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TN Ethical, Legal, and Organizational Medicine > 1. The Canadian Health Care System > Flashcards

1. The Canadian Health Care System Flashcards

1
Q

Describe: Overview of Canadian Health Care System (6)

A
  • one federal, three territorial, and ten provincial systems
  • major complexities in establishment of Canadian health policy include geographical diversity, socioeconomic divisions, and international pressures
  • financed by both the public (70%) and private (30%) sectors
  • each provincial plan must cover all medically necessary health services delivered in hospitals and by physicians; may choose to cover services such as home care and prescription drugs
  • non-insured health services and fees are either covered by private insurance or by the individual
  • workers’ compensation funds cover treatment for work-related injuries and diseases
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2
Q

Describe responsibilities in health care: Federal Government (8)

A
  • Health care services for Indigenous people, federal government employees (RCMP and armed forces), immigrants, and civil aviation personnel
  • Marine hospitals and quarantine (Constitution Act, 1867)
  • Investigations into public health
  • Regulation of food and drugs
  • Inspection of medical devices
  • Administration of health care insurance
  • General information services related to health conditions and practices
  • Role in health derived from government’s constitutional powers over criminal law (basis for legislation such as Food and Drugs Act and Controlled Substances Act), spending, bioterrorism, and ‘peace, order, and good government’
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3
Q

Describe responsibilities in health care: Provincial Government (6)

A
  • Establishment, maintenance and management of hospitals, asylums, charities, and charitable institutions (Constitution Act, 1867)
  • Licensing of physicians, nurses, and other health professionals
  • Determining the standards for licensing all hospitals
  • Administering provincial medical insurance plans
  • Financing health care facilities
  • Delivery of certain public health services
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4
Q

Describe: Principles of the Canada Health Act (5)

A
  1. Public Administration: provincial health insurance programs must be administered by public authorities
  2. Comprehensiveness: provincial health insurance programs must cover all necessary diagnostic, physician, and hospital services
  3. Universality: all eligible residents must be entitled to health care services
  4. Portability: emergency health services must be available to Canadians who are outside their home province, paid for by the home province
  5. Accessibility: user fees, charges, or other obstructions to insured health care services are not permitted
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5
Q

The legal foundation of the Canadian health system is based on what? (4)

A
  • two constitutional documents:
    • Constitution Act (1867)
    • The Canadian Charter of Rights and Freedoms (1982):
  • two statutes:
    • Canada Health Act (1984)
    • Canada Health and Social Transfer Act (1996)
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6
Q

Describe: Constitution Act (1867) (1)

A

deals primarily with the jurisdictional power between federal and provincial governments

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7
Q

Describe: The Canadian Charter of Rights and Freedoms (1982) (2)

A
  • does not guarantee a right to health care,
  • but given government’s decision to finance health care, they are constitutionally obliged to do so consistently with the rights and freedoms outlined in the Charter (including the right to equality, physicians’ mobility rights, etc.)
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8
Q

Describe: Canada Health Act (1984) (1)

A

outlines the national terms and conditions that provincial health systems must meet in order to receive federal transfer payments

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9
Q

Describe: Canada Health and Social Transfer Act (1996) (1)

A
  • federal government gives provinces a single grant for health care, social programs, and post-secondary education; division of resources at provinces’ discretion
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10
Q

The federal government can reduce its contributions to provinces that violate the what? (1)

A

key principles of the Canada Health Act

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11
Q

What happened in the History of the Canadian Health Care System in 1867 (1)

A
  • British* North America Act (now Constitution Act) establishes Canada as a confederacy
  • “establishment, maintenance, and management of hospitals” under provincial jurisdiction
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12
Q

What happened in the History of the Canadian Health Care System in 1965 (1)

A

Royal Commission on Health Services (Hall Commission) recommends federal leadership and financial support with provincial government operation

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13
Q

What happened in the History of the Canadian Health Care System in 1984 (5)

A

Canada Health Act passed by federal government

  • replaces Medical Care Act (1966) and Hospital Insurance and Diagnostic Services Act (1957)
  • provides federal funds to provinces with universal hospital insurance
  • maintains federal government contribution at 50% on average, with poorer provinces receiving more funds
  • medical insurance must be “comprehensive, portable, universal, and publicly administered”
  • bans extra-billing by new fifth criterion: accessibility
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14
Q

