Current Issues and Future Trends in

Health Care in Canada

◤ Chapter 10

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10.1 Discuss the state of mental health

and addiction and the related services in
Canada.

10.2 Summarize the challenges in

Learning managing health care for Canada’s aging
Outcomes (1 of 2) population.

10.3 Explain the problems facing home

care services in Canada.

10.4 Describe current issues related to

pharrmacare and the legalization of
marijuana in Canada.
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10.5 Outline the major health care issues

and related concerns facing Indigenous
Peoples in Canada.

10.6 Explain the impact of electronic health

records and information technology in
Learning health care.
Outcomes (2 of 2)
10.7 Discuss future initiatives for primary
health care.

10.8 Summarize the advantages and risks

of using social media in health care.
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Some
◤
concerns..
1. Underfunded and poorly coordinated care for mental health
issues
2. Aboriginal population faces disparities in socioeconomic and
health conditions
3. Underfunded and inadequate home care
4. No drug benefits for millions, people can’t pay for drugs that
are not covered
5. No national catastrophic drug plan
6. Excessive wait times for emergency care and surgical care
5

Mental Health
▪ 1 in 5 Canadians experience mental illness at some point in
their lives
▪ The overall annual cost of treating mentally ill Canadians
is more than $50 billion
▪ 6.7 million people, i.e., 20% of Canadians experience
mental illness at some point in their lives
▪ Mental health services are inadequately covered under
provincial and territorial plans
▪ There is a shortage of psychiatrists, particularly in rural
regions
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◤
7

Drug Misuse

• Every province and territory in

Canada has been affected by
Mental Health the National Opioid Crisis
and Addiction
Mental Illness and
Disorders Homelessness
• Canadians with mental health
and/or substance misuse
problems have a higher
homeless rate
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◤
Mental Illness and the Justice System
• Offenders coping with mental
illness and/or addiction issues
have increased by over 85% over
Mental Health the last 20 years
and Addiction Mental Illness and Employment
Disorders
• Depression and anxiety are
among the leading disorders
affecting the mental health of
Canadians in the workforce
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◤
Mental Health
⬤Family doctors may provide counselling or
psychotherapy
⬤However, this counselling-
⮚Is limited in most jurisdictions
⮚Is time consuming
⮚Should be left to a specialist in many cases
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◤
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Mental
◤
Health (Cont’d)
▪ Those afflicted with mental illness are affected by-
✔ Stigma
✔ Homelessness
✔ Legal issues
✔ Employment issues
✔ A shortage of adequate, affordable outpatient
services
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Mental
◤
health is offered in-
▪ Tertiary care psychiatry hospitals
▪ Forensic psychiatric hospitals and clinics
▪ Community mental health centers and related
agencies
▪ Some correctional facilities
▪ Adolescent assessment and treatment facilities
▪ Alcohol and drug treatment programs
▪ Long-term care facilities
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The◤ Stigma of Mental Illness

▪ 60% of the people affected with mental illness will
not seek help (MHCC data) because of being
stigmatized
▪ Stigma, prejudice, and discrimination are still
existent
▪ MHCC launched a program “Opening Minds” in
2009 aiming to-
✔ Reduce stigma
✔ Improve how people think about mental illness, and
✔ Promote fair and equitable treatment of these ailments
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Target
◤
groups for Opening Minds Program
Healthcare providers, to create positive,
accepting, and caring attitudes

The Youth to identify those at risk and promote

early intervention

The workforce to encourage understanding and

tolerance at work; and

The media to positively influence public views and

attitudes
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◤
Common Mental Health Disorders

Alcohol and drug addiction

Mood disorders

• Major depression
• Generalized anxiety disorder (GAD)
• Bipolar disorder
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◤
Common Mental Health Disorders

Major depression being the major mood

disorder, expected to be the second leading
cause of disease burden globally by 2020
(WHO, 2001)

Approximately 4000 Canadians commit

suicide every year, who are affected by
mental illness
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◤
Challenges of Mental Health
▪ Mental illness and homelessness
✔ 25-50% of homeless people have mental disorders or
substance abuse problem or both
✔ Reasons could be high stress levels, low self-esteem, and
little or no social support
✔ They also have associated physical ailments
✔ Have high suicide rate
✔ CIHI, 2007 report found that 35% of visits to emergency
departments by homeless people are due to mental health
issues or behavioral disorders
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Challenges
◤
of Mental Health (cont.)
▪ Mental illness and justice system
▪ High involvement in criminal activities
▪ Inmates with mental illness receive only limited treatment
▪ Prison officers/staffs are inadequately trained to deal with
these patients
▪ Suicide remains leading cause of death in Canada’s
correction facilities
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◤
Challenges of Mental
Health (cont.)

