General characteristics of the health care system in Canada
Canadian health care is considered as one of the best and in a pride of the state. The Canadian health care system is funded by the state and is best described as a system of insurance and medical plans of ten provinces and three territories. This system is known as Medicare and provides free or nearly free medical care and medical services to all.
In 1984 was adopted the Canadian Health Act, where were formulated the basic principles of medical care:
- Versatility: Any citizen of the state is entitled to health insurance for common conditions.
- Availability: Healthcare services are provided on a common basis, without pay, in addition to the policy.At the same time, dental care is paid. Canadians are not attached to a doctor and can apply to the medical institutions of their choice.
- Comprehensiveness: insurance covers hospital stay, care, diagnosis, drug use, surgical and other equipment, as well as home care and medicines for outpatient care. However, the volume of services provided is not the same in different provinces, and some even within the same.
- Portability: health insurance in Canada is not reserved for the work place and residence.
- Public Administration carried out through the State accountable for-profit organization created in each province for all payments for health insurance. (www.hc-sc.gc.ca)
Health care management is carried out as follows: Federal Government, regional government and territorial health administration, whose main task is to give people the direct control of medical services by public and private organizations. This structure was designed so that health care belongs to the department of local and provincial authorities, and not the federal government. Health system of each province or territory is based on common principles that are established at the national level. Management and delivery of health services is an area of responsibility of each province or territory. Province or territory plans, finances and assesses the provision of hospital care, services, therapists and other professionals, some medications. The role of the federal government in the health care system is limited to the establishment of and compliance with the general principle of Medicare, partial funding of health programs, provinces or territories and other functions specified in the Constitution of Canada. One such feature is the direct medical care for special groups of Canadian citizens, which include veterans, Aboriginal Canadians living on reserves, and military employees of the Royal Canadian Mounted Police. Among other functions are prevention and protection of public health and promotion of healthy lifestyle. (www.hc-sc.gc.ca)
Canada’s health system relies heavily on primary care physicians, who make up about 51% of all practicing physicians in Canada. They act as intermediaries between the patient and the formal health system, and control access to most specialists, hospital care, diagnostic tests, and drugs. When Canadians need medical care, they turn to the general practitioner or clinic of their choice and show their health insurance card, that is issued to all citizens and legal residents. Canadians do not pay directly for health care services, and they do not need to fill in various forms for services covered by insurance. For such services, there are no limits in terms of money or additional payments. Only dentists work independently from the health care system and their services are not included in the insurance coverage, except when client needs emergency dental surgeon. Pharmacies are also independent from the state organizations. (www.hc-sc.gc.ca)
More than 95% of all Canadian hospitals operate as non-profit private organizations, managed by a local board of directors, volunteer organizations or municipalities. In addition to a national health insurance system, provinces and territories also provide medical services for part of the population that needs additional medical services – for elderly people, children and unemployed. These additional packages of health services often include free medicines, dental treatment, optician services, various devices for the disabled (prostheses, wheelchairs, etc.) and more. Although the provinces and territories provide additional services for some segments of the population, that services are in the private sector and, hence, residents must pay for them from their pockets. In this case it is to purchase insurance that covers most of the costs for the services of a dentist, ophthalmologist, etc. Such insurance is often included in the compensation package that is offered together with wages at workplaces. (www.hc-sc.gc.ca)
Canadian health care system is often called free. In fact, the Canadian Health Act guarantees free medical care only in terms of insured services, and many state services are not covered by insurance or are covered partially. For example, some provinces do not include insurance services to physiotherapy and number of drugs.
Public health insurance programs provide free care in hospitals, including the services of doctors and nurses (diagnosis, treatment, surgery). Beauty, care for maternity cases, meals in hospitals are paid by patients themselves. Insurance programs operate in all Canadian provinces, providing free access to medical services regardless of place of payment of taxes, except Quebec.
