Introduction to rehabilitation & canadian healthcare system

Physical Therapy Assistant
(PTA) Program
Introduction to Rehabilitation,
Physiotherapy/PTA & Canadian
Healthcare System
Instructor: Dr. George Boghozian, B.Sc., D.C.

Dr. George Boghozian, B.Sc., D.C.
Education:
1980-1985: Iranian Medical College
B.Sc. In Medical Laboratory Science
1998-2000: York University
Kinesiology and Health Science
2000-2003: Cleveland Chiropractic College
Doctor of Chiropractic (D.C.)

Dr. George Boghozian, B.Sc., D.C.
Teaching Experience:
1985-1989: Bushehr Midwifery School
Medical Laboratory
Nutrition
Clinical Genetics
2001-2003: Cleveland Chiropractic College
Clinical Laboratory Diagnosis
2005-2006: Canadian Memorial Chiropractic
College
Systems Pathology

Prepared by:
Dr. George Boghozian
Introduction to Rehabilitation,
Physiotherapy/PTA &
Canadian Healthcare System

Introduction to Rehabilitation
Part I
1: History and definition of
Physiotherapy
2: Understanding disability
3: The role of PTA in Ontario Healthcare
System
4: The role of PT in Ontario Healthcare
System
5: Code of Ethics for Physiotherapists

Introduction to Rehabilitation
Part II
1: Ethical Dilemma
2: Medico-legal considerations in
Physiotherapy
3: Communication in a PT setting
Developing clinical interviewing skills (Video)
4: PTAs caring for others
5: Understanding the patient
6: Coping with dying patients

Part I
1: History and Definition of
Physiotherapy

1: History and Definition of Physiotherapy
History:
Physical therapy has its origins in ancient history
With the advent of joint manipulation and
massage in China circa 3000 BC
Hippocrates described massage and hydrotherapy
in 460 BC
In 1894 the British Medical Journal raised
concerns about:
The practices of some masseuses and masseurs
Who were offering immoral services under the name of
massage
It called for an institution to be formed to regulate
massage practice

“The Society of Trained Masseuses” was formed
by well-meaning nurses and midwives
Who were keen to see their massage practices
authenticated
A concern to provide:
An authentic alternative to the massage parlours
And a desire to get medical approval
Led early physical therapy pioneers to:
Adopt a view of the body based on
Biomechanics and kinesiology in health and illness
something that dominates the physical therapy
'philosophy' even to this day

Massage and remedial gymnastics became a vital
service in both world wars
And much was learned through:
Rehabilitation of injured servicemen
From these unfortunate events
Physical therapy grew rapidly after the Second
World War with formation of:
Spinal injury units
Orthopaedic hospitals
And chest clinics
Providing new challenges to the profession
It has blossomed to become the largest allied
health profession

Physiotherapy in Canada:
The contribution of physiotherapy to Canada's
health care system is linked to the major changes
that shaped the country:
From treating returning war amputees of the World Wars
Through innovative therapies for the polio epidemics that
swept communities in the 40s and 50s
And the onslaught of new types of injuries associated
with the widespread introduction of the automobile
Physiotherapy has been there to meet the challenge

thanks to the determination of a small
cadre of women
Who challenged social mores and the
prevailing wisdom of the medical
establishment:
Physiotherapists have emerged as full members
of Canada's health care team
From humble beginnings in makeshift hospitals

Physiotherapists made their early mark in
Canada during both World Wars
When they were recruited in large numbers
to treat injured soldiers
Students trained in the key areas of early
physiotherapy:
Massage
Muscle function
And occupational therapy

Formation of CPA:
In the 1920s, physiotherapy had already
moved quickly to bolster the profession by
founding the Canadian Physiotherapy
Association (CPA)
And using it to develop a more stringent
set of educational standards and
qualifications to augment the hands-on
training acquired in the war years

Transition to peacetime proved even more
challenging, according to Joan Cleather
Whose book “Head, Heart and Hands” chronicles
the rise of the profession in Canada:
"Society at that time was not in favour of women in the
general workplace. In the early days, the women who
entered into the profession came from good, quality
families. They had to have strong characters and terrific
determination to pursue careers in spite of family and
community opposition. Those who got through, banded
together to face their families and the rest of the world;
those who didn't have it, fell by the wayside”

One of the first pioneers, Esther Asplet,
typifies the lengths that physiotherapists
were prepared to go to in order to expand
the scope of their profession
In her native England, she had worked
directly with an eminent physician. Once in
Canada, however, she soon discovered
that therapists were not part of the health
care establishment. Not content with the
status quo, Asplet set out to change things

To do that, she set her sights on Dr.
MacKenzie Forbes, one of the most
prominent orthopaedic surgeons then
working in Montreal. After several hours of
shadowing Dr. Forbes, Asplet met him
face-to-face in the outpatient clinic. When
Forbes asked her what he could do for her,
she quickly turned the tables and stated
she had come "to find out what she could
do for him."

Intrigued, or perhaps taken aback by the
directness of Asplet's approach, Dr. Forbes invited
her to join his staff. If Asplet's tactics lacked
subtlety, her determination and skill helped open
the medical door for other physiotherapists
Cleather writes in her book:
"You had to prove to individual doctors that you could
produce results. If you did that, they were more likely to
trust the next person coming along. You were aware all
the time that you had to live up to expectations; that you
had to be better than good."

Perhaps the most oft-mentioned name in CPA
annals is Enid Graham, considered by many the
chief architect of the Association
It was Graham who ensured that physiotherapists
were accepted members of the medical corps
during the Second World War and who guided the
profession through the tough times of the Great
Depression, sometimes personally financing the
CPA's efforts to expand the level and quality of
training
She remained a driving force on behalf of
physiotherapists until well into the 1970s

A third name closely identified with the
development of physiotherapy in Canada is
Constance Beattie. A native of Brockville, Ontario,
Beattie became the first physiotherapist to travel
into the Arctic in 1949 to treat Inuit patients
suffering from polio and measles
In one of her last letters from the Arctic, she says
her patients' measles "have gone and their
residual paralysis is almost nil. Re-education of
walking is impossible in an isolation hospital for
the floor is contaminated."

The next news about Beattie, then only 24, was
that her plane had gone down, killing all on board.
She had been accompanying seven of her Inuit
patients to a Winnipeg hospital before flying home
for her wedding
The commitment demonstrated by these pioneers
of physiotherapy who came together to carve out
their unique niche in health care was repeated
again and again in Canada as the profession
organized throughout the provinces and territories

Margaret Hitchins remembers how it all began in
Newfoundland. Soon after her arrival from England in
the 1950s, Hitchins became one of five
physiotherapists who "adjourned to a vacant room"
during an informal meeting, sat down on the carpet
and founded the Newfoundland Chapter of the CPA.
"We were in our early- to mid-20s and only recently
qualified," says Hitchins. "Where we'd come from, we
hadn't expected to be part of an Association.
Suddenly, there you were in Newfoundland, and you
were part of the decision-making process...part of the
establishment, simply because there hadn't been one
before."

