Week 2A: Healthcare Delivery

Healthcare Delivery Readings: pg 26-42 (CH 2) The Canadian Health Care System (pg 26-42) - The Canadian constitution outlines the organization of Canada’s health care system, including how health care responsibilities are divided between the federal, provincial, and territorial governments - Outlined in the Canada Health Act (CHA) - Principles of CHA: - Public administration: non-profit - Comprehensiveness: covers all medically necessary services for ALL residents - Universality: equal access and 100% coverage - Portability: insured residents can access healthcare services in another province or territory for 3 months - Accessibility: reasonable access to healthcare facilities and providers - The Canadian health care system is composed of health services provided by health professionals to eligible residents, ensuring that they have reasonable access to medically necessary insured services on a prepaid basis without direct charges Health Care in Canada: The Historic Context - Our current healthcare system has evolved to provide the comprehensive, accessible, and universal health services that Canadians currently enjoy. The British North America (BNA) Act was the cause of this, creating the Dominion of Canada from Ontario, Quebec, New Brunswick, and Nova Scotia which set out terms and provisions for federal and provincial responsibilities for health care. This early document set a precedent for organization and management of the health of Canadians. - Throughout the 20th century a medical approach to health care was dominant, focusing on curing diseases and health problems and equated health problems with physiological risk factors that conveyed disease - Medical intervention was emphasized. Health care was reactive and did not yet incorporate proactive approaches - Tommy Douglas introduces the first provincial hospital insurance program and is known as the father of socialized medicine - In the 1970’s the behavioural approach to health care began, and the Lalonde Report promoted individual responsibility for health, shifting the emphasis away from seeing health problems solely as physiological risk factors that conveyed disease. It began to look at causal influences beyond risk factors, like the determinants of health - Determinants of health in Lalonde Report: biology, lifestyle, environment, health care organizations, access to care - It was believed that health was in individual control and that poor health would be due to lack of knowledge. There was large amounts of education on health, but this approach led to blame of the individual because it was their responsibility to - - - - be in good health - The behavioural approach fell out of favor due to the blame, and the neglect to recognize socioeconomic, sociocultural, environmental, and geographic barriers to making healthy lifestyle choices The Epp Report was introduced after the Lalonde Report and led to the idea of health promotion and environmental determinants. It stressed the important contribution of lifestyle, nutrition, and physical environment in health - The key health challenges stressed by the Epp Report were: - Assessing the health status of disadvantaged groups and reducing inequities - Detecting and managing chronic disease - Identifying diseases that were preventable and focusing on prevention - Enhancing people’s abilities to cope The Ottawa Charter for Health Promotion expanded on Lalondes “health fields” to become “health prerequisites” and included peace, shelter, education, food, a stable ecosystem, income/employment, sustainable resources, and social justice and equity - 5 strategies for health promotion: - Build healthy public policy - Create supportive environments - Strengthen community action - Develop personal skills - Reorient health services The introduction of social determinants of health (or health fields) led the way to the socioenvironmental approach which added on to the previous reports to include social and environmental contexts with a greater understanding of the SDOH and how health is tied closely to social structures - This approach includes the perspective that health is self-defined By 1971, under the CHA, all Canadians were guaranteed access to essential medical services, regardless of employment, income, or health. This Act was first passed in 1984 and includes a condition that provinces/territories that allow private and extra billing within their respective plans would be denied federal financial support The Organization of Health Care in Canada: The Contemporary Context - Although the provinces and territories have authority for health care, Health Canada ensures that they are compliant with the CHA and can impose penalties (such as withholding funding) on those provinces and territories that do not comply - The 5 pillars of the healthcare system - Public administration: each provincial and territorial health insurance plan must be administered and operated on a not-for-profit basis by a public authority - Comprehensiveness: health care insurance plan must cover all insured services provided by hospitals, physicians, or dentists and where the law of the province permits, and with equal opportunity for services among people - Universality: all insured residents of a province or territory are entitled to the insured health services provided by their respective provincial or territorial health - - - - insurance plan on uniform terms and conditions - 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 (not longer than 3 months) before coverage is transferred to their new jurisdiction - Accessibility: protects all insured people of Canada’s provinces and territories from extra charges for health care or from discrimination Canada’s health system is governed by federal, provincial, and territorial governments. Health Canada, in accordance with the CHA, outlines the principles of health care for Canadians. The provinces and territories must follow these principles to manage and provide health care for their residents under the authority of provincial and territorial ministries of health The minister of health (appointed by premier) oversees health-related laws and regulations and is responsible to preparing the annual report of how the provinces have met the conditions of the CHA The administrative structure of Health Canada includes the deputy minister of health and associative deputy ministers, all of whom are appointed from the civil service and are considered apolitical Although the CHA outlines the principles and responsibilities of Medicare, each province and territory is responsible for managing and providing primary, secondary, and tertiary health care for its citizens - - - - Primary Care: refers to an approach to health and 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 and environment - Eg. health promotion, prevention and treatment of common diseases and injuries, basic emergency services, primary mental health care, palliative and end-of-life care, well-baby care and healthy child development, primary maternity care, rehabilitation services, and referral specialist and in-hospital care Secondary Care: usually involves diagnosis and treatment of health challenges of varying complexities by specialists after a referral from a primary care provider - Eg. specialists, specialized care like palliative or long term care in some cases Tertiary Care: highly specialized consultative care involving dedicated support and - - - resources based on a referral from primary or secondary health care providers. It includes diagnosis and treatment of disease and disability in sophisticated large research and teaching hospitals, specialized intensive care units, advances diagnostic support services, and highly trained personnel. - Eg. acute, rehabilitative, or palliative care Quaternary Care: is distinguished by the difference in type and availability of specialized care provided. With highly complex subspecialty services, the providers may act as provincial, national, and international resources Currently, baccalaureate degree as entry to registers nurse (RN) practice is required by all provinces except Quebec (which offers diploma programs) - Other nursing roles include registered practical nurse (RPN), licensed practical nurse (LPN), and registered psychiatric nurse (RPN) The CCNR defined the entry-to-practice competencies and scope of practice for Canadian registered nurses and includes the NCLEX exam Health Care Reform: The Changing Context of Canadian Health Care - Health care reform: a general term that refers to discussion about, changes to, and creation of health policy that affects health care delivery - Eg. addressing issues on the lack of emphasis of health promotion and disease prevention, lack of continuity among providers and institutions, health system access problems etc. - The Kelowna Accord: The purpose of the the Accord was to improve the education, employment, and living conditions for Indigenous peoples through governmental funding and other programs What lies Ahead for Canadian Health Care: The Future Context - The health care system aims to protect, promote, and restore physical and mental wellbeing and to facilitate reasonable access to health services without financial barrier - Health care interests are focused heavily on health promotion and illness prevention over illness treatment - Health care costs continue to skyrocket, leading the federal government to explore strategies to contain costs while more efficiently addressing social determinants of health - A positive future of health care for Canadians focused on health promotion and illness prevention can hold health care costs down and improve quality of life in the long run