Dollars and Sense of Health Care Funding

Define:

  • Medically Necessary: provided by the hospital under the province/territory
  • Primary Health Care: health care professional you see first
  • Secondary health care: health care professionals you get referred to \n Tertiary health care: health care professionals that the specialists refer you to
  • Regional health authorities (RHA): Health authority boards are accountable to the Minister of Health and are responsible for the mandate, resources and performance of the health authority
  • Eligibility: the state of having the right for a service \n Insured services: payed for either by the government or privately
  • Uninsured services: not payed for either by the government or privately \n Co-payment deductible: the amount left that you have to pay after the insurance
  • Dispensing fee: the fees the pharmacy charges to dispense drugs \n Formulary list: list of certified medications in the nation
  • Nonprofit reciprocal agreements: a formal written agreement between a nonprofit and an external or third party
  • Drug identification number (DIN): Any product defined as a drug under the Canadian Food and Drugs Act must have an associated drug identification number

Provincial Jurisdiction

  • Adherence to the principles and conditions of the Canadian Health Act binds the provinces and territories to a predetermined rate.   * Otherwise, each provincial jurisdiction is free to set there own standards
  • Ultimately the provinces are responsible for the leadership, policy direction, and support of these service partners.   * They are to negotiate salaries with the medical professionals

Structure of the Health Plan: Overview

  • Parliament elects a Minister of Health MOH by the premier
  • The Department of health is responsible for   * Providing leadership/support to delivery partners   * Regulating health insurance   * Salaries of health care professionals
  • All provinces have 3 categories of healthcare   * Primary- direct care services   * Secondary- a specialist/short-term care   * Tertiary- highly specialized, refereed by a specialist   * Quaternary- typically clinical trials

Levels of Health Care

Primary Care
  • Primary care refers to the first contact   * Focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury.
Secondary Care
  • Services provided by medical specialists who generally do not have first contact with patients   * Cardiologists, urologists, dermatologists
  • A client must obtain a physician referral to access secondary care
  • This is generally a short-term care arrangement
Tertiary Care
  • Specialized consultative care   * Plastic surgery, neurosurgery, burn units
  • Quaternary Care   * An extension of tertiary care   * Even more, specialized with mostly experimental procedures

Regionalization in Health Care

Autonomous health care organization responsible for the health care administration within a certain area. Through specific boards of governance, RHAs manage funding/delivery of community/institutional health care services within the area.

  • The regional approach was based on the belief that involving the community decisions would   * Increase participation   * Enable the ministry to unique needs of the community   * Define geographic location   * Enable cost-savings
  • Regional Health Authorities (RHA): are responsible for healthcare administration in a defined geographic location within the provinces and territories
How does New Brunswick work
  • The Department of health is responsible for health care in the province
  • Horizon Health and Vitalite are the RHAs of NB   * They are responsible for hospital services, community health services, extramural services, public health services mental and addictive health services
  • The department of health oversees responsibilities for services such as long-term care as well as Ambulance New Brunswick.
N.B. Health System
  • The New Brunswick Health System consists of five sectors   * Department of Health (non-clinical)   * Horizon Health (Clinical)   * VitaliteNB Health Network (Clinical)   * Service of New Brunswick (non-clinical)   * Medavie Health Services New Brunswick (MHSNB) including     * Ambulance NB (Clinical)     * Extramural Program (EMP)     * Telecare 811
Regional Health Authorities
  • New Brunswick transitioned from 8 RHAs to 2 RHAs   * Whom each has a board of directors appointed by the minister of health
  • New Brunswick established Facilicorp NB who was responsible for the provision of non-clinical services
  • Vitalite   * Replaces RHA 1 (West Moncton), RHA 4, RHA 5, and RHA 6
  • Horizon Health   * Replaces RHA 1 (east Moncton), RHA 2, RHA 3, RHA 7
Ambulance NB
  • Responsible for providing land/air ambulance services throughout New Brunswick
  • Funded by the province
  • Managed by Medavie Health Services as an initiative with the extra-mural program and telecare 811
  • Are not addressed in the Canadian Health Care Act meaning provinces can establish their own guidelines
Acute Care
  • Hospital care may also be called acute care
  • Anything medically necessary in a hospital setting is paid for by the government   * E.g. ward accommodations, nursing, tests, x-ray, drugs, specialized rooms
  • Provincial governments are responsible for hospital provisions