Definition:
A health care profession whose primary purpose is
promotion of optimal health and function
This purpose is accomplished through the
application of scientific principles to the following
processes:
Examination, evaluation, diagnosis, prognosis
and intervention to prevent or treat:
Impairments, functional limitations and disabilities
As related to movement and health
Other professional activities serving the purpose
of physical therapy:
Research, education, consultation and administration

Part I
2: Understanding Disability

About 3.6 million Canadians have one or
more disabilities
The process of disablement includes:
Impairment
Loss or abnormality of a body function or structure
At cellular, tissue, organ, or system level
It causes functional limitations
Functional limitations
Decreased ability of a person to perform a task
Disability
Occurs if the functional limitation restricts activity
In a particular context or environment

The Participation and Activity Limitation
Survey is a national post-censal survey of
persons with disabilities. A post-censal survey
uses the census to identify its target
population and construct a representative
sample. Funded by Human Resources
Development Canada, PALS was conducted
by Statistics Canada in the fall of 2001,
following the spring 2001 census

PALS gathered information on children
(aged 14 and under) and adults (aged
15 and over) in Canada who have a
disability--that is, an activity limitation
or a participation restriction associated
with a physical or mental condition or a
health problem. This definition of
disability is discussed in more detail
below

About 43,000 people (35,000 adults and
8,000 children) with disabilities were selected
to participate in PALS. The population
covered by the survey included people living
in private households and some collective
(non-institutional) households in the ten
provinces. People living in institutions and
people residing in Yukon, the Northwest
Territories, Nunavut and on First Nations
reserves were excluded from the survey

PALS used two separate questionnaires,
one for children with disabilities up to
the age of 14 and one for adults with
disabilities aged 15 and over. Most
adult questionnaires were completed
directly with the person with disabilities;
interviews for the children's
questionnaires were conducted with the
child's parents or guardians

PALS collected detailed information in a
number of areas:
the demographic and socio-economic situation of
persons with disabilities;
the prevalence, type and severity of various
disabilities;
the need for and access to disability supports(e.g.,
specialized equipment and aids, specialized
services, medications, assistance with completing
everyday activities)

out-of-pocket expenses related to disability;
health;
employment;
education;
income;
housing;
transportation; and
participation in community activities
Concepts of Disability
In the past, surveys have faced a major challenge-
that there are many ways of understanding and
defining disability, both within and outside Canada

Biomedical perspective:
sees disability as a disease, disorder, medical condition or
biological "abnormality" within the individual
Functional perspective:
Understands disability as a restriction in ability to perform
certain standard tasks in a way considered ‘normal.'
Social/environmental perspective:
presents disability as the result of barriers in the social
environment that prevent persons with disabilities from
participating fully in community, work and learning
Human rights perspective:
focuses on respect for human dignity and on protection against
discrimination and exclusionary practices in the private and
public spheres

In the early 1980s Statistics Canada chose to
adopt the World Health Organization's 1980
model of disability:
the International Classification of Impairment,
Disability and Handicap (ICIDH).
The ICIDH defined disability as:
a limitation in daily activities resulting from an
impairment associated with physical or mental
conditions or heath problems

The ICIDH was revised between 1991 and
2001 after coming under criticism for its
linear causal explanation of disability as a
direct consequence of a disease or a trauma
and for ignoring environmental factors. Newly
named the International Classification of
Functioning, Disability and Health (ICF), the
revised framework was officially launched in
2001. PALS 2001 uses the ICF framework.

It therefore views disability as the
interrelationship between body functions,
activities and social participation, while
recognizing that the environment provides
either barriers or facilitators. The change of
the post-censal survey's name from "Health
and Activity Limitation Survey" to
"Participation and Activity Limitation Survey"
underscores both the updated view of
disability and the major changes to the
survey

This new understanding of disability is
closest to the functional perspective
described above. Under PALS, persons
with disabilities are those who report
difficulty with daily living activities, or
who indicate that a physical or mental
condition or a health problem reduces
the kind or amount of activity they can
do

Respondents' answers to the PALS disability
questions reflect their own perceptions and
are therefore subjective. For example,
individuals who report having pain but do not
associate it with any activity limitation are not
considered to have a pain-related disability.
Children's activity limitations are identified by
their parent or guardian and are not
necessarily diagnosed by a health care
professional.

Identification of a developmental delay is
therefore based on the parent or guardian's
perception of the child's development. This
method of identifying disability differs from
that used by many government programs.
Programs often require an independent
professional assessment of disability or
impose other criteria to meet specific
program objectives

The disability filter questions used to select people
for inclusion in the PALS sample (see Table 1) are
now the standard for identifying persons with
disabilities in Statistics Canada surveys. A major
objective of the PALS revision was to harmonize the
definition of disability in Statistics Canada's social
surveys--including those on labour, health, education
and Aboriginal people--to create a comprehensive
database on persons with disabilities. This
harmonization will make it easier to compare
information on persons with disabilities from one
survey to another

Statistics Canada Disability Filter Questions
1) Does this person have any difficulty hearing,
seeing, communicating, walking, climbing stairs,
bending, learning or doing any similar activities?
Yes, sometimes
Yes, often
No
2) Does a physical condition or mental condition or
health problem reduce the amount or the kind of
activity this person can do:

At home?
Yes, sometimes
Yes, often
No
At work or at school?
Yes, sometimes
Yes, often
No
Not applicable
In other activities, for example,
transportation or leisure?
Yes, sometimes
Yes, often
No

Part I
3: Role of Physiotherapists in

3: Role of Physiotherapists in Canadian
Healthcare System
Physiotherapy Treatments:
Physiotherapists are university-educated experts
who can help you achieve your highest level of
physical functioning (at any stage of life) by
providing you with a personalized treatment plan
based on your specific needs.
Physiotherapy is a regulated profession, i.e. it is
necessary to pass federal examinations and to get
provincial license in order to practice
Just some examples of how a physiotherapist can
help you include:

Healthcare System
Preventing and treating sports injuries
Restoring and increasing range of motion in joints
Increasing coordination
Counselling and educating in pre-and post-natal care
Designing 'user-friendly' or ergonomically-correct homes
and workplaces
Educating clients in the use of devices such as canes,
crutches and wheelchairs
Helping injured individuals return to work successfully
through 'work hardening' programs
Alleviating pain

Healthcare System
Physiotherapists can offer:
Assessment of movement, strength, endurance and
other physical abilities;
Assessment of the impact of an injury or disability on
your physical functioning;
Assessment of physical preparation for work and sports;
Program planning and education to restore movement
and reduce pain; and,
Individualized treatment of an injury or disability based
on scientific knowledge, a thorough assessment of the
condition, environmental factors and lifestyle

