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Chapter 2

1. What is the origin of Medicare?
a. The American health care system
b. Traditional Aboriginal healing practices
c. The religious orders that first provided health care
d. Canada’s federal government

2. Who was assigned the responsibility for health care in the 1867 Constitution Act (British North America Act)?
a. The provinces were responsible for public health care
b. First Nations communities were responsible for Aboriginal health care
c. The federal government was responsible for military health care
d. The provinces were responsible for health policy

3. Where was North America’s first universal health insurance program implemented?
a. Manitoba in 1957
b. Canada in 1967
c. Prince Edward Island in 1867
d. Saskatchewan in 1947

4. What was the purpose of the Canada Health Act (1984)?
a. Provide the provinces with more legal authority
b. Ban extra billing and user fees
c. Establish a national drug plan
d. Increase Canadians’ access to health care based on ability to pay

5. What Act has as its cornerstones publicly administrated, comprehensive, universal, portable, and accessible?
a. Hospital Insurance and Diagnostic Services Act
b. Constitution Act
c. Canada Health Act
d. American Medicare Act

6. What is one of the primary objectives of Canadian health care policy according to the Canada Health Act (1984)?
a. Facilitate reasonable access to hospital care
b. Protect the health care system from privatization
c. Restore stable health care funding to the provinces
d. Protect, promote, and restore the physical and mental well-being of Canadians

7. How has the Canada Health Act (1984) been successful in ensuring all Canadians have access to the health care they need?
a. Creating specific mechanisms to ensure accountability and transparency
b. Establishing criteria and conditions for insured health care services that must be met before federal transfer payments are made
c. Penalizing provinces that do not comply with the public health aspects of the Act
d. Determining the extent to which each province and territory has satisfied the criteria and conditions of the Act

8. Which model dominated public and political thinking about health during the time that the Canadian Medicare system was created in 1957?
a. Healthy lifestyle model
b. Socio-environmental model
c. Biomedical model
d. Health promotion model

9. Who said, “The practice of health care has evolved. And despite efforts to keep pace, Medicare has not”?
a. Monique Begin, Minister of Health
b. Ralph Klein, Premier of Alberta
c. Brian Mulroney, Prime Minister of Canada
d. Ray Romanow, Commissioner on the Future of Health Care

10. How does Canada rank in the world with respect to health care?
a. Canadian men and women outlive Americans.
b. Canada spent 16% of the gross national product on health care in 2008.
c. The Canadian infant mortality rate is one of the best in the world.
d. Canada has the highest cost per capita in health care expenditures.

11. What are the four determinants of health identified by the Lalonde Report (1974)?
a. Socio-environmental, biomedical, disease prevention, and health promotion
b. Gender, culture, working conditions, and education
c. Biological, emotional, spiritual, and psychological
d. Environment, lifestyle, human biology, and the health care system

12. What provided the basis for the Ottawa Charter?
a. Alma Ata Declaration
b. Canada Health Act
c. National Forum on Health
d. Epp Framework

13. What is involved in a health care system that focuses on primary care?
a. People accessing health care services at the first point of contact
b. Health education, proper nutrition, and disease prevention
c. Disease prevention, health protection, and health promotion
d. Accessible, acceptable, and affordable health care

14. Recently, Family Health Teams have been set up to provide primary health care. Where have these been established?
a. Ontario
b. Quebec
c. Nova Scotia
d. British Columbia

15. Who funds public health in Canada?
a. Provincial and/or municipal tax dollars
b. Municipalities
c. Federal government
d. Provinces and federal government

16. What nursing sector is currently the fastest-growing area in Canada?
a. Public health
b. Acute care
c. Home care
d. Long-term care

17. Mr. Jones lives in Ontario and requires home care nursing and support services. Who would deliver these services?
a. Social services branch of the department of health
b. Local public health units
c. Agency contracted by the Local Health Integration Network
d. Local health authority

18. What is a common argument for the discontinuation of publicly funded, not-for-profit health care?
a. Shortage of health care workers
b. The aging Canadian population will escalate health care costs
c. Emerging diseases
d. Pressure from for-profit centres for federal funding

19. What statement is true about community health nurses in Canada?
a. They are slightly younger than hospital nurses.
b. The proportion in leadership positions is increasing.
c. They are more likely to have a university degree.
d. About 75% work full time in the community.