Provinces and territories provide medical services to that part of the population that needs additional medical services – the elderly, children, unemployed and mentally ill citizens. these services should include the following:
- Practical assistance for the disabled, elderly, etc.;
- Providing some free drugs;
- Dental care;
- Services of an ophthalmologist;
- Various devices for persons with disabilities (prostheses, wheelchairs), etc.
In the absence of an insurance policy medical services in Canada are very expensive, and almost are not affordable for the average citizen of the country. (Klatt I)
Levels and types of medical care
Canada’s health system relies heavily on primary care physicians, who make up about 51% of all practicing physicians in Canada. They act as intermediaries between the patient and the formal health system, and control access to most specialists, hospital care, diagnostic tests, and drugs. Such a family physician can be changed an unlimited number of times on the advice of friends or for other reasons. Most doctors have their own private practice and have a high degree of autonomy. Many doctors work in hospitals or local health centers (in Quebec there are health centers). Private doctors are paid for services, depending on the assistance provided, and such fees doctors receive directly from the budget of the province or territory. Therapists who do not have a private practice, receive a fixed salary or fee, depending on the number of medical services provided.
Nurses in Canada are working as part of multidisciplinary teams, providing patients with care in accordance with the plan of nursing care and prescription. The basis of nursing practice is the direct patient care. However, regardless of affiliation to a particular field of activity all nurses work according to the approved standards of nursing practice.
Nursing practice includes a number of interrelated areas:
- direct patient care;
- work in education;
- development of nursing policy and scientific nursing research.
If Canadians need emergency ambulance they can call 911. For example, in case it is impossible to get to hospital, or there is a need of urgent medical intervention (shortness of breath, heart attacks and other possible causes of death), it is necessary to call an ambulance, and the ambulance takes the patient to the emergency department of the hospital, where patient will get immediate help of doctors. If the patient has a chronic disease (diabetes, high blood pressure, allergies to medication), he is obliged to notify the family doctor to provide appropriate medical care, as well as for ongoing monitoring and surveillance of his health.
General information and phone numbers of emergency medical care are given in the first section of white pages of the telephone book, telephone numbers of doctors and clinics are located in the yellow pages. There is also information about health care in the health departments and the CIC, free brochures on various health topics in doctors’ offices and pharmacies.
Mandatory immunization of the population is one of the most effective ways to protect the public from serious infectious diseases (such as diphtheria, etc.). In Canada, there is a schedule of immunization. For example, some vaccinations are made to children 2-month old, some in the 4-month, etc. Each doctor provides a patient with special immunization schedule, which may vary depending on the province. If a patient needs to be vaccinated, he shall apply to the family doctor, or to the central help line by telephone, given in the section “Immunization” in the white pages of the telephone book.
First of all immunizations is necessary for children and students. Information on vaccinations of children of school age can be found in the town hall in the department of Immunization. When sending a child in school parents must present information about vaccinations, and if they are not enough, it is necessary to contact a pediatrician or a children’s health center for vaccination.
Pregnancy and childcare leave is the right of all working mothers in Canada. If a woman is pregnant and must stop work for a while, she can get leave from his employer, in this case leave may be paid. Every woman can get further detailed information on maternity leave at the Department of Labor of the provincial government or in the office of HRDC. To get help before and after childbirth a woman goes to a local community service centre or a hospital: they offer courses in preparation for childbirth, medical care, nurses, and advise what to do in the coming months. They also provide information on how to register the birth of a child to receive an official birth certificate, they can get advice on birth control and abortion.
