Class 7

Question 1

The Canadian Healthcare System

Answer 1

• System Type: Canada’s healthcare system is classified as a Beveridge System (or National Health), in contrast to the United States, which primarily uses a Private Health Insurance model but incorporates all three system types.
• The Canada Health Act (1984): This is the federal legislation for Canada’s publicly funded health insurance.
  
  • Its primary goal is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”.
  • The Act does not specify how services should be delivered, giving provincial and territorial governments jurisdiction over the administration and delivery of insured health services.

Question 2

Criticisms and Gaps: The Canadian system faces several significant criticisms:

Answer 2

• Indigenous Health Disparities: Unacceptable inequities exist, including higher rates of chronic disease and suicide, lower life expectancy, and higher infant mortality rates.
• Limited Coverage: Services outside of universal hospital and physician care are often inaccessible. This includes prescription medications, outpatient mental health services, dental and vision care, home care, and long-term care.
• Long Wait Times: Patients often experience long waits for elective care, such as non-urgent surgery and specialty visits.
• Mental Health Parity: A major issue is the lack of mental health parity. The Canada Health Act does not require insured health services to include psychological services, so they are usually not covered by public health insurance. Consequently, Canadians often must pay out-of-pocket, use private insurance, or endure long waitlists for limited, no-cost community services. The Canadian Mental Health Association has proposed a Mental Health Parity Act that includes strategies like public funding for therapies, integrated services, prevention, and equitable access.

Question 3

Health Equity

Answer 3

• Definition: The source defines health inequity as systematic, avoidable differences in health between groups based on social hierarchies (wealth, power, prestige). In contrast, health equity means equal access to care, equal utilization of services, and equal quality of care for all based on need.
• Measurement Framework: Health equity is influenced by a wide range of factors, including socioeconomic context, social location, material and social circumstances, biology, environment, health behaviours, and psychosocial stressors. This is illustrated through a detailed case example.

Question 4

Healthcare Use, Misuse, and Adherence

Answer 4

• Patterns of Use: Healthcare utilization varies by demographic factors:
  
  • Older adults use more care as their health declines.
  • Men use fewer health-care services than women.
  • Socio-economic status (SES) is not related to hospital use in Canada, but in the US, those with lower SES use physician services less.
  • Ethnic minorities make less use of health-care services.
• Misuse and Overuse: Misuse involves both delaying care and overusing medical services, both of which can cause harm and increase costs. Certain psychological conditions, such as health anxiety, general anxiety, panic disorder, and depression, are associated with the overuse of medical services.
• Adherence: Patient adherence to medical recommendations is vital for good health outcomes, reducing morbidity and mortality. Non-adherence leads to poorer health and higher costs.
  
  • Improving Adherence: The Information-Motivation-Strategy Model is a framework used to improve adherence by providing patients with information, addressing their motivation, and examining their strategies and barriers. Self-regulation, including getting sufficient rest and limiting other activities that require self-control, can also help.
  • Factors Linked to Greater Adherence: Adherence is higher when the condition is severe, the treatment is perceived as effective, recommendations are easy to follow, the patient has higher SES, and there is trust in the provider.

Question 5

Chronic Disease

Answer 5

• Definition and Impact: A chronic disease is one of “long duration and generally slow progression,” such as cancer, diabetes, or arthritis. These conditions place a huge strain on healthcare systems and have devastating consequences, including loss of life, fatigue, pain, sleep problems, disability, psychological distress, and relationship challenges.
• Risk Factors: The development of chronic disease is linked to several psychological and behavioural factors:
  
  • Stress: Chronic stress can increase the risk of developing a chronic disease and worsen existing conditions. During stressful periods, people may also engage in unhealthy behaviours like poor sleep or diet.
  • Lifestyle: Tobacco use, physical inactivity, poor sleep, unhealthy eating, and excessive alcohol consumption are major contributors.
  • Personality: Certain traits, like a Type A personality (driven, hostile), high neuroticism, and low conscientiousness, contribute to disease risk.
• Adjustment: Adjusting to a chronic disease is recognized as integral to health outcomes. It is a dynamic process that unfolds over time, affects multiple areas of life, and is unique to each individual. Factors that predict adjustment include gender, personality, social support, cultural background, SES, and personal coping resources.

Question 6

Case Example: Mahmoud and Health Inequity

Answer 6

The source provides a detailed case study of Mahmoud, a 52-year-old Syrian refugee and former dental surgeon, to illustrate the principles of the Health Equity Measurement Framework.

• The Situation: Mahmoud experiences psychosocial stressors related to his arrival in Canada, language barriers, and the non-recognition of his dental credentials, forcing him to work as a taxi driver.
• Barriers to Care: Despite having public health insurance, he delays seeking care for his health issues due to language discomfort and lack of knowledge. When he is diagnosed with uncontrolled blood sugar, he struggles with adherence due to his unpredictable work hours and the future out-of-pocket cost of medication. He copes through avoidance and does not consult his healthcare team about fasting for Ramadan.
• Health Outcome: Mahmoud’s health needs for his uncontrolled blood sugars are met with delayed and inconsistent care, leading to a hospital admission and the potential development of diabetes. The case highlights that while health resources may be available, they were not truly accessible, acceptable, appropriate, or continuous for him due to systemic and personal barriers.