150-Wk7 Canadian Health Care - Juanita

Front 1

Confederation 1867

Back 1

~British North America Act determined federal and provincial responsibilities
~provinces did not have tax base to meet needs
~churches and charities provided hospital care (eg. St.Paul's Hospital run by the Grey Nuns. Nuns were first nurses and then wealthy women who promoted charity

Front 2

20th Century - Municipality Act of 1916

Back 2

~development of health system and social support system (eg. Family Allowance, Old Age Security, Canada Pension Plan)

Front 3

20th Century - 1930's The Great Depression

Back 3

~great impact on health care system. Development of health care system based on social justice (health care services should be available to people based on need)

Front 4

20th Century - con't

Back 4

~focus on disease and infirmity (medical model) after WWII prompted by new technology and medical advances
~economic boom=building of many hospitals. Philosophy was that quality health care=illness care.
~care moved from community & home into hospital
~huge focus on medical care (Cobalt machine, xrays, vaccines)

Front 5

Saskatchewan 1947 - Roots of Medicare

Back 5

Tommy Douglas introduced public insurance plan to cover hospital costs

Front 6

1957 - Roots of Medicare con't

Back 6

~federal gov't passed Hospital Insurance and Diagnostic Services Act (10 years after Sask!)

Front 7

1961 - Roots of Medicare con't

Back 7

~all provinces had followed Sask lead. Costs born equally federally and provincially

Front 8

1962 - Beginnings of Medicare

Back 8

~Medical Care Insurance Act legislated in Sask (Sask paid for physician services)
~ 23 day Doctors' strike followed (Drs were used to charging what they wanted)

Front 9

1966 - Beginnings of Medicare con't

Back 9

~Medical Care Act legislated federally (4 Principles)
~physician and hospital costs are covered by gov't

Front 10

*** 1972 - Beginnings of Medicare con't

Back 10

~ all provinces on board
~ Medicare in Canada is born

Front 11

1977 - Beginnings of Medicare con't

Back 11

~ cost sharing initially equal via grants; ater via block funding. Province could decide how to spend the money it was given. Dr could charge a user fee.

Front 12

1980 - Beginnings of Medicare con't

Back 12

~ Hall Commission Report. Can't allow user fee because this prevents poor from accessing health care

Front 13

Canada Health Act - 1984

Back 13

~ added accessibility to original 4 principles.
~ outlawed extra billing and user fees
~ physicians no longer sole gate keepers to access (nurses, chiropractors, massage therapists, etc could set up private practice)
~ Federal monies available only if provinces provided health care that kept to 5 principles
~Health Care Transfer - Federal gov't still had rules that had to be followed

Front 14

The Big 5 (Text, p. 17)
(Principles of Canada Health Act, 1984)

Back 14

~ U - universality. Cover costs of health care if Canadian Citizen or landed immigrant.
~ C - comprehensiveness.
4 major things covered by federal and provincial gov't (diagnostic, in-hospital dental, physician and hospital). Province decides the rest.
~ A - accessiblility. Reasonable and timely access for all regardless of race, age, gender, geographic location.
~ P - portability. Covered if travel out of province. Should have private insurance if travel out of Canada.
~ P - public administration. Health care system must operate on non-profit basis.

Front 15

Federal Responsibility

Back 15

~ remained for certain groups - First Nations & Inuit, Veterans, Federal Inmates, RCMP & military
~ Public health policies - Food & Drug Act, Canadian Environmental Protection Act, Quarantine Act
~ Canada Health Transfer; Guardian of 5 principles

Front 16

Provincial Responsibility

Back 16

~ $$$$ spent on healthcare
~ hospitals, LTC's, other facilities needed for services such as mental health, alcohol/drug treatment, cancer care, rehab
~ remibursement of physicians and other HCP''s
~ may have cap on drug coverage, ambulance service, home care, LTC (private health coverage may cover)
~ podiatry, PT, OT, Chiropractic service, massage (covered if Dr decides it's needed)
~ what about dental and eye care?

Front 17

Aboriginal Health Care

Back 17

~ federal responsibility arises out of "medicine chest" clause in some treaties
~ Covers non-insured services: dental, vision,prescriptions, transportation
~ must have Registered Indian status
~ First Nations and Inuit Health Branch (FNIHB) and Indian and Northern Affairs Canada (INAC) - federal organizations

Front 18

Right to Health Care

Back 18

~ is not guarantee by Canadian Charter of Rights and Freedom
~ Canada Health Act only guarantees right to have health care costs covered, as per 5 principles that provinces must honor to recieve federal funding
~ Quebec only province that protects right to health care in provincial legislation.

Front 19

Can physician refuse to provide healthcare?

Back 19

Yes, but not in an emergency situation. Ex. Does not have to treat someone who refuses to quit smoking.
~ However, institution can set rules and then Dr may be obligated by employer.

Front 20

National Health Expenditures, 2006

Back 20

~ 29.8% hospitals
~ 17% drugs - cost of developing new drugs very expensive. Drug companies usually have patent for 15 years
~ 13.1% physicians
~ 10.6% other professions (including nurses)
~ not enough is spent on other health spending

Front 21

70/30 split (CIHI, 2005)

Back 21

~ public vs private funding
~ 30% private sources: insurance plans, out-of-pocket payments
~ what are we paying? drugs, dentist, eye care, diabetic supplies, homecare
~ what does research say? If we start charging, ederly & poor can't afford it so end up in ER which is more costly.