Problems of the state medical industry and reforming prospects
One of the main problems of the Canadian healthcare system are long queues and long waiting for medical treatment. This is particularly true in situations where patients have to wait, despite the presence of acute pain, or in particularly bad condition (while waiting for cancer surgery, radio-or chemotherapy). As family physicians generally work autonomously, there is no organization that could provide consultation of doctors 24 hours a day, 7 days a week. As a consequence there are overloaded emergency rooms at hospitals, as well as additional expenses by contacting profit clinics that work in the evening. That is why the country is expected reforms aimed at creating groups of primary care physicians with an extended working day. They should be specialists of different disciplines – nurses, therapists and narrow specialists. Form of payment can vary from a fixed salary depending on the number of patients, rather than quantity of services provided. (Gratzer 2002)
Experts in Health Canada believe that in the near future, authorities may take amendments aimed to creation and operation of private medical institutions, while the share of state medicine will gradually be reduced. This is due to an aging population and anticipated increase in medical costs. Some of the procedures in the last ten years have been a little cheaper, but unfortunately not enough to avoid a shortage of budget funds. In addition, there is a projected increase in life expectancy in the next century, and the load on the medicine in such a situation would increase significantly. (Conference Board of Canada 2001)
Private practice will help to address these and many other problems. Practicing physicians are sure that the country’s health care quality will not be harmed, but only changed. Though population are less than enthusiastic about these forecasts, that is not surprising, because currently, many of the tests, care, treatment (in some cases) are free. In Canada Health Act prohibited providing paid medical services, excluding those that were not included in the list of provincial health plans. The future changes must significantly change the main feature of Medic care of the country, where people are treated according to both federal and local health programs.
The problem of reforming of Canadian Healthcare system is very controversial and has different points of view. It is necessary to form one and common approach to the reforms and to find a common solution. That is why the Head of Canadian Medical Association informed that people should decide for themselves what health care system is the most preferable for them. In December 2010, representatives of the Association informed of the beginning of consultations to ascertain the views of most Canadians, and such consultation will last until 2014. (Canadian Council of Health, 2010)
According to opinion polls, more than half of Canadians believe that their health care system needs significant improvement. Such opinion poll results were published by the Canadian Council of Health. The “International Public Opinion Poll 2010 Commonwealth on a sound policy”, carried out with the citizens of 11 countries considered the opinions of more than 3000 Canadians on the topic. More than half of the Canadian participants argued that fundamental changes were necessary to the health care system to become more efficient. “The Canadians say they want to keep medical insurance disease. They believe that the quality of care is excellent, but not satisfied with the ability to get it in a timely and orderly manner. There are gaps in the legislation, which must be refined to improve the Canadian health care system, “said John G. Abbott, head of the Canadian Council of Health. (Canadian Council of Health, 2010)
In this study, the Canadians were the most dissatisfied about medical care in after hours. Indeed, 37% of Canadians claimed that it was very difficult to get service in the evening, as well as at the end of the week or weekends. An opinion poll also underlines that, despite the social insurance system, some Canadians have the impression that the costs do not justify medical care.
First of all, all Canadians should have good access to health services according to their needs, and should not pay for it, based on the fact that they live in Canada. The services provided to them should be of high quality, efficient, patient-oriented and safe. The health system must work steadily and be accessible. The main purpose of the future reform is to ensure that Canadians have seen their health care system efficient, responsible and able to perceive the changing needs of citizens.
Establishment of the Canadian Council of Health is must provide continuous evaluation of performance and development of transformations in health care in Canada. In January 2005 the Board of Health in its first annual report to Canadians formulated that the Canadian health care system should accelerate the pace of change otherwise there is risk of loss has already been achieved. In a published report, the Council suggested that the reform of the Health Canada as follows:
- Strengthening governance, Health Canada Human Resources and ensure the appropriate professional staff.
- Accelerating the creation of multidisciplinary teams as the basis for the reform of primary health care. The Board considers the association of health care providers as a key element that ensures the quality and accessibility of health services.
- Immediate expansion of the use of information technology, implementation of national electronic patient records.
- Reducing Inequalities in Health Canada. (Conference Board of Canada)
Awareness of health as a social value, not only as a condition of individual well-being, increasing health care costs, the introduction of new medical technology, inflation, decline in health due to socio-demographic, environmental and other factors made it necessary for health care reform. In the current circumstances, reform of the state system of national health care is associated with a desire to ensure equal opportunities for providing quality health care to all segments of society, with the priority of preventative health care, as well as the permanent increase of medical care in a privatized health care.
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