PPN101 - Week 10

PPN101 - Week 10

• Discuss the history of the Canadian Health Care system, and how it evolved. What was the role of Tommy Douglas?
• Describe key principles and implications of the Canada Health Act (1984).
• Discuss the current healthcare system/issues Canada’s Healthcare System is facing at the provincial and national level.-relate these issues to the nursing profession-discuss the crucial issues that require urgent action
• Discuss the Canadian Health Care System in terms of social justice.
• Identify the role of the various levels of Canadian government in funding and delivery of health services.
• Explain the layers of coverage in the Canadian Health Care system:-Services-Funding-Administration-Delivery

Early health care pre-1867

• Emphasis on local communities and essential services
• Responsive to crises
• Centralized care to local churches and families
• Problems → poor sanitation, infectious disease

British North America Acr, 1867

• Constitution act
• Birth of canada
• Act gave certain powers to the federal and provincial governments

Late 19th-early 20th century

• Industrial revolution led to urbanization
• Patients who couldn't pay for healthcare depended on charity
• Growth of charitable and voluntary health agencies
• 1916
  • Federal government gives municipalities ability to use tax dollars to pay for physicians
• Before WW2 health care in canada was privitaly delivered and funded

Important events in 1940s & 50s

• Establishment of the first universal social programs in canada
• Post-war economic growth and stability with positive effects on determinants of health of population
• Health care continued towards institutional shift
• Immunization programs began

Evolution of Medicare

• By 1961 all provinces and territories were providing coverage for inpatient hospital care
• By 1972 all provincial and territorial insurance plans extended coverage to include medical services provided outside hospitals

Social safety nets

• Canada pension plan, canada assistance plan act, guaranteed income supplement
• Safety nets made towards supporting the poor, elderly, and disabled
• This increased system costs tremendously

The safety net

• A term used to describe the presence of social programs aiming to prevent those most vulnerable from falling below a certain level of poverty and vulnerability

Canada Health Act

• The federal government's response to extra billing becoming a threat to universality and access of medical insurance program
• 5 principles
  • Public administration
  • Comprehensiveness
  • Universality
  • Portability
  • Accessibility

The federal government responsibilities

• Setting and administering national principles or standards for the health care system through the Canada Health Act
• Help with financing of provincial health care through money transfers
• Health services to Veterans, Native Canadians, Persons living on reserves, Military Personnel, inmates of Federal Penitentiaries, RCMP
• Health protection, disease prevention, and health promotion

The provincial/territorial governments responsibilities

• Develop and administer health care insurance plans
• Plan & fund care in hospitals and other health care facilities
• Reimburse health care providers and hospitals;
• Long-term care and rehabilitation services
• Manage some aspects of prescription care and public health
• Determining which services are covered

Canada Health Transfer

• Largest transfer of money from the Federal government to the provinces and territories

Canada Social Transfer

• Will be 16 billion dollars in 2023-2024 and estimated to increase by about 3% each yeat to 2027
• For post- secondary education, child development, early childhood education and childcare, social assistance and social services

Dental care for canadians

• A third of canadians do not have dental insurance
• In 2018, more than one in 5 canadians reported avoiding dental care because of the cost

Public funding

• Health care in Canada is funded at both provincial and federal levels
• Financing of healthcare is provided via taxation both from personal and corporate income taxes
• Approx 70% is public funding

Private funding

• Approx. 30% of Canada’s health care system is privately funded
• Covered by out of pocket payments and private insurance

Primary health care

• The foundation of Canada’s health care system
• The first point of contact in the system for nonurgent/emergent care as well as the vehicle for continuity of care
• PHC is a philosophy and model for improving health that support essential health care services
• 4 pillars → teams, access, information, healthy living

Delivery of health care

• 5 levels of health care services
  • Health promotion
  • Disease and injury prevention
  • Diagnosis and treatment
    • Primary, secondary, tertiary
  • Rehabilitation
  • Supportive care

Primary care

• Usually the first place of contact when canadians need health care
• Directly provides health care
• Includes prevention & treatment of common diseases and injuries
• Primary mental health care
• Health promotion
• Health child development

Secondary & tertiary care

• Secondary
  • Typically care from a specialist following a diagnosis and referral from a primary care physician or nurse practitioner
• Tertiary
  • Specialized care that is focused on complex cases

Two-tiered healthcare

• A system where patients who can pay for private health services receive faster or better services than those using public health
• Countries include UK, ireland, australia, new zealand, germany, sweden, france

Current issues in canadian healthcare

• Sustainability/cost
• Hallway medicine
• Wait times
• Indigenous health
• LTC /acute beds
• mental health
• Equity/Accessibility
• pharma care
• Staffing shortage
• Aging population
• Bureaucracy

Policy changes

• 3 crucial problems that require urgent action
  • Wait times for elective care are too long
  • Services outside the Medicare basket are often inaccessible
  • Indigenous health disparities are unacceptable