▪ Mental illness and Employment

▪ 70% to 90% are
unemployed, depending upon
severity
▪ Highly unemployed or
underemployed
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◤
Challenges of Mental Health
(cont.)

▪ Economic impacts are-

▪ The absenteeism and ineffective productivity
cost over $ 6 billon/year

▪ The private sector spends $ 180 million-300

million on short-term disability benefits and $
135 million for long-term disability benefits

▪ Fastest growing claims category for workplace

disability
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Steps◤ to Reduce
Occupational Stress

▪ Flexible working hours

▪ Work-at-home days

▪ Access to counselling

▪ Sleep rooms

▪ Exercise facilities, and measures to

improve job satisfaction
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◤
The Future of Mental Health

▪ Changing Directions, Changing Lives, the first national

strategy for mental health, was released in 2012
▪ The strategy aims to:
✔ Improve care across the country
✔ Provide the necessary resources and support for those diagnosed with
mental illness and their families
✔ Promote mental health and prevention of mental illness
▪ E-mental health technology
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The Future of Mental Health

▪ Out of the Shadows at Last, a 2002 report focused
on improving services for the mentally ill,
recommended-
▪ Access to a wide range of publicly funded services
▪ Mental health services be made available in the
communities where affected individuals live
▪ Seamless integration of services across all levels of
government and within communities
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◤
The Future of Mental Health
In February 2008, the federal government committed $110
million to the Mental Health Commission of Canada for
research to help homeless people living with mental
disorders

Five projects funded by the Commission are underway in

Vancouver, Winnipeg, Toronto, Montreal, and Moncton

These projects are focused on homelessness and mental

health
 Canada’s Aging Population

◤
By 2026, ◤
one in five Canadians will
have reached age 65

2031
2026
By 2031, one in four Canadians
will be over 65

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One Canadian Out of Seven Is Aged 65 or Over

▪ The high number of older Canadians affects almost
every area of health care
▪ Reasons for this population shift include-
✔ Baby boomers, the large group born between 1945 and
1963, are becoming seniors
✔ The birth rate is the lowest ever at 10.5 live births for
every 1000 people
✔ Although immigration continues to provide for population
growth, one-quarter of Canada’s older adult population
was born outside Canada
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The Aging Population: Associated Concerns

▪ As more Canadians retire, there will be-

▪ Higher government spending for pensions
▪ A lower taxation base
▪ A shortage of workers in all sectors, including health
care
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Older Canadians constitute only 14% of

the population, but account for-

40% of acute hospital stays

The Aging
Population:
Associated 85% of hospital-based continuing care
Concerns
82% of home care, and

95% of residential care

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Challenges
◤ to Providing Health Care for Older
Canadians Include-

▪ Physicians requiring more time to address multiple problems

▪ The shortage of gerontologists (230-242 for 4.3 million
seniors, or 1 for 18,695 patients)
▪ Acute care hospital beds being taken up by clients waiting
for long-term placement
▪ Canadians living longer with multiple health problems
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Shortages of Skilled Manpower

Human Health Resources

◤
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Human Health Resources:

Shortage of Nurses
▪ Despite the claims that the numbers of nurses in
Canada is increasing, there is a shortfall of nurses
▪ Shortage was first felt in the late 1980s and early
1990s
▪ There were funding cutbacks in health care
services and fewer jobs for nurses
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◤
Shortage of Regulated Nurses

⮚ Due to a reduced demand

▪ nursing schools decreased their enrolment
▪ nurses left the country for jobs abroad
▪ The Canadian Nurses Association reports that
Canada has a shortfall of approximately 20,000
nurses now
▪ Will need an additional 60,000 nurse by 2022
▪ In 2011 one in four RNs were over 55 years of age,
looking to retire soon
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◤
Shortage of Regulated Nurses

▪ In response to the projected nursing shortage

▪ Nursing schools increased the number of seats offered
to students
▪ Jurisdictions have developed strategies to recruit new
nurses and to encourage existing nurses to stay in the
profession
▪ Governments have invested millions of dollars in
nursing programs at colleges and universities
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Strategies to Increase Nursing Skills

▪ There has been a nationwide move away from diploma

programs for registered nurses in favour of degree
programs
▪ Licensed practical nurses (LPNs) have an expanded
scope of practice
▪ Nurses can now advance to other levels within their
profession, becoming nurse practitioners or qualifying for
other designations
▪ Strategies have also been undertaken to allow foreign
graduates entry to practice
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◤
What About Doctors?
36

Shortage of Doctors

In 2007, 4.8 million Canadians were without a

family doctor

The number of orphan patients continues to rise

The doctor shortage has affected every aspect of

health care and all specialties
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Why the Shortage?

