Section 5: CHN practice within the Canadian Health Care System

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Overview

•Review of the Canadian Healthcare system and how it applies to Public Health

•Mandate of PHAC•Functions of Public Health•Roles of the Collaborating Center•Comparison PHN and Home Health•Evidence Informed Practice

The Canadian Social Safety Net

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Family Allowance

EI

MSI

Maternity & Parental

Benefits

Transition Houses

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The Canadian Social Safety Net...• ...the combination of a

national health plan (medicare -hospital and medical care) and social welfare programs (employment insurance, old age pension, child tax benefits and social assistance programs) meant to protect human rights and social justice

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Early Health Care in Canada…

•…British North American Act 1867

the provinces were given the responsibilities for health and welfare

•….Pre 1940’s private medicine predominate families had to pay for

services

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•… with WW1 and WW2, provincial and municipal governments became more involved with providing medical care and financial support widows, children and elder families who lost sons in the war.

• veterans looking for work - stimulated proposals for coverage

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•1947: Public insurance plan – Saskatchewan

hospital services only

•By 1961: National Hospital and Diagnostic Services Act

public insurance for hospital costs and diagnostic services

all provinces agreed to covering inpatient care

physicians were against have paid medical services outside the hospital

Canada’s Father of Medicare

Legacy:• A social policy innovator• Pioneered many social

programs that were later modeled & implemented by other provinces/countries

• Promoted ▫ Social welfare ▫ Universal Medicare▫ Old age pensions and

mothers' allowances

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Tommy Douglas *Premier of Saskatchewan for 17 year; *Father of Canadian Medicare

1947 Public Insurance Plan implemented in Saskatchewan

1904-1986

http://medicare.ca/wp-content/uploads/2009/05/factsheet7-2009.pdf

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Early Health Care in Canada: The Beginnings of Medicare

•1966: Medical Care Act

universal availability to medical care services

by 1972 all provinces had joined Medicare

strong emphasis on medical interventions/treatments within the health care system at this time

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•By the end of the 1960’s a strong social safety net was in place for Canadians

▫Medicare, Family Allowance, Old Age Security, Unemployment Insurance, etc.

•The Canada Health Act is federal legislation , that puts in place conditions by which individual provinces and territories in Canada may receive funding for health care services provided they conform with certain specified criteria.

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The Canadian Health Act (1984)

•promoted the adherence to five national standards

the criteria that provincial/territorial health insurance programs must respect in order to receive federal cash contributions)

Five Main Principles In The Canada Health Act

1. Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the province or territory, and their records and accounts are subject to audits. MSI

2. Comprehensiveness: All insured (essential health services, including hospitals, physicians and surgical dentists, must be insured.

3. Universality: All insured residents are entitled to the same level of health care.4. Portability: A resident that moves to a different province or territory is still entitled to

coverage from their home province during a minimum waiting period. This is true for temporary visits to another province or out of country (with conditions)

5. Accessibility: All insured persons have reasonable access to health care facilities, regardless of location. In addition, all physicians, hospitals, etc., must be provided reasonable compensation for the services they provide.

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Organization of Health Care Federal Jurisdiction: Responsible for the administration of principles for the health care system as defined by the Canada Health ActResponsible for financing provinces and territories-transfer fundingDelivers services to First Nations and Inuit, veterans, inmates of federal penitentiariesGovernment policy & programs -i.e............ approved drugs, assess environmental risks, and others

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Organization of Health CareProvincial Jurisdiction:

• Each province is responsible for administration of their own delivery of health services

• Decide on how many physicians, nurses and other care providers are required

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Minister of Health

The Honourable Rona Ambrose

Chief Public Health Officer of Canada: Dr. Gregory Taylor

Public Health Agency of Canada (PHAC)

PHAC is the main Government of Canada agency responsible for public health in Canada.

http://www.phac-aspc.gc.ca/index-eng.php

Creation of Public Health Agency of Canada (PHAC) in

2004•Created in response to growing concerns

about the capacity of Canada’s public health system to anticipate & respond effectively to public health threats

•What event prompted the creation of the PHAC?

Mandate for PHAC

• The role of the Public Health Agency of Canada is to:• Promote health;• Prevent and control chronic diseases and injuries;• Prevent and control infectious diseases;• Prepare for and respond to public health emergencies;• Serve as a central point for sharing Canada’s expertise

with the rest of the world; • Apply international research and development to Canada’s

public health programs; and• Strengthen intergovernmental collaboration on public

health and facilitate national approaches to public health policy and planning.