Healthcare System
Primary Health Care
Primary health care (PHC) models of service
delivery are increasingly seen as effective
strategies to improve access of clients to needed
care while at the same time improving efficiency,
coordination, and continuity to ensure health
needs are met in the right place at the right time
by the most appropriate health care provider.
In recent years, the delivery of health care
services using a PHC model has received much
attention

Healthcare System
Building on work completed within the
physiotherapy profession including:
Manitoba paper entitled “Physiotherapy and primary
health care: Evolving opportunities”
College of Physical Therapists of Alberta
Alberta Physiotherapy Association
And the Canadian Physiotherapy Association
Identified the need to further explore and discuss
opportunities for physical therapists in PHC and
developed the discussion paper entitled, Primary
Health and Physical Therapists - Moving the
Profession's Agenda Forward

Healthcare System
The Canadian Physiotherapy Association was a key
stakeholder in the Enhancing Interdisciplinary Collaboration
in Primary Health Care (EICP) Initiative which focused on
encouraging increased collaboration among primary health
care providers
The EICP Initiative was funded by Health Canada 's Primary
Health Care Transition fund and was intended to provide
research and recommendations that would change the way
health care providers work together
The EICP Steering Committee developed the principles and
framework to encourage and enhance interdisciplinary
collaboration in primary health care in Canada as well as a
collaboration toolkit containing the ‘tools' needed to support
interdisciplinary practices

Healthcare System
CPA developed a position statement on Primary
Health Care to increase awareness and advocacy
efforts of the role that physiotherapists have as
primary health care providers
Physiotherapists provide valuable health care for
people across the life span from birth to older age.
Primarily, they work in 3 practice areas:
Orthopaedics
Neurology and
Cardiorespiratory

Healthcare System
The following are examples of the types of
conditions physiotherapists may treat:
Orthopaedics:
Back and neck pain
Sports injuries
Repetitive strain injuries (i.e.: carpal tunnel, tennis elbow)
Motor vehicle accidents
Post-surgical rehabilitation (i.e.: hip or knee replacement)
Neurology
Stroke
Spinal cord injury
Cerebral palsy
Head injuries
Parkinson's
Multiple Sclerosis

Healthcare System
Cardiorespiratory
Asthma
Chronic obstructive lung disease
Pneumonia
Post-surgical rehabilitation (i.e.: cardiac, thoracic or
abdominal)
Cardiac rehabilitation
Cystic Fibrosis
Physiotherapists also work in areas that span all three
practice areas such as women’s health (including pre and
post natal care, and other women’s health issues),
incontinence, paediatric and senior’s care. They also help
manage the physical complications of cancer and its
treatment, and care for physical symptoms associated with
arthritic conditions

Part I
4: The Role of Physiotherapists
Assistants in Canadian Healthcare
System

4: The Role of Physiotherapists Assistants
in Canadian Healthcare System
Support Personnel
At its May 30, 2004 Annual General Meeting, the
CPA membership approved a series of changes to
the Association’s Bylaws, including ones that
establish a National Support Worker Assembly
The new Assembly will provide a parallel
association structure with opportunities for
leadership roles, networking, communication and
professional development for individuals working
in support roles within the physiotherapy
profession

The new Assembly will provide a parallel
association structure with opportunities for:
Leadership roles
Networking
Communication
And professional development
For individuals working in support roles
within the physiotherapy profession.

The Assembly is accepting members with the
2004/2005 CPA Membership Year (Oct. 1, 2004).
As with the previous Affiliate category, both PTAs
(College educated) and Physiotherapist Aides
(trained on the job) will be able to join the
Assembly
New, however, is a category within the Assembly
for students in PTA programs. Also new for the
Assembly will be an expansion of the services that
Assembly members will be able to access at the
provincial level. Provincial membership will be
phased in as Branches are able to provide services

A Task Force consisting of three PTAs, one Aide,
one PTA Educator, and a representative from the
CPA Board has been struck to develop the
constitution and governance processes for the
Assembly:
Working within the frameworks and guidelines provided
by key CPA documents such as the National Bylaws, the
Position Statement on Physiotherapy Support Personnel,
and the Competency Profile for Physiotherapist Support
Workers in Canada (CPA, 2002) the Task Force
developed a constitution that received Assembly Member
approval in May, 2005, and has provided guidance to the
implementation of an electoral process

Prior to the formation of the NSWA, no national
structure existed for providing membership or
association services to support personnel
With the increase in educational programs, and
the recent establishment of competencies for
support personnel (Competency Profile for
Physiotherapist Support Workers in Canada,
2002), CPA is well positioned to provide this
structure
Support personnel have been recognized by the
CPA Board of Directors for a number of years as a
growing and increasingly integral part of the
physiotherapy profession

and one important objective of the recently-concluded
Membership Review Task Force was to investigate
membership options for support personnel. A
membership survey conducted in March/April 2003
indicated that 90% of CPA members supported parallel
(i.e., Assembly) membership for support personnel
You will notice in various CPA publications and
documents that “Support Workers” and “Support
Personnel” appear to be used interchangeably. In fact,
CPA is moving toward consistent use of the term
“Support Personnel” based on feedback from
physiotherapist assistants and rehabilitation assistants
working on CPA and National Physiotherapy Advisory
Group Task Forces

Unfortunately, the National Support Worker
Assembly name cannot be easily adjusted, as it is
named this way in the CPA Bylaws. This was done
for consistency with the Competency Profile:
Competencies for Physiotherapist Support
Workers in Canada – the “bible” on topics related
to physiotherapist support personnel
It is certainly common for terminology to change
over time, and this situation is a case in point. We
hope the above assists members in understanding
our rationale for usage of ‘worker’ versus
‘personnel’ in various contexts.

Growing Roles for Support Personnel in Canada
Many physiotherapists work with physiotherapy or
rehabilitation support personnel in their practices, to ensure
the best use of resources, skills and knowledge in delivering
client care. As with their growing role in the Association, the
development of education and expectations for support
personnel has been evolutionary. A significant milestone in
the acknowledgement of the support role was the 2002
publication of a document entitled Competency Profile:
Essential Competencies of Physiotherapist Support Workers
in Canada. This document, published jointly by the Canadian
Physiotherapy Association and the Canadian Alliance of
Physiotherapy Regulators after two years of research and
consultation, describes the competencies demonstrated by
two different groups of physiotherapist support personnel in
Canada

“Group One” physiotherapist support personnel, known as
Physiotherapist Assistants, have completed a College-level
educational program that is recognized by their
provincial/territorial Ministry of Education and has registered
physiotherapists on faculty. The curriculum for these
programs covers a variety of physiotherapy practice
environments and client populations, and includes at least
three terms of full-time equivalent study including
physiotherapy-specific coursework (e.g., use of ambulatory
aides), fieldwork, and generic program-related coursework
(e.g., anatomy). Essential competencies for Group One
Physiotherapist support personnel fall under five categories:
Accountability, Collection of Client Information, Intervention,
Communication, and Organization & Delivery of
Physiotherapy Services

