NURS 120 Week 5 Ch. 2 - Health Care Organization in Canada

Week 5: Chapter 2 Health Care Organization in Canada Critical Thinking Question: ● In Canada we have universal access to health care; so why then are there still health inequities? Learning Outcomes: 1. Name and describe the main points of seminal documents concerned with health care in Canada 2. Name and give examples of the 5 pillars of the Canada Health Act (1984) 3. Explain the differences between medical, behavioural, and social environmental approaches to health care 4. Explain the organization of the Canadian health system including the responsibilities of different point of access to health care The Canadian Health Care System ● “By building healthy public policy, creating supportive environments, and strengthening communities across the provinces and territories, Canadians can work collaboratively to improve the heath care system and to promote its future sustainability” ● Importance for nurses: ○ Informed support to clients ○ Types of available care ○ Client health care rights ● Context of concepts: ○ Social, cultural, and physical dimensions of our country affect the complexity, diversity, and richness of health services delivery as well as nursing practice and education ○ Takes into consideration factors that influence client care and may include: historic, social, cultural, physical, economic, and global dimensions ○ Publicly funded, provided by professionals to eligible people to ensure reasonable access to prepaid services without direct charges (socialized medicine) ○ Nursing practice and education Historic Context: ● “Canadians are the shareholders of the public health care system. They own it and are the sole reason the health care system exists.” ● British North America (BNA) Act of 1867 uniting ON, NB, QC, NS ○ This act set out terms and provisions for federal and provincial responsibilities for health care ○ Set a precedent for organization and management of a publicly funded health care system (Medicare) Medical Approach to Health Care ● Throughout the 20th century, a medical approach to health care was predominant, and equated heath problems with physiological risk factors that conveyed disease ● Focus was on curing diseases, did not consider other aspects ● Health care was reactive; it did not incorporate proactive approaches for disease prevention and health promotion ● Not all Canadians could afford health care, so Tommy Douglas introduced the first hospital insurance program in 1947. It was the introduction of socialized medicine, or publicly funded insurance-based coverage Behavioural Approach to Health Care ● Shift from medical to behavioural approach began in the 1970s ● The behavioral approach was an idea that health was in individual control, and led to education on how to be healthy. This often led people to be blamed for poor health (victim blaming) ● This approach neglected to recognize socioeconomic, sociocultural, environmental, and geographic barriers to making healthy lifestyle choices. ● Canada's Food Guide was created ● Lalonde Report (1974) ○ Promotes the individual responsibility for health, shifting the emphasis away from seeing health problems solely as physiological risk factors that conveyed disease ○ The Lalonde report looked at influences beyond the medical approach to see what other factors may affect health ○ Groundbreaking shift in ideas ○ Introduced the determinants of health ● Determinants of health: ○ Biology ○ Lifestyle ○ Environment ○ Health care organization ○ Access to health care ● EPP Report (1986) ○ The EPP Report: Achieving Health for All: A Framework for Health Promotion ○ A function of more than the advancement of medicine and stressed the important contribution to health of lifestyle, nutrition, and physical environment (environmental determinants) ○ Legacy of the EPP Report: ■ Fostering public participation in implementing health promotion programs ■ Strengthening community health services ■ Coordinating health public policy to achieve health for all Canadians ○ Health promotion challenges: ■ Assessing the health status of disadvantaged groups and reducing health ● inequities (eg. shorter life expectancies, higher prevalence of disability, and poorer health than average canadians) ■ Detecting and managing chronic disease ■ Identifying preventable diseases and focusing on prevention ■ Enhancing people's ability to cope Ottawa Charter for Health Promotion ○ Created and signed by 38 countries (collaboration essential to individual and population health) ○ Incorporated socio environmental criteria to health promotion - factors outside health impact health! ○ “Health prerequisites” - Maslows hierarchy of needs ■ Eg. peace, shelter, education, food, stable ecosystem, income/employment, sustainable resources, social justice and equity ○ Used globally as a template for health promotion 5 strategies: ■ 1. Build public health promotion policies at all levels of government ■ 2. Create and maintain supportive physical, social, cultural, spiritual, and economic environments ■ 3. Strengthen community action to achieve better health via priority setting and responsible decision-making inclusive of diligent assessment, planning, and implementation ■ 4. Develop personal skills to enable preparation for all life stages, including illness and injury ■ 5. Redefine and/or reorient health services to better meet the individual and community health needs Socioenvironmental Approach to Health Care ● Builds on the behavioural perspective that humans’ chosen interaction with biology, lifestyle, environment, and health care (or access to care) is a legitimate factor determining health and health outcomes ● Aspects include family and community environment; air, food, and water quality; communication and entertainment technology; transportation; sedentary vs. active lifestyles; and food availability etc. ● Combined social and environmental contexts ● Key: Determinants of Health ○ How individuals, groups, and communities realize their aspirations and satisfy their health, health care, and other needs and at the same time cope with (or change) the socio-environment to benefit health and health outcomes ● Health is self-defined and not dependent on disease ● Explores other contributors to health beyond the individual The Canada Health Act of 1984 ● ● ● ● By 1971, under the CHA, all