Long-term Facilities

  • Services offered   * Homecare: helps individuals with basic personal care, meals, and household maintenance, allowing them to stay at home longer   * Respite care: allows non-professional caregivers relief (family)   * Hospice care: a home-like setting for those unwilling to die at home   * Palliative care: medication and supplies for people dying at home or in a hospital
Rehabilitation Centers
  • Residential institution to provide therapy and training with the goal of increased independence to cope with the world

Community Sector

  • Do not require hospitalization and may receive treatment at a clinic or care facility   * Ex. support groups, crisis intervention, adult daycares, ambulatory care centers
  • A private company may also provide such services and supplies
  • Extramural does things similar
  • Four levels of living facilities   * Level 1- clients are mobile but need 24-hour supervision   * Level 2- require help and some supervision 24 hours a day   * Level 3- medically stable are typically medically and mentally stable. But need more help with personal care and maybe medical attention   * Level 4- typically mentally/behaviorally unstable
Who pays for healthcare?
  • Health care premiums paid by citizens: only in BC and ON
  • Payroll taxes: taxes taken directly from each paycheck
  • Government grants: are the tax dollars paid for the merchandise, food, etc.
  • Donations: volunteer organizations contribute to the cost
Health Insurance
  • To be eligible for health insurance   * Must be a Canadian citizen   * Must be a resident of the province you seek coverage   * Must physically live in the said province for at least 6 months     * Babies are covered automatically when they are born
Private health insurance
  • Approx. 60% of Canadian have private health insurance
  • Usually paid bi-weekly or monthly

Questions

  1. Describe the role of each independent agency that works collaboratively with health Canada

       1. Public Health Agency of Canada- health promotion and disease prevention, tracks outbreaks, TB, and measles, recommends corrective and preventative measures    2. Canadian Institution of Health Research- directs research across Canada    3. Hazardous Materials Information Review Commission- makes decisions on compliance of safety with Prov., Fed., Ter., legislation    4. Patented Medicine Prices Review Board- regulates prices of patented drugs using the consumer price index    5. Public Health Agency of Canada- promotes health, and disease prevention acts as a center of disease control (tracks illnesses, injuries accidents,)

  1. List 5 sectors of New Brunswick Health System

       1. Department of Health non-clinical    2. Horizon Health Clinical    3. VitaliteNB Health Network clinical    4. Services NB clinical    5. Medavie Health Services NB clinical

  1. Describe the responsibilities of the provincial and federal government

       1. Provincial- abides by the Canadian Health Act, responsible for leadership, policy, direction, and support; negotiates health care professional salaries    2. Federal- responsible for primary health care as well as that under the Canadian Health Act

  1. Explain the WHO’s pandemic phases

       1. interpandemic Phase I- between the flu pandemics    2. Alert Phase II- activities to protect the public are exhausted    3. Pandemic Phase III- the subtype develops further into the bigger transmission of disease    4. Transition Phase IV- the disease subsides, the risks are assessed, precautions are reduced, and recovery

  1. Which government is responsible for providing care to the following groups?

       1. RCMP-Federal    2. Inuit. Innu, First Nations Canadians -federal    3. Disabled person-Prov    4. Seniors prov    5. Veterans - Federal    6. Canadian Forces - Federal    7. Individuals on income assistance Prov.    8. Refugee - Federal

  1. Which criteria must be met for a person to be eligible for provincial or territorial health

   insurance?

       1. Canadian Citizen    2. Must be a resident of said province    3. Must live there for. at least 6 months

  1. Explain the different services that are offered with respect to long-term care.

       1. Homecare: helps individuals with basic personal care, meals, and household maintenance, allowing them to stay at home longer    2. Respite care: allows non-professional caregivers relief (family)    3. Hospice care: a home-like setting for those unwilling to die at home    4. Palliative care: medication and supplies for people dying at home or in a hospital

  1. All provinces and territories provide 3 general categories of health care, explain each category.

       1. Primary- direct care Services ex doctors, nurses    2. Secondary- a Specialist short-term care, cardiologist    3. Tertiary- highly specialized, referred by a specialist ex. Plastic Surgery, Neurosurgery

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