Front 22

Predictions

Back 22

~ Total health care spending:
- 89.5 billion in 2000 (80.7 billion)
- 243.8 billion in 2020 (147 billion)
~ provincial spending:
- 32% in 2001
- 44% in 2020

Front 23

Canadian Health Care Challenges: 1) Rising Costs

Back 23

~ new technology - MRI, CT scans
~ New drugs
~ Demographics - elderly pop'n greatly increasing, older women having babies so more complications
~ demand
~ increasing wages
~ other factors - misuse of ER, bed blocking (not enough LTC facilities for elderly)

Front 24

Canadian Health Care Challenges: 2) Access

Back 24

~ non-insured services:
- elderly
- low-income earners
- what about students?
~ wait times - hip replacement, 1yr. Diagnostic imaging, 3mos. cancer care, up to 3 mos. cataracts, up to 1 yr. Cardiovascular care, up to 1 yr.

Front 25

Canadian Health Care Challenges: 3) Shortage of HCP's

Back 25

~ physicians - Canada ranks 23rd in physicians-to-people ratio
- FP's
- Specialists
~ Nurses - age (near retirement)
~ Technicians - lab, xray

Front 26

Reforms

Back 26

~ Regionalization - late 1980s-90s
~ Fyke Report (Sask, 2001)
~ Saskatchewan Action Plan (Sask, 2001)
~ Kirby Panel Report (Federal, 2002)
~ Romanow Commission Report (Federal, 2002)

Front 27

Fyke Report (Sask, 2001)

Back 27

~ work on access to health care
~ Health Centres - Primary Health Care Centres
~ Telehealth - gov't did act upon
~ Northern Health Issues

Front 28

Saskatchewan Action Plan (2001)

Back 28

~establish PHC teams (Dr's, nurses, etc)
~ 24 hour Health line - manned by nurses. Reduce hospital visits
~ Reduce wait times
~ $3 million health education fund (ie. bursaries)
~ EMT funding
~ decrease 32 health authorities to 12 (regional)
~ health quality control
~ increased health research funding
~ hospital restructuring (closing more hospitals, ER at City Hospital only open until 8pm)

Front 29

Kirby Report (Federal, 2002)

Back 29

~ Medicare system is unsustainable
~ Privatization
~ Health care guarantee

Front 30

Romanow Commission (Federal, 2002)

Back 30

~ Medicare system is... worth saving. Don't move to privatization
*** - Expand publicly insured services (comprehensiveness) to include: diagnostice services and home care services, including mental health and palliative care
~ improve IT infrastructure (Infoway) - establishing it now
~ implement new approaches to Aboriginal health
~ establish a National Health Council
~ invest in health care providers to improve PHC - make better use of nurses.

Front 31

Romanow Commission cont
~ establish 5 targeted federal funds to support improvements:

Back 31

~ improve rural and remote access
~ improve and expand HC
- target smoking, obesity
- increase physical activity
- improve immunization
~ strengthen and expand Home Care services
- improve mental health services
- expand palliative home care
- provide increased support for family caregivers, including UI benefits
~ provide "catastrphic drug coverage"
~ improve wait times for diagnostic services

Front 32

Nursing in 1990's

Back 32

~ gov't cutbacks
~ hospital closures
~ nurses faced lay offs/bumping and relocation and casualization of the workforce
~ nursing seats decreased
~ decreased job dissatisfaction

Front 33

What is casualization?

Back 33

~ cheaper to hire casual workers rather than full-time as don't have to pay benefits.

Front 34

Quality of Nursing Workplaces

Back 34

~ high acuity, complex care
~ overloaded and understaffed acute-care urban centres
~ high levels fo stress and burnout
~ new graduates experiencing additioinal stressors with transition.
~ increased non-nursing duties
~ support systems for nurses lacking
~ wage freezes

Front 35

Current picture re: nursing

Back 35

Text, pg 15, CNA, 2008

Front 36

Current Nursing Issues - Shortage of nurses

Back 36

~ decreased enrollment in late 90s...
~ indsufficient educational capacity
~ lack of faculty
~ retirement of seasoned nurses?
~ older nurses preferring part time, altered duties
~ increased need
~ many reasons for nurses to leave profession

Front 37

A look at "Condition Critical"

Back 37

SUN's Presentation to SRNA in Fall, 2007

Front 38

Adressing Nursing Shortage - Recruitment and retention initiatives

Back 38

~ provide mentorship
~ seasoned nurse/new graduate teams
~ Respect for nursing as a profession
~ involvement in decision making
~ alternative staffing arrangements
~ support for education

Front 39

SUN Recommendation (Condition Critical, 2007)

Back 39

~ enhance nurse-patient ratios
~ more than double the number of nursing seats
~ provide full-time supplementary employment to all new graduates
~ strategies to retain new, mid, and late career nurses
~ funding for delayed retirement
~ recruitment from other provinces
~ expand # of NPs
~ support for LPNs who wish to become RNs
~ expanded bursaries

Front 40

Issues in Nursing: The Future
Changing scope of practice

Back 40

~ advanced practice nursing
~ increased skill requirement (explosion of technology)
~ holistic approach - community and public health follow-up
~ change in WHAT nurses do and HOW and WHERE they do it.