Canadian Healthcare System

Question 1

What was the responsibility of government levels of the British North America Act for healthcare? Who paid?*

Answer 1

Responsibility was on provincial government for healthcare and federal government just oversaw everything

All healthcare was paid out of pocket - doctors came to people’s homes and cared for them there

Question 2

How did the Great Depression impact healthcare?*

Answer 2

Everyone was still paying out of pocket and they couldn’t afford it anymore, so many people became sick

Question 3

What government funding/financial responsibilities changed with the medical care insurance act?*

Answer 3

Provinces and territories were to share health care costs equally with the federal government

They negotiated a plan where doctors would be paid by the government rather than the individual

Question 4

What negative outcome resulted from the medical care insurance act? Which health act did this lead to?*

Answer 4

Due to the provincial governments having to take on more costs, they began adding additional fees

The Canada Health Act banned extra billing or user fees

Question 5

What is the current federal jurisdiction in regard to funding (4)?*

Answer 5

1. Set/administer Canada Health Act principles
2. Assist in funding/financing
3. Deliver health services for specific groups
4. Promote national policy and programming to support/promote health and prevent disease

Question 6

What is the current provincial jurisdiction in regard to funding (4)?*

Answer 6

1. Develop/administer health care insurance plan
2. Manage/finance/plan health care services
3. Determine organization and location of health care facilities and services
4. Reimburse physicians and hospital expenses

Question 7

What are the 5 principles of the Canada Health Act? And the additional 6th?*

Answer 7

1. Public administration
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility
6. Sustainability

Question 8

Define public administration*

Answer 8

Provincial/territorial plans operate on a nonprofit basis through a public authority

Question 9

Define comprehensiveness*

Answer 9

Covers medically necessary services (hospital and physician services)

Determine which services are considered medically necessary - differs across Canada

Question 10

Define universality*

Answer 10

Services provided free of discrimination

However, the individual must be a Canadian citizen

Question 11

Define portability*

Answer 11

Insured residents can receive services in another province/territory without cost or penalty

Provide continuous coverage if resident relocates within Canada for up to 3 months

Question 12

Define accessibility

Answer 12

Provide access to health care facilities and providers based on medical need regardless of ability to pay

Question 13

Define sustainability*

Answer 13

Not yet adopted as the 6th principle - desire to make the health care system sustainability

Question 14

Describe the medical approach and which century it was most popular in*

Answer 14

Focused on maintenance of physiological, functional, and social norms - focused on treatment for disease and sees medical intervention as the way to restore health

Little emphasis given to health promotion or disease prevention

Dominant throughout the 20th century

Question 15

Which approach was challenged by the Lalonde report?*

Answer 15

Medical approach

Question 16

What did the Lalonde report promote/advocate?*

Answer 16

Promoted individual responsibility for health

Shifted focus away from seeing health problems solely as physiological risk factors that conveyed disease

Introduced idea of casual influences (determinants of health) that also played a role in health

Question 17

Describe behavioural approach*

Answer 17

De-emphasized medical intervention for the restoration of health

Placed responsibility for health on the individual - proposed new ideas of health promotion and disease prevention

Question 18

What initiatives did the behavioural approach lead to? Why?*

Answer 18

Saw education as a key to improving people’s behaviour or lifestyle and thereby their health

Led to Canada Food Guide and ParticipACTION

Question 19

What was one negative outcome of the behavioural approach?*

Answer 19

Led to some victims blaming issues - if you were still unhealthy after being taught not how to be, it is their fault

Question 20

What was the Epp Report?*

Answer 20

Outlined several health promotion initiatives - proposed there were many other factors that influence an individual’s health

Question 21

What was the Ottawa Charter?*

Answer 21

Expanded the list of determinants of health and included social and political factors; this list renamed as the SDOH

Question 22

Describe the socioenvrionmental approach. What is it based on and what is its goal?*

Answer 22

Acknowledges many social factors that influence the health and health choices of individuals

Based on ideas coming out of Ottawa Charter and Epp Report

Goal is to promote health equity for all people

Question 23

What is one limitation of the socioenvironmental approach?*

Answer 23

Does not look at how certain SDOH are out of individuals’ control

Question 24

Describe primary health care and which services it includes?*

Answer 24

An approach to health and a spectrum of services beyond the traditional health care system - emphasizes the SDOH and strategies to advance individual and population health

Includes all services that play a part in health, such as income, housing, education, and environment

Question 25

What is the dual function of PHC?