“Group Two” physiotherapist support personnel, known as
Physiotherapist Aides, have completed physiotherapy-
specific on-the-job training that is variable in length and
content, and depends on the background of the support
worker and the needs of the client populations with whom
they are working. The training is directed by a registered
physiotherapist, and prepares the support worker for
provision of services within that specific work setting. The
support worker may have completed some formal
education, but this education does not meet all aspects of
the criteria for Group One personnel. The essential
competencies of Group Two support personnel are
described under four of the five categories identified for
Group One personnel: Accountability, Intervention,
Communication, and Organization & Delivery of
Physiotherapy Services

Part I
5: Code of Ethics and Rules of
Conduct

5: Code of Ethics and Rules of Conduct
Code of Ethics:
Physiotherapists are committed to act with
integrity
To honour the rights and dignity of all
individuals
To recognize their responsibility to society
and to pursue a quest for excellence in
professional activities

Rules of Conduct:
Responsibilities to clients:
Physiotherapists shall respect the client's rights,
dignity, needs, wishes and values.
Physiotherapists may not refuse care to any
client on grounds of race, religion, ethnic or
national origin, age, sex, sexual orientation,
social or health status
Physiotherapists must respect the client's or
surrogate's right to be informed about the
effects of treatment and inherent risks

Physiotherapists must give clients or surrogates the
opportunity to consent to or decline treatment or
alterations in the treatment regime.
Physiotherapists shall confine themselves to clinical
diagnosis and management in those aspects of
physiotherapy in which they have been educated and
which are recognized by the profession.
(Physiotherapists are responsible for recognizing and
practising within their levels of competence. The clinical
diagnosis is established by taking a history and
conducting a physical and functional examination. The
identification of the client's problems and the
physiotherapeutic management is based on this
diagnosis in conjunction with an understanding of
pertinent biopsychosocial factors. This rule does not
restrict the expansion of the scope of physiotherapy
practice.)

Physiotherapists shall assume full responsibility for all
care they provide.
Physiotherapists shall not treat clients when the medical
diagnosis or clinical condition indicates that the
commencement or continuation of physiotherapy is not
warranted or is contraindicated.
Physiotherapists shall request consultation with, or refer
clients to, colleagues or members of other health
professions when, in the opinion of the physiotherapist,
such action is in the best interest of the client.
Physiotherapists shall document the client's history and
relevant subjective information, the physiotherapist's
objective findings, clinical diagnosis, treatment plan and
procedures, explanation to the client, progress notes and
discharge summary.

Physiotherapists shall respect all client
information as confidential. Such information
shall not be communicated to any person
without the consent of the client or surrogate
except when required by law.
Physiotherapists, with the client's or surrogate's
consent, may delegate specific aspects of the
care of that client to a person deemed by the
physiotherapist to be competent to carry out
the care safely and effectively.
Physiotherapists are responsible for all duties
they delegate to personnel under their
supervision.

Responsibilities to society:
Physiotherapists shall recognize their responsibility to
improve standards of health care.
Physiotherapists shall comply with all laws and
regulations pertaining to the practice of physiotherapy.
Physiotherapists shall report, to the appropriate
authorities, any member of the profession who appears
to be incompetent or whose conduct while practising as
a physiotherapist appears to be unethical or illegal.
Where a direct fee is charged, physiotherapists shall
inform clients, in advance, of the fee which will be
commensurate with the service provided

Responsibilities to profession:
Members shall abide by the policies of the Association
and support its mission.
Physiotherapists shall conduct themselves in such a
manner as to merit the respect of society for the
profession and its members.
Physiotherapists shall engage in continuing education for
growth and development.
Physiotherapists shall advance the science of
physiotherapy by sharing relevant information and by
supporting, or engaging in, research activities
Physiotherapists shall be responsible for ensuring that
research protocols respect the rights of research subjects
and are in compliance with standards accepted by the
scientific community.

Physiotherapists shall be willing and diligent preceptors
in the education of physiotherapy students.
Physiotherapists shall ensure that their professional
judgment and integrity are not compromised by the
motives of profit.
Physiotherapists shall enter into contracts and
agreements only when professional integrity can be
maintained
Physiotherapists shall ensure that any advertising of their
services is accurate, verifiable and acceptable according
to the legal, social and professional norms of the times,
and does not bring the profession into disrepute

Standards of ethical conducts for PTA:
All PTAs are responsible for maintaining
high standards of conduct while assisting
physiotherapists
They have to act in the best interest of the
patient/client
These standards of conduct shall be
binding on all PTAs

Standard 1:
A PTA shall respect the rights and dignity of all
individuals and shall provide compassionate
care
Standard 2:
A PTA shall act in a trustworthy manner
towards patient/client
Standard 3:
A PTA shall provide selected physiotherapy
interventions only under the supervision and
direction of a physiotherapist

Standard 4:
A PTA shall comply with laws and regulations governing
physiotherapy
Standard 5:
A PTA shall achieve and maintain competence in the
provision of selected PT interventions
Standard 6:
A PTA shall make judgments that are commensurate
with their educational and legal qualifications
Standard 7:
A PTA shall protect the public and the profession from
unethical, incompetent, and illegal acts

1: Ethical Dilemmas
By definition, an ethical dilemma involves the
need to choose from among two or more
morally acceptable courses of action, when
one choice prevents selecting the other; or,
the need to choose between equally
unacceptable alternatives
Advances in medical and information
technologies, increasing economic stress, and
renewed emphasis on team-based approaches
to care are among the many factors increasing
the prevalence and complexity of ethical issues
in healthcare

1: Ethical Dilemmas
As you work with physiotherapists to care for
patients with complex needs, you will
confront varying expectations and values,
some of which will undoubtedly challenge
your personal sense of morality.
In this learning experience, you'll explore a
systematic approach for ethical decision-
making that will help you maintain an
objective perspective as you seek a morally
acceptable resolution to values-based
dilemmas

1: Ethical Dilemmas
As a healthcare practitioner, you will
have to resolve ethical dilemmas that
require you to integrate your own moral
reasoning with that of all parties
involved:
patients, their significant others, and
practitioners from within and outside of
your discipline

1: Ethical Dilemmas
You have to temper this reasoning with the
practical realities of the situation. You will need
to look beyond your own values and work to
facilitate an environment that promotes the
critical exchange of ideas and collaboration
among all involved.
Skills and strategies involved in values
clarification, communication, negotiation,
mediation, and teamwork will serve you well
as you work toward successful resolution of
complex moral issues

1: Ethical Dilemmas
The ethical decision-making model you've
learned here provides a framework for
examining and studying ethical issues
individually or as a group. Following this
process will help you organize the facts and
contextual paramaters of the dilemma, so
that you can look at the situation objectively
and choose a course of action based on logic,
rather than emotions