20. In 2002, Romanow recommended a shift to health promotion and disease prevention. What is a barrier to achieving this goal?
a. Competing care challenges
b. Lack of stable long-term funding
c. Number of people requiring home care
d. Shortage of health care professionals

21. Role clarity has been identified as an issue for community health nurses in the 2010 Synthesis of Canadian Community Health Nursing Reports. What is a component of role clarity?
a. Understanding the role of other health care professionals
b. Common language to describe the role
c. Access to specialized expertise
d. Leadership development

22. What factor has the greatest impact on community health nurses’ ability to practice to their full scope?
a. Staffing shortages
b. Funding
c. Leadership
d. Being valued for their services

23. What organizational supports would encourage the professional development of community health nurses?
a. Regular performance feedback
b. Formalized communication mechanisms
c. Formalized student preceptor programs
d. Articulation of the vision

24. In 1989 the Treasury Board approved the transfer of Indian health services. Which statement is true about this transfer?
a. Transferred responsibility to the provinces
b. Unspent monies were to be returned
c. Requires certain programs to be offered
d. Optional to all First Nation and Inuit communities

25. What health care service accounts for the smallest percentage of health care dollars?
a. Physicians
b. Hospitals
c. Drugs
d. Home care

26. The Best Practice Guidelines on Nursing Leadership (RNAO, 2006) outlined attributes for effective nurse leaders. What is one of those attributes?
a. Avoiding risk taking
b. Organizational ability
c. Social awareness
d. Comfort with routines

27. Contrast the terms primary care and primary health care and give an example for each related to community health nursing practice.

28. Summarize two federal initiatives in the development of health promotion and give one rationale for each that illustrates their importance on an international level.

29. Give an example of where the Canada Health Act (1984) has been successful. Provide a rationale and an example of where its success has been more limited.

30. Describe the importance of three historical milestones in the development of the Canadian health care system.

31. Discuss three Canadian values that are reflected in the current Medicare system.

32. Name three of the five principles of the Canada Health Act (1984) and give an example for each.

Activity Name: Chapter 02

1. c. The religious orders that first provided health care
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Correct: The idea of Medicare evolved from the traditions of religious orders.
Incorrect: The American health care system did not influence Medicare.
Incorrect: Aboriginal healing practices did not contribute to the evolution of Medicare.
Incorrect: Canada’s federal government enacted legislation for universal Medicare, but the idea originated with the early religious orders.
Hints:

2. c. The federal government was responsible for military health care
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The BNA did not assign the responsibility for health policy to either the federal or provincial governments.
Incorrect: Public health care was not assigned to either level of government.
Incorrect: Aboriginal health care was the responsibility of the federal government.
Correct: The BNA assigned health care services for veterans and the military to the federal government.
Hints:

3. d. Saskatchewan in 1947
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: This was the start of the universal health insurance program in Canada, but Canada followed Saskatchewan.
Incorrect: The first universal health insurance program was introduced in Saskatchewan.
Correct: Saskatchewan introduced the first universal health insurance program under Tommy Douglas.
Incorrect: P.E.I. did not introduce the first universal health insurance program.
Hints:

4. b. Ban extra billing and user fees
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The Bill C-3 was introduced to control extra fees being charged by provinces and physicians.
Incorrect: The Canada Health Act did not establish a national drug plan.
Correct: Extra billings and user fees were escalating and threatening the universal health care program.
Incorrect: The Act was to prevent access based on ability to pay.
Hints:

5. c. Canada Health Act
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Correct: These are the cornerstones of the Canada Health Act.
Incorrect: These are not cornerstones of the American Medicare Act.
Incorrect: This Act introduced universal health care in Canada.
Incorrect: The Constitution Act created Canada as a dominion.
Hints:

6. d. Protect, promote, and restore the physical and mental well-being of Canadians
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: It is to facilitate reasonable access to health services, not hospital care.
Correct: This is one of the primary objectives.
Incorrect: This was not one of the primary objectives.
Incorrect: Funding was limited to medically necessary physician and hospital services.
Hints:

7. b. Establishing criteria and conditions for insured health care services that must be met before federal transfer payments are made
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The provinces needed to meet the criteria and conditions or lose funding.
Incorrect: Public authority is accountable to the government but does not ensure access.
Correct: This is the way in which the federal government ensured access to health care across Canada. It prevented the use of user fees and extra billing.
Incorrect: Access would be ensured if the provinces met the criteria, not by penalizing them.
Hints:

8. c. Biomedical model
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The biomedical approach was popular at that time.
Incorrect: The healthy lifestyle model began in the 1970s.
Incorrect: The health promotion model began in the 1970s.
Correct: The biomedical model to health was common during this period.
Hints:

9. d. Ray Romanow, Commissioner on the Future of Health Care
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: This statement was not made by Ralph Klein.
Correct: Ray Romanow made this statement.
Incorrect: Brian Mulroney did not make this comment.
Incorrect: This comment was made after Monique Begin was Minister of Health.
Hints:

10. a. Canadian men and women outlive Americans.
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The United States has a higher cost than Canada.
Correct: Canadian women live three years longer and men two years longer than Americans.
Incorrect: A number of developed countries have lower infant mortality rates than Canada.
Incorrect: Canada spent only 10.4% of the GNP.
Hints:

11. d. Environment, lifestyle, human biology, and the health care system
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: These are the approaches to health enhancement.
Incorrect: These are not the four determinants identified by Lalonde.
Correct: Lalonde identified environment, lifestyle, human biology, and the health care system as the four determinants of health.
Incorrect: These determinants of health were added to refine and add to the original four determinants.
Hints:

12. d. Epp Framework
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The Alma Ata Declaration was signed by Canada at an international conference that focused on the protection and promotion of health for all people.
Correct: The Epp Framework introduced health promotion, which became the basis for the Ottawa Charter.
Incorrect: The Canada Health Act is federal legislation that outlines the criteria and conditions provinces must meet to get federal funding for health care.
Incorrect: The National Forum on Health is an advisory body to the prime minister on ways to improve the health care system and the health of Canadians.
Hints:

13. a. People accessing health care services at the first point of contact
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Correct: Primary care occurs when people are able to access their family physician or nurse practitioner as the first point of contact.
Incorrect: These are some of the criteria that the provinces must meet to receive federal money for health care.
Incorrect: Primary health care refers to first point of contact.
Incorrect: These are some of the roles of public health.
Hints:

14. a. Ontario
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: They were not set up in Nova Scotia.
Correct: Ontario recently set up Family Health Teams in communities to provide health care.
Incorrect: Quebec set up the first primary health units with salaried employees. They were based on Centres Locaux de Service Communautaires.
Incorrect: British Columbia’s walk-in clinics are not called Family Health Teams.
Hints:

15. a. Provincial and/or municipal tax dollars
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The federal government does not fund public health.
Correct: Public health funding comes from provincial and municipal tax dollars.
Incorrect: The provincial government assists the municipal governments in funding public health.
Incorrect: The federal government does not fund public health.
Hints:

16. c. Home care
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Public health is not growing as quickly as home care.
Incorrect: Acute care nursing is not growing as quickly as home care.
Correct: The increasing growth in home care is due to the belief that care in the home will be less costly.
Incorrect: Home care is the fastest-growing sector.
Hints:

17. c. Agency contracted by the Local Health Integration Network
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Public health units do not offer home care services in Ontario.
Incorrect: In the Yukon a social services branch of the department of health offers home care.
Correct: In Ontario services are contracted by one of 14 Local Health Integration Networks.
Incorrect: Most provinces have home care offered through local health authorities.
Hints:

18. b. The aging Canadian population will escalate health care costs
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Correct: The aging population is predicted to escalate health care costs.
Incorrect: There is no evidence that this is escalating costs at the same rate as the aging population.
Incorrect: Some for-profit clinics currently access provincial funding.
Incorrect: Although there is a shortage of health care workers, this is not related to escalating costs.
Hints:

19. c. They are more likely to have a university degree.
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Nurses working in community health are older than nurses in hospitals.
Incorrect: Only 54% work full time in the community.
Correct: This is true.
Incorrect: The proportion in leadership has decreased.
Hints:

20. b. Lack of stable long-term funding
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Funding, not staff shortages, is a major barrier.
Correct: Lack of stable long-term funding is the major barrier. The funding that currently exists is being threatened.
Incorrect: Funding is the major barrier.
Incorrect: Funding, not care challenges, is the major barrier.
Hints:

21. b. Common language to describe the role
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Correct: This is one of the components of role clarity.
Incorrect: The community health nurses’ role is not understood by other health care professionals.
Incorrect: This was not a component of role clarity.
Incorrect: This was not a component of role clarity.
Hints:

22. c. Leadership
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Community health nurses are not currently valued for their services. Role clarity will assist with this.
Incorrect: Although funding is an issue, leadership was identified as having the greatest impact.
Correct: Leadership, especially front-line managers, has the greatest impact on community health nurses being able to work to their full scope.
Incorrect: Shortages of nurses may be a factor in having the capacity to give care, but leadership is the greatest factor in a nurse’s ability to work to full scope.
Hints:

23. a. Regular performance feedback
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: This strategy will improve the infrastructure.
Incorrect: This strategy will improve the workplace but not necessarily develop the nurse professionally.
Incorrect: This is an infrastructure strategy, not a support aimed at professional development.
Correct: Providing community health nurses with regular performance feedback from a variety of sources allows the nurses to develop.
Hints:

24. c. Requires certain programs to be offered
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: The transfer was to those First Nation and Inuit communities who wished to assume authority for their health care.
Incorrect: This transfer of authority was optional for communities south of the 60th parallel.
Correct: Those communities that accepted the authority were required to ensure that certain public health and treatment programs were available.
Incorrect: The community had flexibility in how money was spent, but they were allowed to keep unspent funds.
Hints:

25. d. Home care
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: Physician services are not the smallest percentage.
Incorrect: Hospitals and physician services account for over 50% of the spending
Correct: Despite the growth in home care services, it accounts for less than 5% of the money spent on health care.
Incorrect: The percentage of health care dollars spent on drugs is increasing and is greater that money spent on home care.
Hints:

26. c. Social awareness
Learning Objective:
Chapter 2 Multiple Choice Questions
Feedback:
Incorrect: This was not one of the attributes identified.
Incorrect: Willingness to take risks was an attribute that was identified.
Incorrect: Comfort with ambiguity was identified as an attribute.
Correct: Self-confidence, self-awareness, and social awareness were identified as attributes of an effective leader.
Hints:

27. Primary Care: a person’s first point of contact with the health care system. Primary care services are dominated by medicine and have focused mainly on acute care and treatment of disease. The largest group of primary care providers in Canada is physicians. Other primary care providers are nurse practitioners, dentists, chiropractors, pharmacists, dieticians, midwives, optometrists and to some extent PHNs. Most Canadians access primary care though a family or general practitioner who is reimbursed on a fee-for-service basis. Only a few Canadians receive primary care services through a CHC, walk-in clinics, or emergency rooms.
Example related to CHN practice: A family who a PHN visits in the postpartum period may also see the primary care provider, most likely a GP, around the same time, increasing the need for interprofessional communication.

Primary Health Care: a philosophy or approach to care that involves the principles set forth at Alma Ata in 1978: health care that is accessible, affordable, and acceptable; uses appropriate technology; promotes health; and recognizes intersectoral and interdisciplinary approaches.
Examples related to CHN practice: a multidisciplinary community health council with several CHNs as members collaborates with a community to develop a network of safe bike and walking trails through residential and industrial neighbourhoods.
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

28. – Lalonde Report (1974): acknowledged the limitations of the funded medical/treatment system. Presented a vision for health promotion. Identified four determinants of health, with an emphasis on lifestyle and the environment. Led to a global reconceptualization of health promotion.
– Epp Report (1986): expanded the definition of health promotion, incorporated some of the tenets of primary health care, and emphasized social/environmental/political dimensions of health. Formed the basis for the Ottawa Charter of Health Promotion.
– Ottawa Charter of Health Promotion (1986): International document identifying the prerequisites for health, strategies for promoting health, and outcomes of the strategies. Acknowledges that caring for one’s self and others is conducive to health. Identifies caring, holism, and ecology as essential concepts in health promotion.
– Population Health Template and Population Health Promotion Model (2001 and 1996): resources developed to put population health and health promotion into action. Used nationally and internationally in program planning, community development, and resource allocation.
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

29. – Successful: in abolishing user fees and extra billing. Provinces were penalized for allowing user fees and extra billing through the federal transfer payment plan.
– Less successful: violations of portability criterion between provinces, and suspected violations of comprehensiveness and accessibility. The federal government does not collect enough information on compliance with criteria and does not impose penalties outside of extra billing and user fees.
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

30. 1867-1867—Constitution Act (BNA Act) assigned responsibility for hospitals to provinces. Did not explicitly assign responsibility for health policy to either federal or provincial government.
1919—national health insurance on the Liberal Party platform
1947—Saskatchewan gets Medicare under Tommy Douglas
1957—national Hospital Insurance and Diagnostic Services Act (HIDS) provides financial incentives to the provinces to build hospitals through 50/50 grants if provinces meet five key principles
1962—Saskatchewan gets universal, publicly funded medical insurance
1966—federal Medicare including physicians’ services; if provinces meet same principles as HIDS, feds pay 50% of costs
1971—all provinces participate
1977—Established Programs Financing Act changes federal share of health costs to a per capita block grant
1996—Canada Health and Social Transfer (CHST) payments include federal transfer payments for health, postsecondary education, and welfare
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

31. – Social justice: All members of society, including the most vulnerable, are entitled to free health care in Canada.
– Equity: All Canadians are viewed equally and without discrimination in terms of universal health care coverage.
– Community: All members of society contribute through taxation to provide everyone in the community with access to health care regardless of ability to pay.
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

32. – Publicly administered: Health care funds are administered by a local elected regional health authority under the direction of the provincial health department.
– Portable: A person from Saskatchewan can receive insured health care in Ontario.
– Accessible: Families across Alberta have access to pediatric health care in their own communities or in communities within their health region without additional user fees.
– Universal: All residents of British Columbia are covered by B.C. health care.
– Comprehensive: In-hospital health care, such as medically necessary surgery, is covered in the province of Newfoundland.
Learning Objective:
Chapter 2 Essay Questions
Feedback:

Hints:

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