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Canada (161,540)
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NUR1 221 (1)
Chapter 1

Chapter 1 (Pangman).docx

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NUR1 221
Sebastien Breau

Canadian Health Care System: Nurses’ Journey during Transition to Primary Health Care (Chapter 1 – Pangman) Perspectives on the Canadian Health System  CNA states: principles of PHC + national conditions listed in Canada Health Act provide the conditions that provincial/territorial health insurance plans must respect in order to receive federal cash contributions o These conditions provide the framework for Canada‟s health system of the 21 century Historical Perspective  Canada’s First Nurse o Jeanne Mance: first nurse to arrive in the colony soon to be known as Canada o Built the first hospital in Montreal and ministered to Aboriginals and settlers alike  Fathers of Confederation o Outlined basic responsibilities of the federal government but left much room and responsibility for the provincial governments to be key players in providing health care o Health care costs increased over time  provincial governments turned increasingly to the federal government for financial support o Organization of Canada‟s health care system is largely determined by the Canadian constitution, whereby the federal, provincial, and territorial governments have been involved in ensuring availability and funding of health care and social services  Conception of Medicare o Saskatchewan 1947 Tommy Douglas: introduced legislation to institute Medicare o 1966: federal government introduced Medicare known as Canada‟s national health insurance program o Increasing proportion of Canadians are giving serious consideration to private health care  Significant Canadian Events o Lalonde 1974: federal report which outlined a framework for health consisting 4 determinants  1) Lifestyle  3) Human biology  2) Environment  4) Health care organization  Led to development of successful health promotion programs associated with personal behaviours and lifestyles o International conference on Primary Health Care in Alma Ata in Kazakhstan, in 1978, established goal of “Health for All” by 2000 o International Council of Nurses (ICN): prepared and distributed info. to assist its members first to understand the primary health care concept and then encouraged nursing organizations to assume the leadership role o 1980: CNA submitted the document „Putting Health into Health Care‟ to the federal government‟s commission  This document served as a basis for major lobbying efforts by nurses  Ottawa Charter o 1986 International Conference on Health Promotion – 2 key documents  Epp – Achieving Health for All: A Framework for health Promotion  Ottawa Charter for Health Promotion o Acknowledged that health promotion is the process of enabling individuals to increase control and to improve their health o 5 strategies for health promotion  1) Building healthy public policy  2) Creating supportive environments  3) Strengthening community actions  4) Developing personal skills  5) Reorienting health services o PHC ideology stems from Ottawa Charter o PHC: represents a shift in emphasis toward a social perspective of health, which remains mindful that biomedical and lifestyle considerations are not completely discarded  Canada Health Act o Consolidated previous legislation passed by the federal government to provide financial incentives to the provincial governments to establish universal hospital insurance o Imposed financial penalties that endeavoured to prevent physicians from charging clients more than amount listed in negotiated provincial schedule of fees - no more “extra billing” o Nurses were instrumental in bringing the CHA into law and influential in amending it o Nurses and other health care workers, in addition to physicians, were recognized as potential providers of insurable services  Regionalization (late 1980s and 1900s) o Undertaken to save on public health care costs and to reallocate scarce resources from downstream illness care to upstream illness prevention and health promotion by transferring budgetary authority to geographically based regional health authorities o Marks an important shift in health care governance and service delivery o All provincial governments, except Ontario, which has only a consultative role, have accepted regionalization of health care services – provinces created Regional Health Authorities (RHAs) o RHAs are responsible for:  Controlling costs  Improving health outcomes  Increasing responsiveness to health care needs  Promoting greater citizen awareness of and participation in health care planning  Improving and integrating service delivery within a particular region of the province o Declaration of Montevideo (2005): signed to reaffirm commitment to principles and strategies of PHC  Main thrust: illness prevention and health promotion  Accomplished by:  Assigning appropriate functions to each level of government  Integrating public and personal health services  Focusing on families and communities  Using accurate data in planning and decision making  Creating an institutional framework with incentives to improve quality of services  CNA: Nursing Leadership o Foundation of PHC reform is interdisciplinary team work o New Health Professionals Network (2004): founded by a group of nursing and pharmacy students together with interns and residents in medicine to advocate for strengthening Medicare and interdisciplinary, team- based health care Political Perspectives  Romanow Commission Report and Kirby Panel Report (2002) o Romanow: recommended sweeping changes to ensure long-term sustainability of Canada‟s health care system th  Recommended establishing accountability as 6 principle under CHA and promote the concept of a Health Council of Canada to help foster cooperation among provinces, territories, and federal government  Other key themes:  Maintenance and expansion of universal funding and health care delivery  Improvement of Canada‟s health info technology  Provision of better access to care for rural and remote communities  Strategies for promoting the health of aboriginal populations  Expansion of coverage by the provincial health insurance plans into home-based health care services and prescription drugs  Reform of primary care  Targeting of federal funds, with increased accountability for their use  Medicare maintained as national asset, designed to preserve Canada’s universally accessible, publicly funded health care system o Kirby: suggested a more bureaucratically appointed council with fewer members and with limited advisory capacity  Supported the expansion of the private sector with a single-tier, publicly funded system, allowing for more outsourcing of services to investor-owned agencies and institutions, including private hospitals and clinics o Both: recognize the special health care problems faced by rural and remote communities  First ministers accords (2003) o 2000: First ministers
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