Part II
2: Medico-legal Considerations

Regulated Health Professions:
A regulation is a rule controlling the practices of
individuals or organizations under the authority of
the agency (college)
The manner in which physiotherapy providers are
regulated varies from province to province
All provinces license physiotherapists
A license, however, cannot automatically be
transferred from one province to another
If a provider moves to another province s/he should
apply for a new license according to that province’s
requirements and procedures

Licensure creates:
A scope of practice
Authorizes the individual to practice in a given province
And legally protects the professional title
“Physiotherapist”
Only licensed individuals may refer to themselves as such
All provinces require:
Graduation from an accredited program
And a passing score on the licensing examination
To be licensed

Professional misconduct:
Is often regulated by a state disciplinary
agency
It involves actions by a licensed professional
that demonstrate an inability to competently
perform the duties of a licensed professional
Examples:
Physical/sexual abuse of a patient
Patient abandonment
Improper delegation or supervision of PTAs
Practicing while intoxicated

Complaints of unprofessional conduct are typically
prosecuted provincial administrative bodies
The provincial college is usually consulted
regarding that
A finding that a PT or PTA has committed
professional misconduct may result in that
individual’s being reprimanded, fined, required to
obtain remedial professional education, or placed
on probation or having the license suspended or
revoked

Law:
Is a “body” of rules of action or conduct
Prescribed by the controlling authority
And having binding legal force
Two major areas in law:
Criminal law
Civil law

Criminal law:
Involves prosecution in a court of law for acts
“done in violation of those duties which an
individual owes to the community”
Criminal prosecution will not directly affect a
provider’s license
But may result in referral to a provincial
professional disciplinary agency to initiate such
an action
Examples of criminal law:
Insurance fraud
Sexual abuse of patients
Unlawful practice of a profession

Civil law:
Is concerned with private wrongs and remedies
Civil actions are also prosecuted in courts of
law
But in these cases one private citizen brings a
lawsuit against another to seek compensation
for injuries received
Unlike criminal cases, persons found liable in
civil cases cannot be punished by the state with
fines or incarceration
The only remedy available for civil liability is for
the defendant to pay money damage to the
plaintiff

The most common grounds for civil actions
involving physiotherapy providers:
Negligence
Is defined as the failure to act as a reasonably
prudent person
Example: failure to mop up water that had been
tracked onto the clinic floor, with someone
subsequently slipping and getting injured
Malpractice
Aka professional negligence, is failure to do (or avoid
doing) something with subsequent injury to the
patient
Example: a therapist who excessively mobilizes a
joint and thereby causes injury

Introduction:
Patients rely on verbal communication:
To try to explain what is wrong
Or seek comfort or encouragement from health
professionals
Health professionals rely on verbal, nonverbal,
written, and electronic communication:
To share information
Plan care
And collaborate with others on the health care team

The greater responsibility for respectful
communication between you and the patient lies
with you
Although both must assume responsibility
You will be required to communicate verbally with
a patient to:
Establish rapport
Obtain information concerning his/her condition and
progress
Relay pertinent information to other health professionals
Give instruction to the patient and his/her family

Various ways of communication:
Face-to-Face or Distant:
There are fewer places to hide our fears and
discomforts
There is some evidence that patients are more
satisfied with face-to-face interactions than
with other forms of communication
Face-to-face interaction promotes the greater
trust

One-to-One or group:
Before you begin any type of interaction with a
patient, you should make sure the patient
knows who you are and what you do
If you are meeting a person for the first time,
be sure to introduce yourself first, and use the
patient’s full name
After you introduce yourself, tell the patient
what you do in a few sentences

Institution or Home:
Whatever the environment in which you
encounter patients, there is a strong tendency
to medicalize the setting
Communication is shaped by the environment
The sights, sounds, smells, and urgency of
these high-tech environments have a profound
impact on patients
Particularly because this environment is often
foreign and threatening

Choosing the right words:
The success of the verbal communication
depends on several important factors:
The way material is presented, i.e., the
vocabulary used, the clarity of voice, and
organization
The tone and volume of the voice
Highly technical professional jargon is
almost never appropriate in direct
conversation with the patient

It is imperative that you learn to translate
technical jargon into terms understandable
to patients when discussing their condition
or conversing with their families
Yes/no or forced choice type of questions
rather than an open-ended question results
in more successful communication
The way to respectful communication is to
try as much as possible to talk to patient
as equal

Problems from miscommunication:
Because the health professional is unable to
communicate with the patient in terms
understandable to him/her
Therefore, desired results are lost, there are
confused meanings, and there is disbelief in the
health professional’s interest
Lack of clarity occurs when you launch into a
lengthy description of the diagnosis and proposed
tests, not even realizing that the patient was lost
at the outset

Communicating beyond words:
Non-verbal communication:
Facial expressions:
eye contact, smiling, friendliness
Gestures and body language:
Folding arms, clenching fists, thumb roller, shoulder
shrugger
Physical appearance:
Uniform or no uniform

Touch:
Upon entering a health facility a person who
dislikes physical contact and have to allow himself
or herself to be plapated, punctured with needles,
rubbed and lifted
Patients are generally deeply grateful for being
handled with care by another
Proxemics:
Is the study of how space is used in human
interactions
Relationships would be improved if the health
professional would move down to the patient’s
level

Concepts of time:
Punctuality communicates respect while
tardiness is an insult
There are a variety of ways in which time
may have to be organized within different
cultural context to convey respect toward
the patient and others
Examples: 3:30 p.m., 15:30

Written tools:
There are distinct advantages to its use
over verbal communication (e.g. visual
cues)
The reader has control over the pace of
absorbing the information and can reread
the information any number of times
Other methods of communication:
Voice and electronic mail

Effective listening:
The following are some simple steps to more
effective listening:
Be selective in what you listen to
Concentrate on central themes rather than isolated
statements
Judge content rather than style or delivery
Listen with an open mind rather than focus on
emotionally charged words
Summarize in your own mind what you hear before
speaking again
Clarify before proceeding. Do not let vague or
incomplete ideas go unattended

Part II

Professional capacities:
Being in a position to help
Being able to engage in certain activities
that distinguish your everyday relationships
from professional ones
Having the opportunity to use some
mechanisms for increasing your
effectiveness through shared responsibility
with team members

Personal help:
Personal help is what you are willing to
offer to a person by:
Giving directions
Assisting physically
Donating money to a good cause
Personal help demands an investment in
the well-being of others
Professional helping falls within this
category

Social helping:
Social helping concentrated on the tools
and activities used rather than on the
degree of involvement with the other
person
Any help in which your resources for
providing help are:
Not specific, well-defined professional skills
Can be considered as social helping

Therapeutic helping:
A therapeutic helping relationship develops when
a health professional performs:
Professionally competent acts
Designed to benefit the person who needs his/her
services
It doesn’t necessarily need prolonged contact
Therapeutic helping is of a personal, but not
intimate type
In which your primary resources are:
Specific, well defined professional skills

