HEALTH CARE DELIVERY IN CANADA Week 11 Overview There are many influences on nurses practice.

. Nurses need to understand how these influences have shaped Canadian health services and the systems in which nurses work, including health care policy and the development of Canadas health care system. The Canada Health Act is Canadas federal legislation for publicly funded health care insurance. The Acts sets out the primary objective of Canadian health care policy, which is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers. Ends-In-View To identify the evolution of Medicare and the Canada Health Act Back in the fifteenth century, permanent boards of health did not exist; families, churches and local communities were expected to be self-reliant in handling all other medical and social problems. In 1867 Canada became a self-governing colony with the passage of the British North America Act. By 1920 health and social programs had expanded and voluntary agencies formed; the latter included the Childrens Aid Society (1891), Red Cross (1896), Victorian Order of Nurses (1897) and the Canadian Mental Health Association (1918). The federal Municipality Act of 1916 gave communities the power to levy taxes to pay for physicians. The Great Depression (1930s) dramatically affected the health care system. Since most families were unable to pay for the cost of medical bills and hospital stays, provincial government were inspired to create a prepaid medical and hospitalization insurance plan in 1947 by the Premier Tommy Douglas. This was made more readily available with the passage of the Hospital Insurance and Diagnostic Services Act (HIDSA). In 1961, all provinces and territories were in agreement to provide coverage for inpatient hospital care. The Medical Care Insurance Act was passed in 1962 (Saskatchewan) In 1964, the Royal Commission on Health Services was appointed to study the provision of hospital and medical care to all Canadians and concluded that strong federal government leadership and financial support for medical care was needed. Based on these recommendations, the federal government passed the Medical Care Act (1966) By 1972, all provincial and territorial insurance plans had extended their coverage to include medical services provided outside the hospital. In 1977 the Canadian government enacted the Federal provincial Act to replace cost sharing with block transfers of funds and a complicated formula of transferring tax points from the federal government to the provinces and territories.

The federal governments response was to enact the Canada Health Act in 1984, which amalgamated the previous acts of HIDSA and Medical Care Act and effectively banned extra billing and user fees. To identify and define the principles of the Canada Health Act 1. Public administration A public authority administers and operates the plan on a nonprofit basis; it is responsible to the provincial and territorial governments for decision making on benefit levels and services and is subject to financial audits. 2. Comprehensiveness The plan covers all medically necessary hospital and physician services and, as the province or territory permits, services of other health care practitioners. The palette of services publicly funded for each province and territory varies, which is controversial and under review. 3. Universality Insured residents are entitled to health care services provided by the plan on uniform terms and conditions. Universality negates discrimination based on race, gender, income, ethnicity or religion 4. Portability Insured residents can access health care services in another province or territory without cost or penalty. Personal coverage must be maintained when an insured person moves or travels within Canada or travels outside of Canada 5. Accessibility Insured residents have reasonable access to medically necessary hospital and physician services, regardless of income, age, health status, gender or geographical location. Addition charges for insured services are not permitted, and essential health care services must be available to all Canadians on the basis of need. To distinguish between the federal and provincial jurisdictions over health care To provide examples of federal and provincial health care programs respectively Federal Jurisdictions
Sets and administers national principles for the health care system through the Canada Health Act. Assists in financing of provincial and territorial health care services through transfer payments. Delivers health services for targeted groups, including First nations and Inuit people, military veterans, federal inmates and the RCMP. Provides national policy and programming to promote health and prevent disease, such as healthy environment and consumer safety programs and public health programs.

Provincial Jurisdictions
Develops and administers its own health care insurance plan. Manages finances and plans insurable health care services and delivery, alignment with Canada Health Act principle. Determines organization and location of hospitals or long-term care facilities; the mix of health care professionals employed in hospitals or health care facilities; and the amount of money dedicated to health care services. Reimburses physician and hospital expenses; provides some rehabilitation and long-term care services, usually on the basis of copayments with individual users.