What happened in the History of the Canadian Health Care System in 1996 (1)

A
  • Canada* Health and Social Transfer Act passed by federal government
  • federal government gives provinces a single grant for health care, social programs, and post-secondary education; division of resources at provinces’ discretion
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15
Q

What happened in the History of the Canadian Health Care System in 2001 (3)

A
  • Kirby and Romanow Commissions appointed
  • Kirby Commission (final report, October 2002)
    • examines history of health care system in Canada, pressures and constraints of current health care system, role of federal government, and health care systems in foreign jurisdictions
  • Romanow Commission (final report, November 2002)
    • dialogue with Canadians on the future of Canada’s public health care system
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16
Q

What happened in the History of the Canadian Health Care System in 2004 (1)

A
  • First* Ministers’ Meeting on the Future of Health Care produces a 10 year plan
  • priorities include reductions in waiting times, development of a national pharmacare plan, and primary care reform
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17
Q

What happened in the History of the Canadian Health Care System in 2005 (1)

A
  • Chaoulli* v. Québec, Supreme Court of Canada decision
  • rules that Québec’s banning of private insurance is unconstitutional under the Québec Charter of Rights, given that patients do not have access to those services under the public system in a timely way
18
Q

What happened in the History of the Canadian Health Care System in 2011 (4)

A

2011 First progress report by the Health Council reviews progress (2004 First Ministers’ 10 year plan)

  • significant reductions in wait times for specific areas (such as cancer, joint replacement, and sight restoration), but may have inadvertently caused increases in wait times of other services
  • despite large investments into EMRs, Canada continues to have very low uptake, ranking last in the Commonwealth Fund International Health Policy survey, with only 37% use among primary care physicians
  • little progress in creating a national strategy for equitable access to pharmaceuticals; however, there has been some success in increasing pharmacists’ scope of practice, reducing generic drug costs, and implementing drug information systems
  • increases in funding to provinces at 6% per annum until the 2016-2017 fiscal year; from then onwards, increases tied to nominal GDP at a minimum of 3% per annum
19
Q

What happened in the History of the Canadian Health Care System in 2012 (2)

A

Second progress report by the Health Council reviews progress towards 2004 First Ministers’ 10 year plan

  • funding is sufficient; however, more innovation is needed including incentivizing through models of remuneration
  • 46 recommendations made to address the lack of progress
20
Q

What happened in the History of the Canadian Health Care System in 2014 (1)

A

Expiry of current 10 Year Health Care Funding Agreement between federal and provincial governments

  • Canadian Doctors for Refugee Care v. Canada, the Federal Court of Canada ruled that the federal government could not significantly reduce/eliminate healthcare services for refugee claimants as to do so would constitute “cruel and unusual treatment” contrary to the Charter of Rights and Freedoms
21
Q

What happened in the History of the Canadian Health Care System in 2015 (1)

A

Negotiations underway for a new Health Accord with a $3 billion investment over four years to homecare and mental health services by the elected Liberal government

22
Q

What happened in the History of the Canadian Health Care System in 2017 (1)

A

New 10 year Canada Health Accord reached with a $11.5 billion federal investment over 10 years to homecare and mental health services and a 3% annual rise in the Canada Health Transfer (down from 6% in the previous agreement) by the elected Liberal government

23
Q

What happened in the History of the Canadian Health Care System in 2019 (1)

A

The federal government announced the creation of a national drug agency. It will negotiate prices on behalf of Canada’s drug plans, assess the effectiveness of prescription drugs, and develop a national formulary

24
Q

The projected total health care expenditure in 2018 is expected to reach what? (1)

A

$253.5 billion, comprising 11.3% of the GDP, or approximately $6839 CDN per person

25
Q

Name: Sources of Health Care Funding (3)

