28 January 2010

Healthcare corner #5 - Resources, delivery, and workers comp

a little bit of this and that in class today.

the human resources of the health sector:
- about 1.5 million people (or about 1 in 10) across canada work in the health sector (this includes not only health professionals, but also people in health research, management, teaching, as well as the medical facility food services, housekeeping...)

- in 2006, there were 350,000+ registered nurses in canada (this number included both employed and unemployed nurses and combined RNs, LPNs, RPNs, and NPs.)

- the nursing population is aging. for every RN aged 35 or younger there are 1.9 RNs aged 50+ (i think this is similar in the u.s.)

- in 2006, there were 62,307 physicians in canada (physician-to-population ratio: 190 per 100,000. and the general practitioner-to-specialist ratio is about 50:50)

- in 2005, 22% of the physicians in canada were international medical graduates (these could either be canadians who received their MD abroad and returned home, or foreign doctors who came to canada to practice)

health care delivery:
- the days of having lots of procedures done in hospitals are gone. there is a focus to get the elective and non-major surgeries/procedures out of the hospital and into day clinics or home care settings (similar in the u.s.).

- as i mentioned before, each province is broken down further into regional health authorities (RHAs). each province organizes them in different ways, but the idea is that each RHA receives a global budget from the province and is moderately free to spend it in a way that is custom fit to their population (maybe they spend more on nursing homes, mental health/addictions, public health, health promotion, etc). this is most parallel in the u.s. to our setup with a state health department that then funds smaller county health departments (and, where appropriate, city health departments).

- goals and potential benefits of the RHA system: able to align needs and resources, can integrate services, can monitor service quality, improve promotion and prevention, improve accountability, and increase public participation

- challenges of RHAs: balancing the relationship of authority and accountability (between the province and each RHA), involving physicians more, developing an environment with the flexibility for change

- just interesting to note, there are TONS of health organizations at all different levels of the government (and some are non-government) that function within canada. a sample: Health Canada (has many functions, one of them includes acting as their version of our FDA), Canada Institute for Health Research or CIHR (their version of our NIH), Statistics Canada (which is the infrastructure for all national data, including health data), Canadian Institute for Health Information or CIHI (collects, maintains, and studies health information on the nation), Public Health Agency of Canada or PHAC (their version of our CDC), Health Council of Canada (board created to monitor, through accountability and transparency, and report on the tenants of the 2003 Accord on Health Care Renewal), Canadian Health Services Research Foundation or CHSRF (non-profit that promotes the use of evidence to strengthen canadas health system), Canada Health Infoway (non-profit that develops and promotes the use of electronic health information), Canadian Public Health Association or CPHA, and Genome Canada...to name a few.

workers compensation boards (WCBs):
- pre-dating the canada health act (CHA) or anything resembling it, the government created these WCBs back in the early 1900s as part of a “historic compromise” between workers and employers whereby workers gave up the right to sue employers in return for defined levels of no-fault compensation for workplace injuries and illnesses.

- each province and territory administers its own WCB, though all share the principles of no-fault compensation, no worker right to litigation, full funding by employers, administration by public agency and benefits linked to pre-injury income.

- WCBs finance or provide three types of services and benefits to individuals who suffer a work-related injury or illness: healthcare, which aims to restore an injured or ill workers functional capabilities and allow a timely and safe return to work; vocational rehabilitation, which assists injured or ill workers in finding alternate employment when necessary; and disability benefits, which provide compensation to a worker for lost income (temporary or permanent) and, in the case of permanent impairment, compensation for pain, suffering and loss of enjoyment of life.

- in the 1990s, the WCBs underwent a major change due to: service delays and new evidence showing a link between workplace absence and long-term disability (basically the longer an employee was out of work due to injury, the more likely they were to stay on disability permanently...costing the WCB lots of money).

- new WCB strategies then focused on expediting care by: creating new service-delivery arrangements and providing financial incentives to health professionals to treat WCB patients quicker.

- while on workers comp, the patient is outside of the CHA provisions and you can see that people within the regular medicare system might get a little upset that these injured workers are "queue jumping" and not having to wait on the wait lists.

- however, the WCBs also point out some of the benefits reaped by the public: 1. they purchase special medical equipment with their funding and place it in public hospitals for use by WCB patients, but if their patients arent in need of the equipment, the general public and their providers have access to it. 2. any specialized personnel trained and paid for by the WCBs to operate special equipment or to perform special services are also available to the public and their providers if not in use by an injured worker. 3. also, the WCBs favor the use of evidence-based medicine which, in turn, can positively influence the practices and care of the public.

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