To describe the issues regarding health care spending in Canada Canadians pay, directly or indirectly, for every aspect of our health care system through a combination of taxes, payments to government, private insurance premiums and direct out-of-pocket fees of varying types and amounts. 78% of Canadians asserted that fundamental change or a complete overhaul was needed, as they were dissatisfied with the health care system. In 2006, Canada spent roughly $148 billion on health services, rounding off to $4548/person, which was three times more than in 1975. Spending is higher for children and older adult than for younger adults. In 2006, health care spending as a share of Canadas gross domestic product was 10.3%, in comparison to 16% in U.S or 9.4% in Sweden Hospitals and health care institutions, retail drug sales and physician accounted for more than half of health care spending. Hospital expenditures $40.35 billion Drug expenditures $23.34 billion Physician services expenditure $18.34 billion Public health services $8.46 billion Other health care professional services $ 15.21 billion To differentiate between the five levels of health care (health promotion, prevention and protection from disease and injury; diagnosis and treatment, rehabilitation, and supportive care) 1st level of health is health promotion, which focuses on the process of enabling people to increase control over and to improve their health. Ottawa Charter for Health Promotion list 5 strategies: 1- building healthy public policy 2- creating supportive environments 3- strengthening community action 4- developing personal skills and 5reorienting health care services. 2nd level of health is illness prevention, a service to help clients, families and communities to reduce the risk factors for disease and injury. 3rd level of health is diagnosis and treatments, which are the services most often used; focus on recognizing and treating clients existing health problems. This level can be further divided into 3 sublevels. 1- Primary, first contact of a client with the health care system that leads to a decision regarding a course of action to resolve any actual or potential health problem. 2- Secondary, involves provision of a specialized medical service by a physician specialist or a hospital on referral from the primary practitioner. 3Tertiary, specialized and highly technical care in diagnosis and treating complicated or unusual health problems. 4th level of health is rehabilitation, a restoration of a person to his/her fullest physical, mental, social and vocational functioning possible. It initially focuses on preventing complications from the illness or injury. The goal is to assist a client in regaining maximal functional status, thereby enhancing quality of life while promoting independence and self-care. 5th level of health is supportive care, which consists of health, personal and social services provided over a prolonged period to people who are disabled, who do not

function independently or who have a terminal disease. Palliative care and respite care are components of supportive care. To describe client rights within the health care delivery system Everyone has the right to health care. In general consumers have the right to determine what kind of health care should be available to them. However, the Canadian Charter of Rights and Freedom (1982) does not explicitly include health care as a right. Workers right: reasonable working conditions, including safety and absence of discrimination. To identify current challenges faced by the Canadian health care system Challenges and issues can be categorized into either cost accelerators or as costs associated with trying to provide equal care and access to care for all (otherwise known as Equality and Quality). Costs accelerators are due to the increase in cost related to 1- new technologies such as new generation antibiotics, diagnostic imaging equipment and specialized beds. 2Demographics, because the population is aging and therefore require more treatment and drugs and 3- consumer involvement, since Canadians are better informed about options and are demanding higher-quality care for their tax dollars. Equality and quality can further be separated into 1- income status, 2- Cultural competence, 3- Evidence-Informed practice, 4- Quality and client safety, 5- Quality workplaces, 6- Privatization of services and 7- Health care human resources. To discuss the role of Nurses in health care reform Critical thinking skills Applying the nursing process Coordinating and delegating care elements Stressing client teaching and post discharge self-care KEY CONCEPTS Medicare is a key component of Canadas social safety net Government plays a major role in the Canadian health care system by funding national health insurance and by setting health care policy according to the principles of the Canada Health Act The Canada Health Act forbids extra billing and user fees and stresses the principles of public administration, comprehensiveness, universality, portability and accessibility Health care services are provided in institutional and community settings, across all age groups and for individual, family, group, community and population clients. The five levels of health care are as follows: Promotive, preventive, curative, rehabilitative and supportive Escalating costs are driving health care reform efforts, challenging health care institutions to deliver quality care more efficiently

Issues of equality, access and continuity of care challenge the health care system To achieve continuity of care when a client is discharged from a hospital, the staff nurse must anticipate and identify the clients continuing needs and then work with all members of the multidisciplinary team to develop a plan that transfers the clients care from hospital to another environment The rise in primary health care and home care is a result of reforms to the health care system. Successful health promotion and disease prevention programs, such as those found in community health centres, schools and community clinics, are designed to help clients acquire healthier lifestyles and achieve a decent standard of living Home care is one of the fastest growing components of the health care system partly because clients are sent home from hospital sooner than they used to be Demographic, geographical and technological realities affect the functioning of the Canadian health care system The existence of sufficient and qualified health human resources is a key challenge to the Canadian health care system Enhancing the health of Aboriginal peoples in Canada is a significant challenge to society and to the health care system Nurses must continually seek out information and evidence to remain responsive to providing quality and safe client care In Class 1) Small Groups: Each group will be assigned one of the principles of the Canadian Health Act. Define this principle and discuss what it means to you and your clients as consumers of Canadian health care. Are there any problems underlying the principle? If so, outline. How does this principle relate to ethical principles (e.g. autonomy, veracity, etc)? Consider how it related to your ethical commitments? What ethical dilemmas are possible within the framework of the Canadian Health Care principle? What do you see as nursings role and/or responsibility to clients within this principle? 2) Large Group: Present data from the discussion of Canadian health care principles. Discuss the ethical challenges facing todays health care providers because of fiscal constraints in the health care delivery system and its impact on consumers Progress to Praxis In the changing landscape of health care delivery and the rising costs for providing services discussions are happening around cost-containment measures such as rationing methods that affect access to health care. Reflect on the implications, for consumers, of setting limits on the amount of available health resources.