A therapeutic helping relationship takes place
between:
A person who has a special problem
And another person skilled in techniques that can
alleviate or diminish that problem
Specific limits are imposed by the relation
between the individual’s problem and the health
professional’s skills
For example, a physiotherapist cannot enter into a
therapeutic helping relationship with a patient who
has speech problems

Some patients who initially seek your services
seem to resist any kind of help
Even though you judge that these services offered
should benefit them
For them receiving help may be seen as sign of
weakness
Even though their suffering has driven them to
your door
Sometimes people who are lonely do not comply
with your efforts to help
Because if they do they will lose the benefit of
your company

Being an expert helper:
Doing a job well is closely tied to feelings
of self-respect
Therefore, making sure you are in a
situation where your best self can be
expressed is extremely important
Being an expert helper in the health
professions usually necessitates working
closely with people

Positive consequences for PTAs:
A positive consequence is that professional
assistant programs were introduced to help
provide lower-cost optimal care
To create employment opportunities for
those who did not want to or could not
pursue a longer and more demanding
professional preparation
And to alleviate serious personnel shortage
in many health fields

Teams and Teamwork:
Teams were developed to try to effect
several important goals in patient care
First, because of specialization it becomes
obvious that professionals must band
together to provide coordinated and
comprehensive care
One goal of teamwork is to provide
protection against the complete
fragmentation of services that could result
from more specialization

The second goal grew from the belief that
team-coordinated care is more likely to
ensure that the patient’s many needs are
met
The team itself can become a means of
support, growth, and increased
effectiveness for the health professional
who wants to maximize his/her personal
strength while performing necessary
professional tasks

In conclusion:
As a health professional you will assume
many roles in the course of your career
Essential components include:
Self-respect
Understanding
Maintaining your competence
Meeting the challenges
And remaining compassionate

Part II
5: Understanding the Patient

Respect in a diverse society:
Bias, Prejudice, and Discrimination:
Respect involves sensitivity to individual and
group differences
Each person interprets actions, facial
expressions, choice of words, and other forms
of communication according to his or her
cultural conditioning and past experience
Differences encountered include personal and
cultural biases, prejudices, and discrimination

Cultural bias:
A tendency to interpret a word or action according to
some culturally derived meaning assigned to it
Regarding health care, attitudes toward pain, methods of
conveyance of bad news, management of chronic illness
and disability, beliefs about the seriousness of illness,
and death-related issues vary among different cultures
These differences have an impact on health care seeking
behaviour and acceptance of the advice and intervention
of health professionals
Understanding a patient’s concept of health is critical to
the development of interaction strategies that are
acceptable to the patient

Personal bias:
A tendency to interpret a word or action in terms of
some personal significance assigned to it
It is found largely in what is commonly called prejudice
Whenever bias is present, it affects the type of
communication possible between the persons involved
and therefore just be recognized as one determining
factor in respectful interaction
Personal bias may produce a positive personal bias or
“halo effect”on certain individuals
Halo effect: two people may have common interests or
characteristics, and their friendship is immediately
apparent

Culture:
Primary characteristics:
Race, gender, age, ethnicity
Secondary characteristics:
Place of residence, sexual orientation, socioeconomic
status
Every exchange between a patient and health
professional undoubtedly will be influenced by cultural
differences and other sources of personal bias
It should be emphasized that treating people differently
because of race, religion, ethnicity, or gender does not
necessarily imply prejudice and discrimination

Respect for differences includes understanding when
those differences should count, how they inform the
responses of people, and the process of caring for them
Developing effective interaction skills with others must
begin with self-examination and consideration of what
cultural differences mean to you
Summary:
The issues relevant to showing respect in the midst of
diversity must continually be examined and reflected
upon
The only constructive approach to evaluating human
differences with the goal of showing respect is to take
each experience as an opportunity to learn more about
the rich diversity of the human condition and to take
what one learns as a gift that will enrich one’s own file

Challenges to patients:
Maintaining wellness:
Today more and more health professionals
practice using preventive approaches: teaching
people how to remain healthy
A healthy lifestyle depends on:
Good eating, sleeping, exercise
Having high levels of emotional health, and security
Having fun with friends and relatives
Engaging in activities one enjoys
Learning new skills

Loss of former self-image:
This sense of self-alienation is temporary; however, it
may become more lasting for a person experiencing
continuing changes associated with injury and illness
Self-image depends to a large extent on body image
Painful sanctions are imposed on those whose
appearance deviates too far from standards of normality
determined by the society
Approval and acceptance are given for normal
appearance only
There is a close relationship between appearance,
accompanying body image, and sense of self-worth

Losses associated with institutional life:
Home:
Physical comforts
Psychological comforts
Privacy:
Intense discomfort when robbed of privacy
Loss of independence:
Visiting hours
switchboard

Ambulatory settings:
Patients are in difficult position of sitting on the
fence between two worlds
They may appear completely well and therfore
not be stigmatized by the label of “sick” or
“disabled”
However they are definitely patients for the
following reasons:
Impairment of physical or mental function
Enough to produce discomfort in the person
Or to result in his/her inability to proceed with some
activities formerly taken for granted

Symptoms are severe enough to have been openly
acknowledged by the person and confirmed by a physician
or other health professional
The person has agreed to participate in a treatment or
diagnostic regiment that requires regular trips to health
facility
The visit takes high enough priority in the patient’s life so
that other competing activities are sacrificed
Home care patients:
Special challenges:
On the one hand there is a sense of relief that there will be
assistance with foreign equipment and procedures and
help with the burden of continuous care
On the other hand, there is a feeling of intrusion into
personal space and behaviours that accompanies
professional care in the home

Advantages of remaining in the patient
role:
Escape: protection
Financial gain: malingering patients
Social gain: attention
Summary:
There are many peculiarities of the patient’s
challenges
They involve some degree of disruption from
long-established patterns
Their challenge then becomes your challenge
too

Part II
6: Coping with dying Patients

Definitions:
Terminally ill patient:
A term that is commonly used to describe people who
are dying from a pathologic cause
Hospice:
Provides care to terminally ill patients
Palliative care:
Is that which is done when no cure is possible
Fears of dying:
Fear of isolation, fear of pain, fear of dependence

Dying and death in modern society:
Individuals respond different to it
One common thread shared by all is that
they are going through a “process”
In addition, all persons share some
awareness that the end of the dying
process is the death event
Western societies are death-denying

Fear of death itself:
There are many possible reasons why a
person might dread being “dead and
gone”:
Separation from loved ones
Unfinished business
Concern for the welfare of those left behind
The fear of being totally alone in some other
world or other uncertainties about what comes
after death
The dread of extinction

History:
In 1946 Tommy Douglass, the colorful premier of
the huge but sparsely inhabited Saskatchewan,
revolutionized Canada’s health care system.
Using the authority that Canada’s courts had given
provinces over health care, Douglass crafted North
America’s first universal health insurance scheme.
He did so at a time when Saskatchewan was
heavily in debt and suffered from a severe
shortage of doctors and nurses. Douglass had no
model to follow and little data on actual costs.