▪ In the early 1990s, government stakeholders and

health care policy advisors determined that Canada
had too many practicing physicians in relation to
the national population growth
▪ As a result-
▪ Medical schools began to decrease enrolment by 10% to
20%
▪ Steps were also taken to restrict the number of foreign
doctors practicing in the country
▪ Older physicians were offered retirement incentives
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Why the Shortage? (Cont’d)

▪ The number of female physicians, who often cease

practicing medicine for periods to have children or
choose to practice part-time, has increased
▪ Younger physicians, seeking lifestyle balance, are
working fewer hours
▪ Fewer physicians are choosing family medicine,
particularly in rural areas
▪ Aging doctors are retiring or reducing the size of
their practises
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Strategies for the Future

1. Increased enrolment in medical schools

2. Attracting more foreign-trained physicians
3. Attempts to draw individuals from underserviced
areas into medicine
4. Promoting family medicine
5. Attracting doctors to northern and rural areas
40

Home Care Issues

▪ With a population living longer and more people coping
with chronic diseases, the demand for home care is
growing at an alarming rate
▪ Other concerns regarding home care include-
✔ Home services remaining outside of provincial or territorial health
plan coverage
✔ Poor coordination of services
✔ Insufficient human resources
✔ Inconsistent care
✔ Poor-quality care
41

▪ To improve the situation-

▪ Organizations and stakeholders have asked
the federal government to expand Medicare
to include home care
Home Care
▪ Provincial and territorial governments are
Issues working toward extending funding for
certain aspects of home care
▪ Some jurisdictions have legislated a
compassionate leave to increase
availability of volunteer caregivers
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▪ Common goals most provinces and territories want to

achieve:
▪ Increasing the number of funded visits recipients
can receive
Home and ▪ Developing a system to recruit and retain human
Continuing health resources
Care ▪ Developing a strategy to make the best use of
The Future existing resources
▪ Advocate for national ‘carers’ strategy
▪ Advancing the use of technology to improve
access and coordination
▪ Improving access to training for providers
◤
DRUGS
IS IT A PROBLEM?

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▪ Prescription drugs compose the fastest

growing health care cost
▪ Many Canadians carry no private drug
insurance and face financial hardship when they
need medications
Drug
Coverage ▪ Although the need for providing a national drug
plan has been recognized, no immediate
strategy has resulted
▪ A national and comprehensive drug program
would cost the federal, territorial, and provincial
governments hundreds of millions of dollars
45

◤
Cannabis became legal in
Cannabis Canada in 2018

Issues are multiple and

include:
• Use or misuse in workplace
• Driving under the influence
• Use in the armed forces
• Growing at home
• Possession limit 30 grams
• Online availability
• How to keep edible products away
from youth
• Concerns about long-term effects,
especially in youth and younger adults
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Wait Times and Access

◤

to Medical Care
47

Services that clients often must wait for include-

1. Access to specialists
2. Diagnostic tests
3. Visiting a general practitioner for routine medical
care
4. In the case of disabled individuals, seeking help
with daily routines
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◤
The causes of long waits, which vary
across the country, include-
1. More people requiring services
2. A shortage of human health resources
3. Limited access to required diagnostic services
4. Lack of coordination of services
5. Limited access to operating rooms and operating
time for surgeons
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◤
Wait Times and Access to Medical Care (Cont’d)
▪ Most provinces and territories host websites outlining the
approximate wait for each service
▪ The federal government is leading and funding an initiative for
the provinces and territories to establish “reasonable”
guaranteed wait times by 2010
▪ As a result-
▪ The provinces and territories have produced “benchmark” wait times
▪ Each province and territory must provide clients with alternative
treatment if the wait time guarantees are unmet

▪ People experiencing emergency or urgent medical situations

are not subject to wait lists
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Aboriginal
◤
Health Care
▪ When compared to other Canadians, First Nations, Inuit, and
Métis people-
▪ Are more likely to die from injuries, suicide, diabetes,
cardiovascular disease, and alcohol and substance
abuse
▪ Endure poverty, inadequate housing, and contaminated
drinking water
▪ Suffer from poor self-esteem and feelings of isolation
▪ Have a higher morbidity and mortality rate
▪ Have a lower life expectancy
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◤
No consensus on the best approach

