    • Physician offices
    • Community health centers and clinics
    • Assisted Living
    • Home Care
    • Adult day support programs
    • Community and voluntary agencies
    • Occupational health
    • Hospice and palliative care

Types and Levels of Healthcare

• Primary Health Care (PHC):
  • An overarching term focused on preventing disease, promoting health, and managing illness.
  • Emphasizes health and wellness rather than specific disease states.
  • Aspects (vs. Primary Care):
    • Definition: A broad philosophy and system approach to health.
    • Focus: Population health, prevention, equity, and social determinants of health.
    • Scope: Community-based, includes health promotion, prevention, and intersectoral work.
    • Providers: Teams including doctors, nurses, social workers, dietitians, public health staff, community workers.
    • Examples: Vaccination programs, community health centers, smoking cessation campaigns, housing/nutrition initiatives.
    • Approach: Proactive, addresses root causes, and keeps populations healthy.
    • Level: Community / population.
• Primary Care:
  • Different from, but related to, Primary Health Care.
  • Focuses on managing illness.
  • Typically conceptualized as the first point of contact between a doctor/Nurse Practitioner (NP) and a client when a health problem arises.
  • Aspects (vs. Primary Health Care):
    • Definition: First point of contact with the health system for individuals.
    • Focus: Diagnosis, treatment, and management of illness at the individual level.
    • Scope: Clinical care (check-ups, chronic disease management, prescriptions).
    • Providers: Family physicians, Nurse Practitioners, nurses, pharmacists.
    • Examples: Visiting a doctor for flu, NP for diabetes follow-up, pharmacist for medication.
    • Approach: Reactive, responds to illness when it occurs.
    • Level: Individual.
• Secondary, Tertiary, and Quaternary Care:
  • These types of healthcare occur after the initial encounter with a primary provider (e.g., doctor, NP).
  • Secondary Healthcare: Occurs when an individual is referred to a specialist or for further testing.
  • Tertiary and Quaternary Care: More specialized and complex, often involving types of surgeries or complex care requiring hospital admission.
    • A quaternary hospital can provide the highest level of in-hospital care.
• Levels of Healthcare in Canada (Hierarchy from bottom up):
  • Primary Care: First contact (family doctor, NP).
  • Secondary Care: Specialist care on referral.
  • Tertiary Care: Highly specialized hospital services.
  • Quaternary Care: Experimental, rare, ultra-specialized.

Discussion and Reflection Assignment

• Discussion Points:
  • Strengths: Benefits/positives of the Canadian healthcare system.
  • Weaknesses: Negatives of the Canadian healthcare system.
  • Differences: Comparison with healthcare systems in participants' home countries.
• Reflection Assignment (Due October $1$st by $2359$):
  • **Questions to Answer (maximum $1-2$ pages, Must be student's own words, not AI-generated):
    1. What was known/unknown at the start of the class (readings, previous classes, personal experience)? What were/are beliefs about the topic? Were/are there biases impacting nursing practice?
    2. What are things like in the home country or most recent place of residence?
    3. What was learned during the group discussion?
    4. What was taken away from the class lecture or comments from other students not in the discussion group?
    5. How has the perception of the topic changed or grown? How will it specifically impact nursing practice (avoid being general)? Would it be hard to care for this population?
  • Late Penalty: $5$% per day after midnight.

Next Week

• Determinants of Health & Quiz #$1$ (worth $10$% on Week $1$ & $2$ Content).