HSCI 305 Lecture Notes - Lecture 3: Pharmaceutical Care, Physical Therapy, Population Ageing

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LECTURE 3
1) Delivery vs. Financing
(TRUE) B. In Canada, services may be privately delivered but are financed through public insurance. Private providers can include for-profit and not-for-profit
institutions that offer hospital, long-term care, and community services funded by provinces. Physicians contract with provincial insurance providers for established
rates but are not employed by the government.
Public vs. Private, Delivery vs. Financing
Public Financing
Private Delivery
Family doctors, Hospitals
Public Financing
Public Delivery
Health Authorities (Nurses)
Private Financing
Private Delivery
Counselling, Physiotherapy, Surgery
Private Financing
Public Delivery
Premium room and single room (paying privately)
Extra days at the hospitals
2) Health spending in Canada
How does Canadas health spending compare?
Orange is adjusted, blue is current spending
dollars
- Population spending and growth
- Advancement in technologies
The relation to health spending and GDP
Health increases then GDP increases, if
health falls then GDP decreases. Money is
being spent towards healthcare
- A lot of private spending in USA
- Canada - Has more out of pocket spending towards
pharmaceutical care
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3) What are we spending money on?
4) Population aging and health spending
C. Health care spending increases with age, though spending on babies is also pretty high
5) Sources and flow of funds
Federal funding
• Transfers to provinces
• Direct payment for
Armed forces
• Residents of federal correctional facilities
• Some services for First Nations and Inuit
Federal funding: Non-Insured Health Benefits Program (NIHB)
• Eligible persons include:
• A First Nations person who is registered under the Indian Act (referred to as a status Indian)
• An Inuk recognized by an Inuit land claim organization
• A child less than 18 months old whose parent is a registered First Nations person or a recognized Inuk
• Some First Nations/Inuit Organizations assumed responsibility for the delivery of pharmacy, medical supplies and equipment, and dental benefits. For example:
• Nunatsiavut Government (formerly the Labrador Inuit Health Commission)
• Nisga'a Valley Health Board
• Gingolx (Kincolith)
• Gitakdamix (New Aiyanish)
• Lakalzap (Greenville)
• Gitwinksilkw (Canyon City)
• First Nations Health Authority has assumed regional NHIB responsibilities in BC
Provincial funding
• General revenues: Income taxes, consumption taxes, corporation taxes, and income cases resource royalties
• Other mechanisms
• BC collects flat-rate premiums for each individual or family (poll tax not true insurance)
• Set to be eliminated in 2020
Other funding
• Workers’ Compensation Boards
• Excluded from the definition of insured health services
• Automobile insurers (ICBC)
• Out-of-pocket payments
• Private insurance (funded via payment of premiums)
• Voluntary and charitable donations (hospital, disease based foundations, volunteers)
• Capital or equipment
• Health research
• Other services
What percentage of Canadians receive palliative care in their last year of life? 15%
Financing and service delivery
• Think through one of the following patient cases. Which of the actors, finance, and service flows in the diagram might be involved in the patient’s care? Feel free to
fill in any missing on your own. (For example, would the patient described require prescription drugs? Other services? How might these be covered?)
• 30 year old woman whose pregnancy is managed by a midwife in Burnaby who also sees a GP and physiotherapist regarding a workplace knee injury
• 35 year old with concurrent opiate dependence and bipolar disorder who frequently presents in the emergency department in Surrey and has intermittent contact with a
doctor providing methadone and with community mental health treatment programs
- Hospitals have been slowly decreasing due to substitution like
clinics. Depends on the health problem. Less invasive so no need
to really stay as long in the hospital
- Physicians have been constant
- Increase on spending on drugs due to increase in drug prices
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Document Summary

In canada, services may be privately delivered but are financed through public insurance. Private providers can include for-profit and not-for-profit institutions that offer hospital, long-term care, and community services funded by provinces. Physicians contract with provincial insurance providers for established rates but are not employed by the government. Counselling, physiotherapy, surgery: health spending in canada. Orange is adjusted, blue is current spending dollars. The relation to health spending and gdp . Health increases then gdp increases, if health falls then gdp decreases. A lot of private spending in usa. Canada - has more out of pocket spending towards pharmaceutical care. Hospitals have been slowly decreasing due to substitution like clinics. Less invasive so no need to really stay as long in the hospital. Increase on spending on drugs due to increase in drug prices: population aging and health spending, health care spending increases with age, though spending on babies is also pretty high.

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