Locally controlled and managed gaining favour

Access and universality pose the greatest

Indigenous challenge
Health Care Health Centres well equipped by most standards,
however too often individuals need to leave
community for treatment

Retaining medical and nursing staff is a challenge

Health centres are incorporating traditional

healing practices into their programs
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◤ Acknowledge current state of

Aboriginal health is a result of
Acknowledge previous Canadian government
policies

Establish measurable goals to

Establish identify and close gaps in health
outcomes
Truth and
Reconciliation
Commission (1 of 2) Recognize, Recognize, respect and address the
respect and distinct health needs of the Metis,
address Inuit and off reserve

Provide sustainable funding for

Provide existing and new Aboriginal healing
centres
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◤
Recognize the value of Aboriginal
Recognize healing practices and use them in
treatment

Increase Aboriginal
Truth and professionals, retain them in
Reconciliation Increase Aboriginal communities, provide
Commission (2 of 2) cultural competency training for
all health-care professionals

Require medical and nursing

Require students to take a course in
Aboriginal health issues
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Aboriginal Health Care (Cont’d)

▪ To address these issues, the Health Council of
Canada has introduced
▪ A population health approach-
▪ Involving all levels of governments and stakeholders
within Aboriginal communities
▪ Addressing the health problems unique to Aboriginal
communities
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◤
Aboriginal Health Care (Cont’d)

▪ For this approach to prove successful-

✔ Health care professionals must show sensitivity
to the needs of the population
✔ Aboriginals must be involved at all levels of
health
✔ Canada needs more Aboriginal health care
professionals

▪ https://www.fnha.ca/wellness/our-history-our-health
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◤
◤

Electronic Health Technology

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Use of Electronic Technology

▪ Most hospitals in Canada either fully or partially use

electronic systems
▪ Most Canadian physicians do not yet have a fully
electronic office
▪ Converting to electronic systems remains a slow
process for several reasons, including
✔ Software standards and compatibility issues
✔ Cost
✔ Limited comfort level amongst health care professionals
✔ Confidentiality concerns
60

◤ The Connected Health Information in Canada

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National Initiatives to Promote Electronic Systems

▪ The Canada Health Infoway (CHI) is leading the

transition to electronic health systems with projects
that include-
▪ Digitizing diagnostic imaging
▪ Expanding drug and laboratory information systems
▪ Expanding and promoting the interoperable electronic
health records (EHR) program
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◤
National Initiatives to Promote Electronic Systems

Short-term goals are as follows:

▪ By 2010-2011, 50% of Canadian doctors will use

electronic medical records (EMRs)

▪ By 2010, Canadians residing in northern and rural regions

will have improved Telehealth access

▪ By 2015, there will be EMRs in all doctors’ offices

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Advantages to Electronic Technology

▪ The pan-Canadian establishment of EHRs and EMRs
will
▪ Allow family doctors’ offices to connect with specialists’
offices
▪ Facilitate the prompt delivery of laboratory tests

▪ Enable clients to access their medical records and to

participate in their own health care management
▪ Improve access to home care facilities and services

▪ Facilitate a drug information system

▪ Enable implementation of public health tracking systems

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Challenges
▪ The initiative will require
▪ Stakeholder commitment and collaboration
▪ Continual financing and support systems
▪ A public that trusts that their health information will be managed
respectfully and securely
▪ Foolproof tracking and security systems
▪ Computer software programs that talk to each other
▪ A uniform vocabulary of technical language
▪ Clearly defined laws governing the use and exchange of health
information
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◤
Social Media

▪ A repository of electronic
communication channels used to share
information
▪ Mobile devices have increased access
▪ Concerns about the credibility of some
content
▪ Impacts the provider/patient
relationship
▪ Support groups on social media can be
part of a treatment plan
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Medical robotics changing

health care in Canada
◤https://globalnews.ca/video/rd/1189886531935/?jwsource=cl
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The Future of Primary Health Care Reform

▪ The current trend toward community-based health care
and the collaboration of health care groups to offer that
care will continue
▪ Health care teams will expand
▪ Alternative health care professionals are also likely to
become part of these teams
▪ Primary health care reform includes providing the
public with 24/7 access to health information and advice
through telephone helplines
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Monitoring Health Care Initiatives

▪ The Health Council of Canada has completed a new

strategic plan to guide its future work
▪ Working toward a “sustainable and high-
performing health care system,” the Council will
▪ Educate the public
▪ Support the health care community
▪ Monitor and report on successes and challenges
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Thanks