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
- 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
Describe the role of each independent agency that works collaboratively with health Canada
- Public Health Agency of Canada- health promotion and disease prevention, tracks outbreaks, TB, and measles, recommends corrective and preventative measures
- Canadian Institution of Health Research- directs research across Canada
- Hazardous Materials Information Review Commission- makes decisions on compliance of safety with Prov., Fed., Ter., legislation
- Patented Medicine Prices Review Board- regulates prices of patented drugs using the consumer price index
- Public Health Agency of Canada- promotes health, and disease prevention acts as a center of disease control (tracks illnesses, injuries accidents,)
List 5 sectors of New Brunswick Health System
- Department of Health non-clinical
- Horizon Health Clinical
- VitaliteNB Health Network clinical
- Services NB clinical
- Medavie Health Services NB clinical
Describe the responsibilities of the provincial and federal government
- Provincial- abides by the Canadian Health Act, responsible for leadership, policy, direction, and support; negotiates health care professional salaries
- Federal- responsible for primary health care as well as that under the Canadian Health Act
Explain the WHO’s pandemic phases
- interpandemic Phase I- between the flu pandemics
- Alert Phase II- activities to protect the public are exhausted
- Pandemic Phase III- the subtype develops further into the bigger transmission of disease
- Transition Phase IV- the disease subsides, the risks are assessed, precautions are reduced, and recovery
Which government is responsible for providing care to the following groups?
- RCMP-Federal
- Inuit. Innu, First Nations Canadians -federal
- Disabled person-Prov
- Seniors prov
- Veterans - Federal
- Canadian Forces - Federal
- Individuals on income assistance Prov.
- Refugee - Federal
Which criteria must be met for a person to be eligible for provincial or territorial health
insurance?
- Canadian Citizen
- Must be a resident of said province
- Must live there for. at least 6 months
Explain the different services that are offered with respect to long-term care.
- 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
All provinces and territories provide 3 general categories of health care, explain each category.
- Primary- direct care Services ex doctors, nurses
- Secondary- a Specialist short-term care, cardiologist
- Tertiary- highly specialized, referred by a specialist ex. Plastic Surgery, Neurosurgery
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