Canadians were guaranteed access to essential medical services, regardless of employment, income, or health Sets out criteria, conditions, and national standards for insured health care services that provinces and territories MUST meet to receive federal funding ○ To bill privately for health care was against the CHA which wanted to “protect, promote and restore the physical, and mental well-being of ○ Canada and to facilitate reasonable access to health services without financial or other barriers” ○ Provinces or territories that allow private and extra billing would be denied federal financial support. Doctors were forbidden to charge clients beyond the scheduled fee-for-service set by the province/territory Mandated universal health care coverage for all Canadians Replaced Hospital Insurance & Diagnostic Services Act of 1957 and the Medical Care Act of 1966 Five Pillars of Canada's Health Care System 1. Public administration: Each provincial & territorial health insurance plan must be administered & operated on a not-for-profit basis by a public authority (e.g. the Regional health authority -AHS) Records are publicly audited 2. Comprehensiveness: The health care insurance plan of a province or territory must cover all insured services provided by hospitals, physicians, or dentists & be available to all provincial or territorial residents with equal opportunity 3. Universality: All insured residents are entitled to 100% coverage of insured health services provided by their respective provincial or territorial health insurance plan on uniform terms & conditions. 4. Portability: Residents moving from one province or territory to another continue to be covered for insured health services by their home jurisdiction during any waiting period 5. Accessibility: a. Protects all insured people from extra charges for health care b. Guarantees reasonable access to insured hospital, medical, & surgical-dental care on uniform terms & conditions c. Access without discrimination on the basis of age, health status, or financial circumstances d. reasonable access means access to services when & where they are available, as they are available Organization of Health Care in Canada ● Administration by Health Canada ● Branches and agencies ● 2016-17 CHA Non-compliance Report: Continuing concerns: ○ Private clinics and extra billing, queue jumping for medically necessary tx at private clinics Provincial and Territorial Plans ● Provinces and territories must follow principles outlined by the CHA to manage & provide health care for their residents under the authority of provincial & territorial ministries of health. ● 13 separate health care insurance programs across Canada. ● Each province & territory is responsible for managing & providing primary, secondary, & tertiary health care for its citizens. ● Costs are unsustainable ● Inequities: vaccines free in some areas and not others ● Prescription Drugs ○ Canada lacks a national pharmacare program. ○ Price of prescriptions continues to increase, thereby causing many Canadians to be unable to pay for essential medications. ● Reorganization of Health Systems ○ To make the health system more responsive & accountable to the public & streamline decision-making, each province & territory has undertaken regionalization of health systems. Points of Care ● Primary Health Care as a concept - Approach to health & a spectrum of services beyond the traditional health care system. It includes all services that play a part in health, such as income, housing, education, & environment. (Upstream thinking) ● ● Primary Health Care as a point of care: Focus on health care services, including health promotion, illness & injury prevention, & the diagnosis and treatment of illness & injury. Coordination of care services to promote continuity of care (Midstream thinking) ● Secondary Health Care: Involves diagnosis & treatment of health challenges of varying complexities by specialists. (Downstream thinking) ● Tertiary & Quaternary ○ Tertiary health care is specialized consultative care involving dedicated supports & resources usually based on a referral from primary or secondary health care providers. ○ Highly technical level of health care includes diagnosis & treatment of disease & disability in sophisticated large research & teaching hospitals. ○ Quaternary care is distinguished by the difference in type & availability of specialized care provided. The Changing Context of Canadian Health Care ● Health Care Reform ○ Population, health ecology (superbugs), & prevalence of chronic health challenges are among aspects challenging the current health care system. ○ Growing concern about publicly funded health care systems & if it can continue to meet changing needs of Canadians. ○ Pan-Canadian Strategy for Client-Oriented Research (SPOR) created to “support evidence-informed transformation & delivery of more cost-effective and integrated health care.” ○ Includes 47 recommendations that “serve as a road-map for a collective journey by Canadians to reform and renew their health care system.” ○ Kelowna Accord: government attaches specific significance to the health of Canada’s Indigenous population (Box 2.5) ● Primary Health Care Reform ○ Changes to primary health care are ongoing ○ Key changes include: a shift from individual health providers to teams; telehealth ○ Reliant on adequate supply of human resources and up-to-date technology ● Secondary Health Care Reform ○ Providing the best care in the most client-appropriate environment while ○ ○ managing health care more efficiently Providing the best care in the most client-appropriate environment while managing health care more efficiently (e.g. changing patterns of care from institutional to community-based) Currently entering into a phase with provinces making bilateral agreements with the federal government rather than health accords The Future Context ● Health care interests are focused on health promotion & illness prevention over illness treatment ● Federal government is exploring strategies to contain costs while more efficiently addressing social determinants of health. ● In 2018, Indigenous and Northern Affairs Canada (INAC) was dissolved & split into two legislative structures that will focus on renewing government relationships with Indigenous peoples & improve quality of services for First Nations, Inuit, & Metis people.