博思讲堂第十九讲-钱熠老师主讲《Health Care System and Family Medicine in Canada》

主讲人

钱熠

时 间

2013-4-16

题  目

Health Care System and Family Medicine in Canada

主  要

内  容

1.     Country health profile：

•         General:

Total population (thousands): 34, 017;

Gross national income per capita ($): 38, 370;

•         Mortality and burden of disease:

Life expectancy at birth (years): Male 79, Female 83, both sexes 81; Under-5 mortality rate (per 1000 live births): Both sexes 6; Adult mortality rate (probability of dying between 15 and 60 years per 1000 population): Both sexes 70; Prevalence of HIV (per 1000 adults aged 15 to 49): 2; Prevalence of TB (per 100, 000 population): 6

2.     History of health care

•         Government-funded universal health insurance program;

•         Federal – provincial – territorial shared cost agreement;

•         Regarding health care as a social good not merely another purchasable commodity;

•         Three main Acts: 1957, 1966, and 1984 (The Canada Care Act)

•         The Canada Act: Complete coverage for all necessary hospital and physician services through a publicly funded “single-payer” insurance system.

•         Public administration, Comprehensiveness, Universality, Portability, Accessibility

3.                 Health financing system

 4.                 Health care delivery

Provincial governments:

•         The key role of administration and delivery of health care services , guided by the Canada Health Act.

•         Providing basic medical services including most primary and secondary care services such as visits to family physician and specialized hospital care through mandatory and universal health insurance plans.

•         Providing some groups (low-income group) with supplementary health benefits not covered by the Act, such as drugs prescribed outside hospitals, ambulance costs, and hearing, vision and dental care.

5.                 Primary health care

Definition:

•         First-contact care that deals with the majority of health problems.

•         Foundation of any health care system

Benefits:  Close relationship between PHC and efficiency, effectiveness and equity of health care system.

•         Improved access to health services

•         Improved health outcomes

•         Lower overall health care costs through better prevention, coordination and continuity of care

6.                 Family Medicine (Background, definition, principals)

•         Demographic and social factors:

Longevity & Aging

Chronic illness

Complexity

Comorbidities

Access related issues

Shift of institutional care to community care

Inequity in coverage for provision of certain services

•         Declining availability of informal community care

•         Reform of Primary Health Care

•         Family medicine in Canada is defined by

Importance of continuity of care

Importance of comprehensiveness of care

Centrality of the doctor-patient relationship

Undifferentiated symptoms and the ability to deal with uncertainty

•         Four Principles of Family Medicine :The Doctor Patient Relationship is Central to the Role of the Family Physician; The Family Physician is a Skilled Clinician; Family Medicine is Community-Based; The Family Physician is a Resource to a Defined Practice.

7.     FPs (Coverage, ways of practice, scope of practice, training)

•         Total number of physicians 66,906.

•         51% of all physicians (34,810) are Family Physicians.

•         GP/Population: 1:970.

•         Approximately 85% of Canadians have a family physician (goal is 95%).

•         Four to five million Canadians (15 - 16%) still need a personal family doctor.

•         Scopes of family practice vary depending on location (urban vs rural), community need, range and availability of other specialists, distance from nearest hospital, personal/professional family physicians considerations

•         Remuneration of FPs in Canada

On a basis of fee-for-service mode of payment.

FPs increasingly prefer blended methods of remuneration

FPs payment (constituting 90%+ of their source of income)

    38.8% by fee-for-service

    6.4% by salary

    4.1% by sessional/per day/hourly

    2.5% by capitation

42.2% blended

•     Income of FPs in Canada

•         Every doctor’s income is different;

•         Average FP $255,000;

•         Average for all MDs $300,000;

•         Average family income (2 people, after tax) $76,000;

•         Average teacher payment $45000 to $75,000.

•         New reform:  CanMEDS-FM and  Triple C Competency-based Curriculum

•         In response to the adoption of CanMEDS-FM competency framework by CFPC.

•         Triple C Competency-based Curriculum:

Comprehensive Care and Education

Continuity of Education and health care

Centred in FM

现  场

反  馈

讲座内容非常全面、系统，对我校的专业教育有启发。