In my MHST 601 course, we have been exploring the Canada Health Act (CHA), universal health care and how it relates to our personal and professional experience. It has been very insightful to discuss and reflect on how our different roles in the health system are impacted and how we can leverage to modernize the Act.
According to Health Canada (2004), "the CHA is our federal legislation for publicly funded health care insurance and its primary objective is to protect, promote and restore the physical and mental well-being residents of Canada and to facilitate reasonable access to health services without financial or other barriers". The keyword here for me, is 'reasonable access to health services'. In August 2018, three new initiatives to strengthen the CHA were added: Diagnostic Services Policy, Reimbursement Policy and Requirements to Strengthen Reporting. I understand this may take time to implement and the focus of this is to improve access to medically necessary hospital/physician services, specifically for diagnostic services, however this is more for urgent medical needs and not necessarily early intervention.
In relation to reimbursement, the pathways need to be clear at all levels. If providers and different levels of government are not aware of deductions or reimbursement policies/pathways, this will be downloaded to the patient and add increased pressure, costs, and barriers to care for the patient. In addition, standardized reporting is beneficial to understand and increase transparency and accountability across the provinces.
Taking this into account and reflecting on opportunities to modernize the CHA, the shortage of family physicians, increased wait times at emergency departments (ED), and barriers for residents to access preventative, continuous and integrated care in our health system has been an issue for a long time. The pandemic has highlighted and magnified this at multiple levels. Canada has a "universal health care system" in place, although availability and accessibility of this varies across provinces and territories (Health Canada, 2021). As a public health professional, providing care through a population health and equity lens is key (Dyck et al, 2018).
Discussions shared by a variety of health professional peers in this course have provide further insight for this. Many of us have seen how the gaps in our health care system impacts our patients and communities. For example, dental colleagues have shared how basic universal oral care may help prevent many diseases from developing in the mouth. It was also shared that children miss three times more school days when they have poor oral health than their cohorts. (Jackson et al., 2011). From a population health lens, this basic universal oral care can promote positive health and hygiene outcomes for the community as a whole.
Throughout the pandemic, access to medical care has varied and hesitancy to seek early intervention care has increased. Treatment and repeat visits to emergency departments has been a heavy burden for patients, community and our health system. I have been reflecting on the root of this and I keep coming back to equity and access. From an equity lens, we need to continue advocating and addressing social determinants of health, plus increasing access to health services.
In addition to our current universal health care funding, many people need to depend on subsidized income funding or private insurance to support their payments of their prescriptions and/or treatments. As a public health nurse, I have had clients who shared that they will often need to decide which medications they fill based on cost or decide to ration medications to make them last longer.
Supporting mental health and the need for increased access to services has also been a theme throughout our peer discussions. The need to address and support people experiencing hoarding challenges, increased child/youth anxieties, increased need to focus on harm reduction from alcohol/drug use, perinatal health disparities, and health care workers experiencing burnout, is all a priority now. One important option that our health system needs to leverage to help further address mental health is the positive impact Nurse Practitioners (NP) have for individuals, communities and the whole population. NPs can and do reduce wait times, save health care dollars and improve overall health outcomes (Bennet, 2018).
Working to ensure continuous care from prevention, early detection, treatment, rehab, and community support all need to occur across our health care system. Most importantly, support is needed for research and development, to review and evaluate the changes and effectiveness of our system and the effect on population health and programs/services.
I am looking forward to further discussing how we, as health leaders, can further advocate for policy changes to address the gaps in our "universal" health care system.
References
Bennett, G. (2018). Fulfilling Nurse Practitioners' Untapped Potential in Canada: Results from the CFNU Pan-
Canadian Nurse Practitioner Retention & Recruitment Study. Canadian Federation of Nurses Unions, 48.
Dyck, L. A., Snelling, S., Morrison, V., Haworth-Brockman, M., & Atkinson, D. (2018). Equity reporting: A
framework for putting knowledge mobilization and health equity at the core of population health status reporting. Health Promotion and Chronic Disease Prevention in Canada, 38(3), 116–124. https://doi.org/10.24095/hpcdp.38.3.02
Health Canada (2004, July 26). Canada Health Act.
Health Canada. (2021, December 3). Health care in Canada: Access our universal health care system.
Education and awareness]. https://www.canada.ca/en/immigration-refugees-citizenship/services/new-immigrants/new-life-canada/health-care/universal-system.html
Jackson, S. L., Vann William, F., Kotch, J. B., Pahel, B. T., & Lee, J. Y. (2011). Impact of poor oral health on
children’s school attendance and performance. American Journal of Public Health, 101(10), 1900 1906. https://doi.org/10.2105/AJPH.2010.200915
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