Provincial Minister of Health & Wellness

• The organization and mandate of the department is set out in the Health Act. The department is responsible for all aspects of public health, including health services and insurance, health care institutions, health engineering, community health services, psychiatric mental health and drug dependency rehabilitation.

• The mandate of Public Health Services in NS is to improve the population’s health by working in partnership with communities, families and individuals to identify needs.

• http://nslegislature.ca/index.php/people/members/Leo_Glavine

• http://novascotia.ca/dhw/programs-and-services.asp

Leo Galvine-Minister of Health & Wellness

Chief Public Health OfficerThe mandate of Public Health Services in NS is to improve the population’s health by working in partnership with communities, families and individuals to identify needs.

Core Functions of Public Health

Population health assessment & surveillanceCommunicable disease control and preventionDisease and injury preventionHealth promotionHealth protectionEmergency response and prepardednessPopulation health advocacyEnvironmental healthHealth communitiesHealth Development

http://novascotia.ca/dhw/publichealth/

Community Health Boards

•Community Health Boards are made up of everyday citizens of all ages and walks of life who serve as the eye, ears and voice of or communities.

•Based on population and geography.•Antigonish’s CHB established in 1999•Communities define what their needs and

strengths are.

The Role of CHBs

• Collect and share information on local health needs and services • Encourage partnerships and community participation around health initiatives • Identify factors that influence health • Help educate the public about health and the health care

system • Develop community health plans which set priorities and

advise their health authority on ways to improve health and health services.

• Identify ways to make the communities healthier. • Participate in the allocation of grants to promote better

health

Who works for Public Health

NursesNutritionists Doctors (Medical Officers of Health)Food inspectors (Dept. of Environment)Health educatorsDentists and dental assistants

Definition of Public Health Nursing (PHN)•The Canadian Public Health Association

(March 2010) defines PHN as a nurse prepared at the baccalaureate level who focus is on promoting , protecting and preserving the health of populations and who practice in diverse settings such as youth health centers in schools or communities, street clinics and nursing outposts.

Essential Roles and Functions of the PHN

Home Health NursingOverview Roles

• Differ in terms of client emphasis.

• Both PHN and Home Health Nurses operate from the same standards for CHN.

• Both have discipline specific competencies

• Direct care & heath education

• Enhance self-care skills• Link the client to

community services• Prevent complications in

chronically ill persons• Minimize effects of

disability and illness

What’s new in 2014?• Government passed the Health Authorities Act

on, Oct. 3, that sets the groundwork to consolidate 10 district health authorities into two.

"Nova Scotians told us they wanted a strong, unified health-care system. They want us to spend less on administration, and focus on front-line care," said Premier Stephen McNeil. "Most of all they want to know that the health-care system puts their needs first. That's what this act will allow.“

• http://www.cbc.ca/news/canada/nova-scotia/health-authority-merger-structure-unveiled-in-nova-scotia-1.2820157

National Collaborative Centers for Public Health

• National Collaborating Centers synthesize, translate and share knowledge, making it useful and accessible to policy-makers, program managers and practitioners. They identify knowledge gaps, stimulate research in priority areas, and link public health researchers with practitioners to build strong practice-based networks across Canada.

• The Centers collaborate extensively with one another and each Centre has a national mandate to collaborate with a variety of partners on a specific area of public health:

• Aboriginal Health , Prince George, British Columbia• Determinants of Health , Antigonish, Nova Scotia• Environmental Health , Vancouver, British Columbia• Infectious Diseases , Winnipeg, Manitoba• Healthy Public Policy , Montreal Quebec

• Methods and Tools, Hamilton, Ontario • http://www.nccph.ca/en/home.aspx

What is Evidence Informed Practice?

• “The integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (DiCenso, 2005).

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Roots of EBP & EIP

Roots in Medicine: Archie Cochrane

British epidemiologist who stated that people should only pay for health care that is based on scientific evidence

Established Cochrane center- research evidence needs to be prepared systematically through a rigorous process.

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Systematic Review….

•A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question

•Please explore this website…

http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html%20

Importan

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Why we must accelerate EIP:

Despite an aggressive movement, the majority of findings from research often are not integrated into practice.

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The Cochrane Collaboration & Application to Public Health• Cochrane Collaboration

• https://www.youtube.com/watch?v=0Ji-wsSfQH0&list=PLCo8P5_ppmQjkzvR1fzJebaBdWycQFrXl&index=1

• Application in Public Health

• http://www.nccmt.ca/resources/multimedia-eng.html#peel

Summary

•Review of the Canadian Healthcare system

•Mandate of PHAC•Functions of Public Health•Roles of the Collaborating Center•Comparison PHN and Home Health•Evidence Informed Practice