A
  • 69% of total health expenditure in 2018 came from public-sector funding with 65% coming from the provincial and territorial governments, and another 5% from other parts of the public sector: federal direct government, municipal, and social security funds. 31% is from private sources including out of pocket (16%), private insurance (12%), and other (3%)
  • public sector covers services offered on either a fee for service, capitation, or alternate payment plan in physicians’ offices and in hospitals
  • public sector does not cover services provided by privately practicing health professionals (e.g. dentists, chiropractors, optometrists, massage therapists, osteopaths, physiotherapists, podiatrists, psychologists, private duty nurses, and naturopaths), prescription drugs, OTC drugs, personal health supplies, and use of residential carefacilities
26
Q

Describe: Delivery of Health Care (2)

A
  • hospital services in Canada are publicly funded but delivered through private, not-for-profit institutions owned and operated by communities, religious organizations, and regional health authorities
  • other countries, such as the United States (a mix of public and private funding, as well as private for-profit and private not-for-profit delivery), and the United Kingdom (primarily public funding and delivery) have different systems of delivery
27
Q

Name: Key Physician Certification and Licensing Bodies in Canada (5)

A
  • MCC
  • RCPSC
  • CFPC
  • Licensing Body
  • CPSO
28
Q

Describe: MCC (1)

A

Certifies physicians with the LMCC. LMCC acquired by passing the MCC Qualifying Examination Parts I and II

29
Q

Describe: RCPSC (2)

A
  • Certifies specialists who complete an accredited residency program and pass the appropriate exam
  • Voluntary membership of the RCPSC is designated FRCPC or FRCSC
30
Q

Describe: CFPC and Licensing Body (2)

A
  • CFPC: Certifies family physicians who complete an accredited residency program and pass the Certification Examination in Family Medicin
  • Licensing Body
    • ​13 provincial medical regulatory (licensing) authorities
    • All postgraduate residents and all practicing physicians must hold an educational or practice license from the licensing body in the province in which they study or practice
31
Q

Describe: CPSO (5)

A
  • Membership to the provincial licensing authority is mandatory
  • Licensing authority functions include:
    • Provide non-transferable licensure to physicians
    • Maintaining ethical, legal, and competency standards and developing policies to guide doctors Investigating complaints against doctors
    • Disciplining doctors guilty of professional misconduct or incompetence
    • At times of license investiture and renewal, physicians must disclose if they have a condition (such as HIV positivity, drug addiction, or other illnesses) that may impact their ability to practice safely
32
Q

Physician certification is governed ____, while the medical profession in Canada self-regulates under the authority of ____ legislation

A

physician certification is governed nationally, while the medical profession in Canada self-regulates under the authority of provincial legislation

33
Q

Self-regulation is based on the premise of what? (2)

A
  • that due to the advanced education and training involved in the practice of medicine, the lay person is not in a position to accurately judge the standards of the profession
  • the self-regulating colleges have a mandate to regulate the profession in the public interest
34
Q

What is responsible for monitoring ongoing CME and professional development? (2)

A
  • RCPSC
  • CFPC
35
Q

Certification by the LMCC plus either the RCPSC or CFPC is a minimum requirement for what? (1)

A

licensure by most provincial licensing authorities

36
Q

Name: Key Professional Associations (5)

A
  • CMA
  • OMA and Other PTMAs
  • CMPA
  • RDoC and PHO
  • CFMS and FMÉQ
37
Q

Describe: CMA (3)

A
  • Provides leadership to doctors and advocates for access to high quality care in Canada
  • Represents physician and population concerns at the national level
  • Membership is voluntary
38
Q

Describe: OMA and Other PTMAs (3)

A
  • Negotiates fee and benefit schedules with provincial governments
  • Represents the economic and professional interests of doctors
  • Membership is voluntary
39
Q

Describe: CMPA (4)

A
  • Physician-run organization that protects the integrity of member physicians
  • Provides legal defence against allegations of malpractice or negligence
  • Provides risk management and educational programs
  • Membership is voluntary
40
Q

Describe: RDoC and PHO (2)

A
  • Upholds economic and professional interests of residents across Canada
  • Facilitates discussion amongst PHOs regarding policy and advocacy items
41
Q

Describe: CFMS and FMÉQ (2)

A
  • Medical students are represented at their universities by student bodies, which collectively form the CFMS or FMÉQ
  • FMÉQ membership includes that of francophone medical schools

TN Ethical, Legal, and Organizational Medicine (2 decks)

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