Module 6

• A country is a provider of universal health coverage (UHC) if it passed legislation and has essential service coverage
• Passed legislation explicitly states that the entire country is covered under a specified health plan.
• Essential service coverage includes four components:

  • reproductive, maternal, newborn and child health
  • Infectious diseases
  • non-communicable diseases
  • service capacity and access
• Employer based insurance is purchased by employers for their employees and financed through employer contributions
• Private health insurance is purchased by individuals to cover the cost of healthcare services
• State coverage is healthcare that is provided and financed by the government through tax payments.
• Social insurance is health coverage for employees, employers, and self-employed individuals that pay contribution towards health services
• Well-functioning health care services are accessible and offer quality service
• Four factors must be met for a country to claim they have achieved UHC: a high quality healthcare system, proper financing, access to technology and medicine, and capacity of well-trained health workers
• The simple model of a health care system includes 3 main branches: the structure, the provision, and the health outcomes
• The WHO has four characteristics of well-functioning healthcare systems: a robust financing mechanism, a well-trained and adequately paid workforce, reliable information for decision-making, and well-maintained facilities and logistics
• A well functioning healthcare system responds to needs in 5 ways: participating, improving, protecting, providing, and defending
• The First Nations Health Authority (FNHA) gained governance over primary care, mental health addictions, administration non-insured benefits, etc. of First Nations.
• The FNHA was structured into 3 blocks to ensure adequate coverage for Indigenous People: protection, benefits, and support
• Indigenous driven health models is based around stakeholders in the community. This includes aid from health regulatory bodies in the establishment and commitment to cultural safety and humility in health services
• BC's commitment to Indigenous healthcare lead to increase participation, increased training of staff, improved access, and reduced service time
• Canada healthcare is under the tax-funded model: more than half the public expenditure is funded through taxes and revenues outside of payroll taxes, ie income taxes, sales taxes, tobacco taxes, etc.
• Urbanization 1870-1910, world war I 1914-1918, the Great Depression 1929-1939, and world war II 1939-1945 have led to UHC in Canada
• Saskatchewan was scared that UHC would enable the government to dictate how doctors practiced medicine.
• Canada provides UHC to over 90% of the population, legislated through the Canada Health Act.
• The Canada Health Act has five main principles: public administration, comprehensiveness, universality, portability, and accessibility
• In Canada, services beyond medically necessary must be paid out of pocket by the individual or through private insurance plans.
• Indian Act of 1876 and Treat 6 state that Indigenous peoples' health is the responsibility of the government. The services are governed by the First Nations and Inuit Health Branch of the federal government.
• The Non-Insured Health Benefits program (NIHBP) includes people who are registered Indian, Inuk, or an infant less than one with an eligible parent.
• Members of the Canadian Armed Forces are covered by the National Defence Act.
• The Interim Federal Health Program (IFHP) provides temporary and limited coverage to refugees, protected persons in Canada, victims of human trafficking, and detainees. Immigrants are not covered
• Healthcare system in France is largely funded by government national health insurance. It covers dentists, mental health, and transportation
• Government spending of mental health in Canada is less than 5% of their total spending, compared to England, where 13% is allocated to mental health
• Australia's UHC, known as medicare, is publicly funded by the federal government. The mental health coverage is funded by the Australian government, state and territory governments, and private sector
• Private insurance covers private services provided by psychiatrists, psychologists, and other mental healthcare professionals
• Canada struggles with providing access to family doctors
• Canada ranked last (out of 11 OECD countries) in the percentage of people who are able to book same or next day appointment with their family physician. This results in emergency departments and walk-in clinics being used
• Germany has mandatory private insurances, and has a higher doctor to population ratio than Canada (4.3 vs 2.8)
• The Affordable Care Act (Obamacare) is a healthcare reform law that expands and improves access to healthcare in the US (not a UHC country). It mandates all Americans to have healthcare insurance
• In low resource countries, health issues are associated with poor living conditions, inability to access healthcare, health illiteracy, and malnutrition
• Geographic accessibility is influenced by lack of infrastructure and communication in remote areas. It is also influenced by travel time to health services. May Indigenous people report lack of access to healthcare services
• Geographical accessibility being difficult results in low doctor retention rates and lack of Indigenous doctors
• In Canada, there are Aboriginal Patient Navigators in place to help Indigenous people feel safe with their experience at the hospital
• Many Indigenous People experience discrimination in healthcare, while others report inadequate services and insensitive healthcare
• The brain drain is when skilled workers leave their communities to pursue better opportunities