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ELOM2 Ethical, Legal, and Organizational Medicine
Acronyms
Toronto Notes 2019
Acronyms
AE adverse event
ART advanced reproductive technologies
RDoC Resident Doctors of Canada
CFMS Canadian Federation of Medical Students CFPC College of Family Physicians of Canada
CMA Canadian Medical Association
CME continuing medical education
CMPA Canadian Medical Protective Association CPSO College of Physicians and Surgeons of Ontario EMR electronic medical record
FMEQ FRCPC FRCSC GA GDP HCCA IVF LMCC MCC OECD
Fédération médicale étudiante du Québec
Fellow of the Royal College of Physicians of Canada Fellow of the Royal College of Surgeons of Canada gestational age
gross domestic product
Health Care Consent Act
in vitro fertilization
Licentiate of the Medical Council of Canada
Medical Council of Canada
Organization for Economic Co-operation and Development
OMA Ontario Medical Association
OTC over the counter
PHO Provincial Housestaff Organization
PIPEDA Personal Information Protection and Electronic Documents Act POA power of attorney
PTMA Provincial/Territorial Medical Association
RCPSC Royal College of Physicians and Surgeons of Canada
SDM substitute decision-maker
Principles of the Canada Health Act
1. Public Administration: provincial health insurance programs must be administered by public authorities
2. Comprehensiveness: provincial health insurance programs must cover all necessary diagnostic, physician, and hospital services
3. Universality: all eligible residents must be entitled to health care services
4. Portability: emergency health services must be available to Canadians who are outside their home province, paid for by the home province
5. Accessibility: user fees, charges, or other obstructions to insured health care services are not permitted
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The Canadian Health Care System
Overview of Canadian Health Care System
onefederal,threeterritorial,andtenprovincialsystems majorcomplexitiesinestablishmentofCanadianhealthpolicyincludegeographicaldiversity, socioeconomic divisions, and international pressures
financed by both the public (70%) and private (30%) sectors
each provincial plan must cover all medically necessary health services delivered in hospitals and by physicians; may choose to cover services such as home care and prescription drugs non-insuredhealthservicesandfeesareeithercoveredbyprivateinsuranceorbytheindividual workers’compensationfundscovertreatmentforwork-relatedinjuriesanddiseases
Table 1. Division of Government Responsibilities in Health Care
Federal Government
Health care services for Aboriginal people, federal government employees (RCMP and armed forces), immigrants, and civil aviation personnel
Marine hospitals and quarantine (Constitution Act, 1867) Investigations into public health
Regulation of food and drugs
Inspection of medical devices
Administration of health care insurance
General information services related to health conditions and practices
Role in health derived from government’s constitutional powers over criminal law (basis for legislation such as Food and Drugs Act and Controlled Substances Act), spending, bioterrorism, and ‘peace, order, and good government’
Legal Foundation
Provincial Government
Establishment, maintenance and management of hospitals, asylums, charities, and charitable institutions (Constitution Act, 1867)
Licensing of physicians, nurses, and other health professionals Determining the standards for licensing all hospitals Administering provincial medical insurance plans
Financing health care facilities
Delivery of certain public health services
The federal government can reduce its contributions to provinces that violate the key principles of the Canada Health Act
The legal foundation of the Canadian health system is based on: • twoconstitutionaldocuments:
1. Constitution Act (1867): deals primarily with the jurisdictional power between federal and provincial governments
2. The Canadian Charter of Rights and Freedoms (1982): does not guarantee a right to health care, but given government’s decision to finance health care, they are constitutionally obliged to do so consistently with the rights and freedoms outlined in the Charter (including the right to equality, physicians’ mobility rights, etc.)
• twostatutes:
1. Canada Health Act (1984): outlines the national terms and conditions that provincial health systems
must meet in order to receive federal transfer payments
2. Canada Health and Social Transfer Act (1996): federal government gives provinces a single grant
for health care, social programs, and post-secondary education; division of resources at provinces’ discretion