Before Douglass shook the foundations of
Canadian health care it looked much like
the current American system.
The federal government had tried to
institute a national health care plan
immediately after World War II, but
abandoned the effort when the provinces
failed to reach consensus.

By 1949 both British Columbia and Alberta had
followed Saskatchewan’s lead. In 1957 the federal
government adopted the Hospital Insurance and
Diagnostic Services Act.
The six pages bill stipulated that once a majority of
the provinces, representing a majority of the
population, adopted a universal hospital insurance
plan, the federal government would pay
approximately half of the costs of normal
maintenance and operating expenditures for
hospital care.
Four years later all provinces had universal
hospital insurance plans in place.

Provincial innovation had become federal policy.
The ink was barely dry on provincial hospital
insurance before Douglass was at work on a plan
to cover all essential medical coverage, regardless
of where it was provided.
Despite a massive propaganda campaign (in
which Douglas was likened to Marx) and a three-
week strike by Saskatchewan doctors, a universal
health care plan went into effect on July 1, 1962.

Once again, the federal government followed
Saskatchewan’s lead.
The Medical Care Act of 1966, or medicare (with a
small "m") as it is referred to in Canada, is only
eight pages in length (by contrast, American
Medicare is governed by 35,000 pages of statutes,
regulations and program manuals).
By 1971, all Canadians were guaranteed access
to essential medical services, regardless of
employment, income or health.

Canada’s universal medical care system was
designed from the bottom up, by provinces and for
provinces.
There is no "Canadian" health care system, but
rather ten distinct provincial systems, tailored to
the needs of their citizens and to their unique
political philosophies.
To qualify for federal support (originally about half
of total provincial costs), the provinces are
required to meet five principles:

Public Administration: All administration of
provincial health insurance must be carried out
by a public authority on a non-profit basis.
They also must be accountable to the province
or territory, and their records and accounts are
subject to audits.
Comprehensiveness: All necessary health
services, including hospitals, physicians and
surgical dentists, must be insured.
Universality: All insured residents are entitled
to the same level of health care.

Portability: A resident that moves to a
different province or territory is still entitled to
coverage from their home province during a
minimum waiting period. This also applies to
residents which leave the country.
Accessibility: All insured persons have
reasonable access to health care facilities. In
addition, all physicians, hospitals, etc, must be
provided reasonable compensation for the
services they provide.

These elements ensure that all essential services
are covered; that everyone is covered and can
receive care in any province; and that health care
is administered by a nonprofit public agency
As a result, Canada’s version of national public
health insurance is characterized by local control,
doctor autonomy and consumer choice.
The key to the Canadian system is that there is
only one insurer -- the government.
Doctors generally work on a fee-for-service basis,
as they do in the U.S., but instead of sending the
bill to one of hundreds of insurance companies,
they send it to their provincial government.

In both countries there is a continual tug
over the dollar between health care
providers and insurers.
The difference is that in Canada the
insurance company is owned not by
shareholders, but by the taxpayers -- who,
as one analyst explains, must constantly
balance "their desire for more and better
service against their collective ability to pay
for it."

Costs and Outcomes:
In 1971, the year that all ten provinces adopted universal
hospital and medical insurance programs, Canadian health
care costs consumed 7.4 percent of national income in
Canada, compared to 7.6 percent in the United States.
In the thirty years since, however, Americans’ health care
expenditures as a percentage of Gross Domestic Product
(GDP) have nearly doubled
While Canadians’ have remained relatively stable, increasing
only to about 9 percent.
And despite its high cost, the U.S. system fails to insure
more than 44 million of its citizens.
Some analysts predict that figure will grow to 60 million by
2008.

Canada’s system is not only efficient; it is
immensely popular.
A 1993 Gallup Poll found that 96 percent of
Canadians prefer their health care system to that
of the United States.
As Saskatchewan doctor E.W. Barootes, originally
an opponent of universal health care, puts it,
"today a politician in Saskatchewan or in Canada
is more likely to get away with canceling
Christmas than ... with canceling Canada’s health
insurance program."

In a 1998 poll conducted in the five major
English-speaking countries (Australia,
Canada, New Zealand, U.K., U.S.), 24
percent of Canadians thought they
received excellent care in the past twelve
months
The highest figure out of the five countries.
Nineteen percent of Americans felt that
they had received excellent care, which
tied for third with Australia

Life expectancy and similar statistics are good
measurements of the quality of medical care.
Such figures are influenced not only by the quality
of health services but by social, environmental and
demographic factors.
Nevertheless, Canada consistently outperforms
the United States on such measures.
Canadians have the second longest life
expectancy of all countries (79 years).
The United States ranks 25th at under 77 years.

This may seem like an insignificant difference, but
it has been estimated that to raise the life
expectancy by only five years would require the
elimination of all deaths from cardiovascular
disease and almost all deaths from cancer, the two
leading causes of death in the U.S. and Canada.
More importantly, Canadians have a better chance
of living free of disability.
Canadians average 70 years of disability-free life,
compared to 68 in the United States.

Infant mortality rates are also frequently used to grade
the health of a particular population.
Here the U.S. fares even worse.
In countries belonging to the Organization for
Economic Cooperation and Development (OECD), the
median infant mortality rate was 5.8 deaths per
thousand live births in 1996.
The U.S. rate was 7.8, better only than Hungary,
Korea, Mexico, Poland and Turkey. Canada’s was 5.6.
Maternal mortality rates in the United States were
double those in Canada in 1988, with seven out of
every 100,000 dying in Canada compared to 14 in the
U.S.

The Changing Face:
Canada’s health care system has changed
significantly over the past 30 years.
In the late 1970s, worried about its open-ended
agreement to pay half of each province’s medical
bills, the federal government began to transfer a
lump sum per capita payment to each province,
based on past practices.
Since it was no longer picking up precisely half the
tab, the federal government no longer required the
provinces to mail in their bills.
This reduced the administrative costs to the federal
government.

Doctors continued to send their bills to their
provincial government.
Their fee schedules for various services
were, and still are, negotiated by the
provincial medical associations and the
provincial governments.
The province establishes the overall level
of payments to hospitals and physicians.
The setting of specific fees is left to the
provincial medical associations.

In the early 1980s, many provinces placed limits
on the fees doctors could collect for their services
-- essentially capping their incomes.
These caps, however, were seldom effective.
Many doctors simply imposed additional fees on
patients for services -- a practice called "extra
billing."
This controversial practice led to the passage of
the Canada Health Act in 1984, which established
penalties for provinces that permitted extra billing
and combined the hospital and medical insurance
bills into one comprehensive piece of legislation.

