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19 Cards in this Set
- Front
- Back
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Sources of Health Care Benefits |
Government Plans Group Plans Individual Plans |
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Canada Health Act |
Outlines the principles and requirements for the provinces and territories with regard to health care If provinces don't abide by the rules, the federal government gave itself the right to withhold transfer payments which cover these costs |
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What are the Basic requirements outlined in the Canada health act? |
Public Administration: non-profit basis Comprehensiveness Universality: coverage available to all residents of a province/territory Portability: so that you are covered when you are not in the province where yo live Accessibility: meaning everyone has equal access to the service |
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Which two services must be included? |
-extended health care services such as nursing homes and home care services -insured health care services which includes medically-required services in a hospital |
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Expressly forbids |
-extra-billing -user fees -private clinics from offering a service for a fee that is covered by a provincial plan |
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Who is exempt? |
-armed forces -RCMP -people doing time in a federal penitentiary -people who do not yet meet the minimum residency requirement |
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Doctors operating out of health care plans |
Opted-out: charge the patient what they would get from the plan based on the schedule of benefits, but they invoice the patient directly and the patient must submit a claim to be reimbursed Non-Participating: doctors charge patients whatever the marker will bear and patients cannot be reimbursed |
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Travel Insurance |
-you are covered by your provincial plan but only at that province's rate
-coverage for 183 days in each 12 month period -in some jurisdictions it can be extended for studies, work, missionary work; 2 year maximum |
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Restrictions for travel insurance |
-pre-exisiting conditions even if it is under control with medications -high risk sporting actives (sky-diving) -war/certain destinations -duration of trip -treatment for substance abuse -suicide |
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Long Term Care Insurance |
-pays for in-home care should you be unable to fully manage by yourself -premiums sold should never go up Applies if: -you have cognitive impairment -you cannot perform 2 of the 6 activities of daily living unaided Provides: -in-home care -adult daycare -nursing home care - long term facility -assisted living facility -respite care - assistance given to relieve a relative or friend who is a part-time care giver |
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Health Care USA |
Universal health care for: -people over 65 years old (Medicare) -low-income people (Medicaid) |
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Extended Health Care Services |
-nursing home intermediate care service -adult residential care service'-home care service -ambulatory health care service |
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Insured Health Services |
-hospital services (any services provided to in-patients or outpatients at a hospital, if the services are medically necessary) -Physician Services -Surgical-dental services (performed in a hospital) |
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Excluded Coverage |
1. Not medically necessary a) uninsured hospital services b) uninsured physician services 2. certain services and groups of persons (ex. armed forces) |
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Why is there a shortage of doctors? |
-longer training requirements -fewer foreign doctors finding residency places -cuts to medical school enrolment |
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Bench marks for wait times |
Cancer Care: 4 weeks Cardiac Treatment: 2-26 weeks (depending on severity) Diagnostic Tests: mammograms ever 2 years, cervical cancer screening every 3 joint replacements: 26 weeks, hip fracture within 48 hours Cataract surgeries: 16 weeks for high risk patients |
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Against for-profit health care |
-wait times are longer -for-profit clinics take doctors and nurses out of the public system -"cream-skimming" in for-profit care chooses easy-to-treat patients -for-profit care costs more -health care should be based on need, not on ability to pay |
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Group Health Plans |
-offered by employers or associations -premiums paid by employer, employee, or both -premiums are tax-deductible for the employer |
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Private Plans |
-offered by private (non-government) companies for individuals not covered by group plans |
