Module 4 Cda's Health Care System

Question 1

The federal govt’s transfer payment program in support of the health systems of the provinces and territories of Canada

Answer 1

Canada Health Transfer

Question 2

Federal legislation that sets out the national principals for a “national” health insurance system.

Answer 2

Canada Health Act

Question 3

Services provided at the first point of contact within the Health Care System. Ie DR, Nurse, Nurse Practitioner, Pharmacist, Dentist

Answer 3

Primary Health Care Services

Question 4

Services that include specialized care at a hospital or services provided in the home or community (generally for short-term) or in long-term care facilities (generally for long-term and chronic care). Ie adult day care, chronic care in LT facility specialized nursing,

Answer 4

Secondary health Care services

Question 5

Services that include prescription drugs outside of the hospital, dental care, vision care, medical equipment and appliances, and the services of other health professionals outside of the hospital.

Answer 5

Supplementary Health Care Services

Question 6

Medically necessary hospital, physician, and surgical-dental services provided to insured persons

Answer 6

Insured Health Services

Question 7

Residents of a province or territory who are eligible for insured services

Answer 7

Insured Persons

Question 8

Serving members of the Canadian Forces or inmates of a federal penitentiary

Answer 8

Excluded Persons

Question 9

Certain aspects of long-term residential care and the health aspects of home care and ambulatory care services.

Answer 9

Extended health Care Services

Question 10

Medically necessary inpatient and outpatient services provided in a hospital

Answer 10

Insured Hospital Services

Question 11

Medically required services rendered by medical practitioners. (not specialist)

Answer 11

Insured Physician Services

Question 12

Services provided by a dentist in a hospital, where a hospital setting is required to properly perform the procedure

Answer 12

Insured sergical-dental services

Question 13

Payments made directly by the user of the health care services.

Answer 13

Out-of-pocket payments

Question 14

Services that are not considered medically necessary and are not insured by provincial and territorial health insurance plans. There are also referred to as non-insured services.

Answer 14

Excluded health care services

Question 15

Something that is administered and operated on a non-profit basis by a public authority.

Answer 15

Public administration

Question 16

Plans that cover all insured health services provided by hospitals, physicians, or dentists

Answer 16

Comprehensieness

Question 17

All insured resident of a province or territory must be entitled o the insured health services provided by the provincial/territorial health care insurance plan on uniform terms and conditions

Answer 17

Universality

Question 18

Residents moving from one province or territory to another must continue to be covered for insured health care services by the home jurisdiction during any waiting period.

Answer 18

Protability
Note: all prov participate in reciprocal agreements (hospitals & physicians) except QB (protability)
Have coverage for 3 mos under old prov if moved

Question 19

insured residents in a province or territory have reasonable access to insured hospital, medical, and surgical-dental services on uniform terms and conditions

Answer 19

Accessability

Question 20

When a medical practitioner or dentist bills for an insured service in addition to the amount paid by the provincial/territorial health care plan. Ie. office visit

Answer 20

Extra Billing

Question 21

Any charges for an insured health care service other than Extra Billing that are permitted by a provincial/territoral plan and are not payable by the Plan. Ie facility fee

Answer 21

User Charge

Question 22

Includes health services provided to individuals suffering from serious and sudden health conditions that require ongoing professional nursing care and observation

Answer 22

Acute Care

Question 23

Care required by a person whose acute phase of illness is over or who has a functional disability and requires a range of services and medical management that can only be provided by a hospital

Answer 23

Chronic Care

Question 24

Practitioners who do not participate in the public health system. They bill patients directly and patient pay them directly.

Answer 24

Non-participating practitioner

Question 25

Practitioners who operate outside the provincial/territorial health plan and bill patients directly at the plan rate.

Answer 25

Opted-out practitioner

Question 26

Practitioners participating in the public health system who are reimbursed by the public plan administrator following the fee schedule.

Answer 26

Participating practitioner

Question 27

Fed Govt responsible for 5 things

Answer 27

1. Setting and Administration - standards of Health Care System through CHA
2. Assisting Prov Healthcare via $ trans
3. Ensuring requirements of CHA are met
4. Fulfilling functions the Fed govt is resp for ie. FN, reservations, Inuit, Army, Inmates refugee
5. Health protection, disease prevention & Health promotion

Question 28

5 Program Criteria

Answer 28

1. Public Administration - non-profit basis by govt
2. Comprehensiveness
3. Universality - everyone treated the same
4. Portability - covered when move b/w prov or travel
5. Accessability - reasonable access to services w/out fin barriers