Within two years all the provinces had passed
legislation banning extra billing, despite vehement
physician opposition, including a strike by Ontario
doctors.
Doctors must choose to work within the confines
of the publicly funded system or to accept only
those patients who can afford to pay out-of-pocket.
Most have chosen the former.
The ban on extra billing has not left physicians
impoverished. In 1997 Canadian doctors averaged
about $120,000 in annual income, while American
doctors averaged about $165,000.

In 1996 the federal government began to lump
health care payments to provinces together with
payments for post-secondary education and social
assistance.
The intent was to give provinces the flexibility to
set their own priorities among these broad
purposes.
But it also slashed the federal contribution to
these social programs from $18.5 billion Canadian
to $12.5 billion in 1998.
The provincial health plans absorbed half of this
cut.

Thus today federal payments make up only slightly
more than 20 percent of provincial medical care costs,
on average.
In some provinces this figure is even lower.
British Columbia, for example pays for 88 percent of its
health-care costs.
Many Canadians worry that a continued reduction in
payments will reduce the incentive for the provinces
As federal contributions to health care decline,
provinces are finding themselves trapped between:
The public’s unlimited expectations of a free system
and a federal government intent on reducing the debt

Provincial Health Insurance
Health insurance in Canada is handled by
individual provinces and territories.
New residents to a particular province must apply
for health coverage.
Upon being granted health coverage, a health
card is issued which provides coverage in that
particular province or territory.
For new residents, there are typically waiting
periods before health coverage will be granted.
This can vary, but cannot exceed three months as
part of the Canada Health Act.

Excluding inmates, the Canadian Armed
Forces and certain members of the RCMP,
the Canada Health Act requires all
residents of a province or territory to be
accepted for health coverage.
Once a health card is assigned, it is used
whenever visiting a physician or health
care provider. The health card contains an
identification number, which is used to
access a person's medical information.

After obtaining health coverage, one can register
with a primary care physician.
For routine visits to a physician, one needs only
present their health card.
There are typically no forms to be filled out or
individual service fees.
The availability of physicians depends largely on
the number of doctors and the current demand for
medical services.
Currently there is about 1 primary care doctor for
every 1000 Canadians

Certain provinces (British Columbia, Alberta, and
Ontario) require health care premiums for
services.
Under the Canada Health Act, however, health
services cannot be denied due to financial inability
to pay premiums.
In addition to standard health coverage as
described in the Canada Health Act, provinces
typically provide additional services.
These can include chiropractic, physiotherapy,
and prescription medicines.

Private Health Insurance
While the health care system in Canada covers
basic services, including primary care physicians
and hospitals, there are many services that are not
covered.
These include things like chiropractic,
physiotherapy, dental services, optometrists, and
prescription medications.
Extended healthcare plans are usually offered as
part of employee benefit packages in many
companies.
Alternatively, Canadians can purchase insurance
packages from private insurance providers.

The main reason many choose to purchase private
insurance is to supplement primary health
coverage.
For those requiring services that may not be
covered under provincial health insurance such as
corrective lenses, medications, or home care, a
private insurance plan offsets such medical
expenses.
While private insurance can benefit those with
certain needs, many Canadians choose to rely
exclusively on the public health system.

Public Health Care Providers
Under the Canada Health Act, primary care
doctors, specialists, hospitals and in-patient dental
surgery are all covered by provincial insurance
policies.
Primary care physicians are the forefront of
Canadian health care.
There are currently about 30000 primary care
doctors in Canada, and they account for just over
half of all physicians.
They provide basic medical treatments and
preventative care.

Specialists are provided for services outside the
scope of primary care physicians.
Typically, an individual's physician will refer them
to specialists as needed.
There are currently about 28000 specialist doctors
working in Canada.
Hospitals operate both with referrals from
physicians as well as on an emergency basis.
Ambulatory services are provided for those unable
to transport themselves to a hospital in the event
of an emergency.

Private Clinics
In addition to public health care providers such as
primary care doctors and hospitals, many private
clinics offering specialized services also operate in
Canada.
Under federal law, private clinics are not legally
allowed to provide services covered by the Canada
Health Act.
Regardless of this legal issue, many do offer such
services.

The advantage of private clinics is that they
typically offer services with reduced wait times
compared to the public health care system.
For example, obtaining an MRI scan in a hospital
could require a waiting period of months,
whereas it could be obtained much faster in a
private clinic.
Private clinics are a subject of controversy, as
some feel that their existence unbalances the
health care system and favors treatments to
those with higher incomes.
Costs in private clinics are usually covered by
private insurance policies, which will typically pay
around 80% of the costs.

Health Care Funding
Health care in Canada is funded at both the
provincial and federal levels.
The financing of health care is provided via
taxation both from personal and corporate income
taxes.
Additional funds from other financial sources like
sales tax and lottery proceeds are also used by
some provinces.
Alberta, British Columbia, and Ontario also charge
health premiums to supplement health funding,
but such premiums are not required for health
coverage as per the Canada Health Act

At a federal level, funds are allocated to provinces
and territories via the Canadian Health and Social
Transfer (CHST).
Transfer payments are made as a combination of
tax transfers and cash contributions.
The amount of funding provinces and territories
receive is significant, and topped $35 billion in
2002-2003.
In 2000, the new budget injected an additional
$23 billion of investment into the health care
system.

Health Care and the Economy
Canada's health care has a large impact on
the Canadian economy.
Here are a few facts and figures about the
economy and health care:
Health care expenditures in Canada topped
$100 billion in 2001.
Approximately 9.5% of Canada's gross domestic
product is spent on health care. In comparison,
the United States spends close to 14% of its
GDP on health care.

Individually, Canadians spend about $3300
per capita on health care.
At a provincial level, funding is between
one-third and one-half of what provinces
spend on social programs.
About three-quarters of all funding comes
from public sources, with the remainder
from private sources such as businesses
and private insurance.

Health Care and Politics
One of the forefronts of debate in Canadian
politics is its health care system.
There are many factors in the debate, but some
key issues are:
Federal involvement in health care: Because
provinces and territories are responsible for the actual
administration and delivery of health care in Canada,
friction is apparent whenever policies are set at a federal
level.

Private health care: While privately funded clinics do
provide certain services with shorter wait times than the
public system, there are those who object to any
privatization of the health system.
The arguments are that a "two-tier" health care system
will unbalance the system and favor those with higher
incomes.
The shortage of doctors and nurses in Canada:
Some feel that Canada's health care system does not
adequately compensate health care providers.
This has led to a "brain drain" of Canadian doctors and
nurses, which have left Canada to pursue careers in the
United States.
Attracting and keeping skilled medical workers is a
priority if Canada is to be able to provide proper medical
services.

Introduction to rehabilitation & canadian healthcare system

Recommended

Recommended

More Related Content

What's hot

What's hot (18)

Similar to Introduction to rehabilitation & canadian healthcare system

Similar to Introduction to rehabilitation & canadian healthcare system (20)

Recently uploaded

Recently uploaded (20)