Answer 25

1. direct provision of first-contact services 2. A coordinating function to ensure continuity and ease of movement across the system

Question 26

What is the primary/main focus of PHC and who is it currently delivered by mostly?*

Answer 26

Main focus is on diagnosis and treatment of disease/injury Currently delivered chiefly by family physicians and general medical practitioners

Question 27

List and describe the four pillars of PHC*

Answer 27

1. Teams - teams or networks deliver patient-centred care, which improves access through collaboration, coordination, continuity, and quality 2. Access - attempts to address issues with accessing family physicians, especially in urgent or after-hours situations 3. Information - uses technology to improve efficiency and quality of care provision, and increase access to individual and general health information 4. Healthy living - embraces strategies of prevention, chronic illness management, and self-care

Question 28

What are two individual-level barriers to PHC?*

Answer 28

1. Lack of role clarity - makes it unclear who exactly you are supposed to see or speak with to address health concerns 2. Lack of trust - attributed to lack of knowledge, scope of practice, or competency of other team members

Question 29

What are two practice-level barriers to PHC?

Answer 29

1. Hierarchical issues in governance and leadership 2. Team attributes and skills

Question 30

What are 4 system-level barriers to PHC?

Answer 30

1. lack of interprofessional education and collaboration 2. lack of funding 3. lack of monitoring and evaluation - no metrics or reviews to determine if the system is actually working 4. focus on illness care, instead of wellness care, by Canadian populace - only accessing the doctor when ill instead of accessing healthcare for general wellness/health promotion

Question 31

List the 5 levels of health care in Canada*

Answer 31

1. health promotion 2. disease & injury prevention 3. diagnosis and treatment 4. rehabilitation 5. supportive care

Question 32

Define health promotion (level 1) and provide examples*

Answer 32

Enabling people to increase control over or improve their health Ex. anti-smoking education, anti-bullying campaign, heart healthy menu options

Question 33

List and describe the 5 health promotion strategies that extend from the Ottawa Charter

Answer 33

1. building healthy public policy - no smoking policies on campuses 2. creating supportive environments - workplaces that are positive and less stressful, OH&S 3. strengthening community action 4. developing personal skills - educational skills to teach people self-management 5. reorienting health care services - shifting toward socioenvrionmental and PHC focuses

Question 34

Describe disease and injury prevention and provide examples*

Answer 34

Reduces risk factors for illness and injury Ex. cervical cancer screening, immunizations, support groups, it's your move

Question 35

Describe the differences between primary, secondary, and tertiary prevention*

Answer 35

Primary - prevent disease or injury before it occurs (i.e., use of seatbelts) Secondary - promote early detection of disease once pathogenesis has occurred or slow the progress of injury (i.e., mammograms) Tertiary - directed toward minimizing disability from disease or injury and helping people to live with limitations (i.e., cardiac or stroke rehab programs)

Question 36

List and describe the three levels of care in diagnosis and treatment (level 3)*

Answer 36

1. Primary care - first contact with health care such as family physician or NP 2. Secondary care - provision of specialized medical services in hospital or home settings; often referred to specialized practitioner for further diagnosis/care 3. Tertiary care - specialized and highly technical care usually provided in hospitals with advanced care equipment/practitioners Ex. Goes to a doctor with chest pain (primary), physician says you need to get lab work (secondary), come back to physician with results and he says you need to see a cardiologist (secondary), then the cardiologist says “I need to perform an angioplasty” which he performs (tertiary)

Question 37

Describe the rehabilitation level and provide examples*

Answer 37

Promote independence and self-care; improve health and quality of life for those facing life-altering conditions Ex. physiotherapy, occupational and speech therapy, social services

Question 38

Describe the supportive care level and provide examples*

Answer 38

Clients with chronic illness, progressive illness, or disability - goal is no longer recovery but rather quality of life/comfort focused Ex. long-term care, respite care, palliative care, home care

Question 39

What are the 4 on-going issues needing to be addressed in Canadian health care?

Answer 39

1. Lack of continuity among providers and institutions - are all practitioners providing the same type of care based on same evidence-informed practices 2. Health system access problems 3. Lack of care in rural and remote areas of Canada 4. Quality of work life for health care providers

Question 40

What was the Romanow report and how many recommendations did it contain?*

Answer 40

Tasked with evaluating the healthcare system to see if it was sustainable – argued it was not sustainable and provided recommendations for change but the government has not implemented many of the changes suggested 47 recommendations