Canada: colonial country; constitutional monarchy (head of state is a king or queen/elected
parliament passes legislation/PM is the head of gov); is a federation (central “federal” gov. +
10 provincial govs and 3 territories - ALL have the same power but diff. responsibilities).
Health: state of complete PMS Wb and not merely the absence of ds. or infirmity.
Ottawa Ch: ...able to ID/realize aspirations, satisfy needs, ∆/cope w/env.
System: org. set of connected things/parts/principles/procedures forming a complex whole.
1ry prev: intervention before evidence of injury or ds.
2ry: intervention after ds has begun but before symptoms.
3ry: intervention after ds occurs.
HC systems: each province has its own HC system. Federal Gov. has separate
responsibilities with indigenous gps., prisoners, veterans, etc. ∴15+ systems ∴our
experiences and HC system issues and challenges vary on location.
Policy: set of interrelated decisions by political actors or groups concerning goals and
means of achieving them. For specific purposes and contexts. Making is not linear.
H Legislation: body of rules that regulate promotion and protection of H, H services, and
equitable dist of available resources.
Cycle: Objectives, policies (3I´s), tools, decision making, program implementation,
benchmarking/monitoring, evaluation. NOT how it works in reality.
1ry care: GP or family practitioner. Long term continuity, comprehensiveness, access/1st
point of consultation, coordination (Starfield, 1998). /// vs. 1ry H care? approach to H policy
including pop-level H care functs. as well as indv. patient care; ie, universal access, equity…
Gatekeeper model: you access other +specialized services through 1ry care.
Rostering: process by which a patient formally registers w/ a physician. Doctor
agrees to provide comprehensive care and patient to only access this doctor unless
traveling or in an emergency.
Who pays? provinces. MSP. Mostly fee for service in BC.
2ry care: specialized attention. + acute care for brief but serious cdts. ie. injury, childbirth.
3ry care: +specilized care, usually in hospital (ie. cancer trt, neurosurgery, etc)
Public H: pops. rather than indvs. H promotion, ds control/prevention, surveillance,
emergency preparedness, epidemic response, etc. Federal gov, provinces, and
municipalities pay for these activities.
Emergency D: staffed by specialist physicians and surgeons, fellows, specialist family
physicians. Also serves as 1ry care for many patients, especially after hours. Provinces pay.
Transportation (ie. ambulance), pre-hospital/inter-hosp. care? Provincial subsidies + out of
pocket ($80 if MSP or +500 if you don’t).
--Rehab/intermediate care: orthopedists, neurosurgeons, etc. Inpatient: provinces pay.
Outpatient: workers compensation, out of pocket. / Public coverage varies by province tho!
--Pharmaceutical care/drugs: inpatient/in hospital (public provincial insurance pays),
outpatient (private insurance + public insurance (for designated pops) + out of pocket OOP).
--Mental H care: family physicians provide most of 1ry MHC, however, services by
non-physician providers (ie. psychologists) through private insurance or OOP mostly.
--Home and long term care: serve older adults or idvs. of any age w/physical or learning
disabilities or chronic ds. Offered in a range of settings (home, institutions, etc). Coverage
varies by province. Typically services by province and ie. room by OOP. Also veterans or
indigenous ppls? different coverage.
Informal caregivers: care provided by friends and family members (critical role for HC).
Dental care: by independent practitioners. $ Private insurance, OOP, special programs
(Indigenous, receiving social assistance, etc.). Wide socioeconomic inequities.
Traditional, complementary, and alternative medicine: ie. herbal remedies, trad. Chinese
med, etc. Mostly OOP or very limited insurance coverage.
***Physician supply in Canada continues to outpace (grow faster than) pop. growth. Meaning
+ physicians per capita across all provinces than ever before. ∴why do we still talk about
a doctor shortage? Pop. needing HC is ∆ing (ie. aging ppl increasing); demographics
∆ing/different practices in medicine (ie. more time off, new gen. of doctors have new ideas
about what a GP should do ie. less work); no lack of doctors but, lack of doctors wanting to
be family physicians or GPs; long wait times,
Workforce planning issues:
Scope of practice:professional licenses limit many HC practitioners to work to their
full scope of practice (capacities, abilities, procedures).
Interprofessional team models: teams formed by different HC disciplines, working
together towards common goals to meet the needs of a patient pop. Work is spread
according to scope of practice. This involves a coordinated process of info sharing,
interventions, etc., to support one another´s work.
Cultural awareness: acknowledgment of difference (ie. beliefs, values, customs, and how
these shape decisions and behaviors).
C. sensitivity: respecting difference
C. competence: focuses on the skills, knowledge, and attitudes of practitioners.
C. safety: analyzes power imbalances, inst. discrimination, colonization relationships as
they apply to HC. Requires self-reflection (our own culture impacts our behavior).
Institutionalized racism: racism expressed in the practice of social and political institutions.
Expressed as disparities in wealth, income, employment, housing, HC, education, pol. power
Personally mediated racism: indv. prejudice and discrimination expressed as lack of
respect, suspicion, devaluation, dehumanization, etc. Most ppl don’t consider themselves
racists or guilty of racist behavior. Our underlying biases and beliefs express in direct or
subtle ways in how we treat ppl. This has implications for HC ie. how likely doctors are to
help different ppl., make sure they receive the care they deserve, etc.
3-I´s Framework (help to understand policy dvpmt or full context of a particular issue).
Interests: agendas of social groups (entrepreneurs, society, etc). Policy dvpmt and
choices driven by the real interests of various stakeholders (including those inside
the gov). Who wins and who loses with a particular decision? and by how much?
Ideas: knowledge or beliefs influencing policy dvpmt. and choices. How do different
stakeholders perceive the problem? how they perceive policy actions acceptable,
feasible, etc? // different types of ideas: informed experts, experiential knowledge of
social groups/societal values, gov. ideology, etc.
Institutions: Gov. structures, arrangement. Relationships btw. gov and outside
actors? policy legacies (ie. past policies)?
Path dependence: range of optns. available limited by choices made in the past, even when
the circumstances giving rise to those choices are no longer relevant (ie. QWERTY or during
confederation, HC was given to provincial jurisdiction; still remains today).
Public Goods: no one can be excluded from its use, and its use by a person doesn’t
decrease availability for others.
Canada: colonial country; constitutional monarchy (head of state is a king or queen/elected parliament passes legislation/pm is the head of gov); is a federation (central federal gov. 10 provincial govs and 3 territories - all have the same power but diff. responsibilities). Health: state of complete pms wb and not merely the absence of ds. or infirmity. Ottawa ch: able to id /realize aspirations , satisfy needs, /cope w/env. System: org. set of connected things/parts/principles/procedures forming a complex whole. 1ry prev: intervention before evidence of injury or ds. 2ry: intervention after ds has begun but before symptoms. Hc systems: each province has its own hc system. 15+ systems our responsibilities with indigenous gps. , prisoners, veterans, etc. experiences and hc system issues and challenges vary on location. Policy: set of interrelated decisions by political actors or groups concerning goals and means of achieving them.