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CANADA'S HEALTH CARE SYSTEM (Evolution of Healthcare (1867 - Provinces…
CANADA'S HEALTH CARE SYSTEM
Evolution of Healthcare
1867 - Provinces mostly in charge of health. Federal Department of Agriculture looked after health; private healthcare
1919 - Department of Health Created; privately funded healthcare
1947 - Saskatchewan had province wide universal healthcare plan
1950 - BC and Alberta had similar universal health plans
1957 - Hospital Insurance and Diagnostic Services Act; federal govt reimburse/cost-share half of province of specific medical costs
1966 - Medical Care Act - federal govt reimburse/cost share provinces for doctor services outside hospitals
1977 - cost sharing replaced with block fund (combination of tax points and cash payments)
1984 - Canada Health Act; prohibit extra billing and fees for insured services
1995 - Canada Health and Social Transfer
2000 - reforms in primary health care, increased cash transfers in support of health
2003 - Accord on Health Care Renewal; structural change to support access, quality and long-term sustainability
2004 - 10-Year Plan to Strengthen Health Care; reform wait times, Aboriginal health, home care, primary care, medical equipment, public health etc.
2007 - All provinces and territories aim to have Patient Wait Times Guarantee by 2010
Role of the Government
Federal Govt.
National principles for Canadian Health Act
Make sure that provinces and territories give proper access to medical services for their citizens
Funding to provinces and territories
Primary and supplementary services to certain people; First Nation, Veterans, etc. :check:* Aims to be culturally safe. The delivery of services to First Nations groups specifically aims to keep their cultures in mind, but may not be successful all the time.
Health protection and regulation
Consumer safety
Disease prevention and surveillance
Health promotion and research :check:*Aims to be culturally safe. More and more research is looking into SDOH and how culture plays a large role in delivering care, such as McGough et al. (2018) study on Australian Aboriginal culture and how understanding it ensure they have better health.
5 Canada Health Act Principles
Public Administration
Comprehensiveness
Universality
Accessibility
Portability
Possible Citizen Feedback/Participation?
Consult with communities/cities/provinces/reserves to see what SDOH are lacking and what can be done about them? Such as fixing education, housing etc.? Create plans where people can take part in building their homes, have Indigenous languages be options in school curriculum, get people in continuing care to design their ideal living/care/nutrition/activity plans, ask homeless/impoverished people what facilities they think they need to help them?
Provincial Govt
Administration of health insurance plans
Planning and funding if care in hospitals and other health services
Services provided by doctors and other health professionals
Planning and implementation of health promotion and public health initiatives. :check: *Aims to be culturally safe in some provinces. Northern Health BC's video (2017) on cultural safety talks about what can be done in BC and other provinces to promote cultural safety in our health system.
Negotiation of fee schedules and health professionals
Fund supplementary benefits, such as dental/vision/drugs, for certain groups (low-income, seniors etc. )
Many supplementary services are financed privately; need insurance or pay out of pocket for things like vision and dental
Fund independent worker's compensation agency; for people hurt on the job
Possible Citizen Feedback/Participation?
1)Asking provincial citizens what insurance plans they are looking for; do they need more dental care, more pharmaceutical care, more eye/hearing care? 2) Consult with communities/cities/towns/reserves to see what SDOH are lacking and what can be done about them? Such as fixing education, housing etc.?
How Health Care Services are Delivered
First: Primary Health Services
Direct provision of first-contact health services
Coordinates patient's health care services to ensure continuity of care and ease of movement across health systems/ specialized services
Prevention and treatment of diseases
Basic emergency services
Primary mental health :red_flag:**Not culturally safe all the time. McGough et al. (2018) states that when it comes to mental health in Australia, clinicians have "limited experience, skills and knowledge to work with Aboriginal people" (p.206). I believe this applies to Canada as well. It is important we take their culture into consideration when delivering their health as it may be crucial into fixing their problems.
Referrals
Palliative care, maternity care, etc. :red_flag:**Not culturally safe all the time. I know maternity care here in Edmonton is working to make all new mothers and babies feel safe and culturally respected, but much work is still needed (source is my mom, who is a clinical educating nurse in post-partum care here in Edmonton).
Second: Secondary Services
Provided in home, community, institutions
Referrals for this care is made my doctors, families, patients, community agencies
Patient's assessed by medical professionals
Care provided by formal, informal, and volunteer care givers
Continuing Care - certain ones provided by provincial govt.
:red_flag: **Not culturally safe all the time. I work in Continuing care/palliative care, and many religious activities and recreation activities are Christian based or euro-culture based even though all the centers I work in believe in multi-faith ideologies etc. We only have Christian church services, no Islamic, Buddhist, Jewish services. It is important to have activities that reflect Indigenous cultures, Asian cultures etc. as there are people from those cultures living in continuing care. To keep them fulfilled and happy we should partake in their cultural activities.
Federal does provide continuing care to some veterans, First Nations on reserves and Inuits
Health services - paid by provincial govt
Room and Board - provided by individual/family
Supplementary/Additional Services
Provinces/Territories provide certain people (children/low-income/seniors) services not provided under publicly funded healthcare
Include prescription drugs outside of hospital, vision, dental, prosthetics, visits to physio etc.
Trends/Changes in Healthcare
Primary Care
Reform to have more community services, on call services, improving work environments etc.
Possible Citizen Feedback/Participation?
Survey communities to find out what services they think they need and what services they would be willing to participate in/volunteer for? Also ask what is not working in the community/what services are not needed?
Wait time reduction
EHealth
Improve access, safety, quality of care, productivity
Possible Citizen Feedback/Participation?
Online surveys that participants can fill out after receiving EHealth; how was your care? what could be improved? what worked for you? would you like to switch to a different healthcare provider for your next appointment?
Patient Safety
Actors in society in general who influence the prevalence of equity-oriented practices that affect health
CEO's, Owners of Businesses etc. They control what they pay their workers based on the jobs they do; not all work is paid equitably by businesses. Ex. minimum wage in Alberta is $15, however some businesses are against this wage and want to cut wages for teenagers and alcohol servers. Other provinces allow businesses to pay youth less than adults. Allowing businesses to pay specific groups less could translate to paying cultural groups less, which would be culturally unsafe. Fair pay for employees allows cultures to feel safe and afford to live.
https://www.thestar.com/edmonton/2019/02/19/edmonton-food-shops-clarify-positions-on-minimum-wage-after-backlash-over-restaurants-canada-campaign.html
Transportation services: Subways and Buses do not run 24 hours or don't run in some communities, so it can be difficult to receive care. Sometimes cultural groups live in certain areas of a city, and if transportation services don't run there, it could be culturally unsafe. Transportation to all areas allows all people to get where they need to go to increase health and quality of life.
Teachers and Schools. Not all schools have fair treatment of LGBTQ children or children with disabilities. Teachers who have biases and treat children unfairly, harm children, or neglect to educate children can be detrimental to health and not culturally safe. Including all cultures and making them safe can increase education and quality of life.
https://edmontonjournal.com/news/local-news/school-lgbtq-policies-out-of-step-with-school-act-changes-advocacy-group-says
AND
https://edmontonjournal.com/news/local-news/61-alberta-private-schools-running-afoul-of-gay-straight-alliance-law-minister-says
AND
https://edmontonjournal.com/news/local-news/inclusion-alberta-not-satisfied-with-provinces-draft-guidelines-on-seclusion-rooms
General Citizens. When we do not treat others fairly based on their gender, race, religion, ethnicity, age etc. it can negatively affect health. We have a role in keeping each other safe and willingness to understand other cultures so we can all have access to good health.