Access to Health Services in Canada Literature Review

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Determinants of Health Related to Chronic Disease Management of Elderly in Canada

It is agreeable that the health of Canada's population is well, particularly in contrast to various developed economies. However, the prevention and management of chronic diseases among the elderly present the greatest challenge to Canada's health care system. Today, the seniors have a tendency to living longer as they are healthier and economically better off compared to the previous generations. However, as they age, studies reveal that the elderly suffer increasingly from chronic diseases that exert extra burdens on the country's healthcare system. Canada's elderly populations are highly prone to poverty and have the greatest demands for community, home and acute care services (Belanger, Gosselin Valois & Abdous, 2014). Lack of government support and the shortage of home care nurses imply that most of the seniors are confronting health challenges of aging. As a result, the only health care alternatives are the ambulances from emergency units to hospital admission (Belanger, Gosselin Valois & Abdous, 2014).

Little is known about the distinct impact of social determinants of health to chronic disease management for the elderly in Canada. However, it is evident that the spiritual, emotional and physical dimensions of chronic disease management among this population are distinctly influenced by a variety of social determinants. This literature review will focus on three major social determinants. They include access to health services, physical environment and income and social status, which influence the management of chronic diseases of the elderly along a continuum from excellent to poor health. In fact, "Illness related variables were associated with poor health, with smaller but significant contributions from demographic and lifestyle factor" (Cott, Gignac, & Badley, 1999, p.731). For the sake of this literature review, the three determinants of health will be explored.

Access to health services, physical environment and income and social status influence the health vulnerability and chronic disease management of the elderly. This population is not only a burden on the national health care system but is normally restricted to from access to resources, which could ameliorate their problems. Not only do the three determinants influence the diverse health outcomes of the seniors but they also trigger health complications that often result in circumstances that in turn, reflect subsequent health determinants (Mery, Wodchis, & Laporte, 2015). For example, living in low-income households is associated with high levels of illness and disability. In turn, this reflects diminished opportunities to participate in gainful employment hence aggravating poverty and chronic diseases among the elderly.

Researchers in this area have attained tentative agreement regarding the three determinants of health related to chronic disease management of elderly in Canada (Belanger, Gosselin Valois & Abdous, 2014). Moreover, the contexts and mechanisms via which these determinants influence the health of this group have been articulated clearly. For decades, researchers have been mapping the complex interconnections that prevail. These researchers have demonstrated these linkages in an empirical format (Belanger, Gosselin Valois & Abdous, 2014).

Access to health Services

Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, and Beckles (2016) measured Health Inequities and Social Determinants of Health to Support the Advancement of Health Equity. They report Canadians must have the social, physical and political access to these services to experience the benefits of the advanced healthcare system. However, often, this is not the case for Canadian seniors suffering from chronic diseases. The nation's system of healthcare delivery for seniors with chronic diseases mirrors a program with fragmented delivery, limited accountability and jurisdictional ambiguity. Salzman, Collins, & Hajjar (2012) added that the present health care services for chronic diseases for the elderly are focused on communicable illnesses. However, morbidity and mortality among the elderly are increasingly due to chronic illness. Similarly, social access to health care is limited for the elderly because the healthcare system accounts for neither age nor the social position of the seniors' health (Salzman, Collins, & Hajjar, 2012).

Compared to other populations, the elderly living in rural areas have challenges accessing healthcare services for their chronic illnesses because of long wait list (Salzman, Collins & Hajjar, 2012). Moreover, they are restricted to required services unapproved or covered by the government --Non-Insured Health Benefit (NHIB) Plan, and nurses or doctors not being available in their area. Researchers have also cited frequent cases of inadequate or culturally inappropriate health provision. Because many Canadian seniors live in isolated and rural communities, it presents an obstacle in accessing the much-needed health care services (Cott, Gignac, M & Badley, 1999).

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For the roughly 50% of Canada's seniors living in the remote and rural areas, lack of transport, low population density, long waits and inadequate human resources pose as significant obstacles to healthcare access. Low population density and large distance imply greater delivery costs per capita. In turn, this translates into reduced health professionals and access to health services for seniors living with chronic illness (Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, & Beckles, 2016).

In particular, this geographic remoteness acts as an obstacle in Northern Canada, a region characterized by remote and rural communities. Belanger, Gosselin Valois and Abdous (2014) focused on individual and contextual determinants of social home care usage. For instance, his findings indicate that of the Inuit Nunaat communities that hold the majority of Canada's Inuit population; only a few have hospitals, and none have year-round road access. In such communities, healthcare provision tends to be via health facilities, staffed by a nurse rather than a physician. Seniors with chronic diseases are less likely to access specialized health care experts like a family physician, dentists and other medical experts, greatly because these experts are often non-residents and are only flown into communities for short periods to attend to patients. The isolation and remoteness of such communities similarly lead to low retention of health professionals (Cott, Gignac, & Badley, 1999).

Most Canadian seniors battling with chronic illness live in rural communities, characterized by a crucial shortage of medical personnel. Canada's nursing industry is in crisis and from a proportional perspective, the number of doctors serving this population is said to be "under half of that serving the cities" (Mery, Wodchis, & Laporte, 2015). Low retention rates combined with the lack of permanent health professionals leads to less continuity of care. Consequently, this lowers the effectiveness of health services for chronic disease management among Canada's elderly. For instance, patients undergo lengthy paper work procedures that could take even days or months before they can obtain a drug exemption for a drug that is not presently listed on the NHIB program's drug benefit list. For the elderly, this procedure is so complex because patients ought to depend on visiting health experts who tend to be available for appointments one per month (Mery, Wodchis, & Laporte, 2015).

According to Penman-Aguilar, Talih, Huang, Moonesinghe, Bouye, and Beckles. (2016), lack of access to healthcare services for the management of chronic diseases among the elderly has had numerous implications. First, these patients have been forced to leave their communities to access specialized care. Typically, they are transferred to cities for medical appointments with medical specialists, emergencies, hospitalizations, diagnosis and treatment. This implies that they tend to leave behind their support networks and communities. For instance, 10% of seniors with chronic disease in Inuit Nunaat report that they had to be temporarily away from their communities for months due to sickness. A lack of an interpreter could add additional stress to patients who cannot speak because they cannot understand the nature of the disease or the treatment prescriptions. The concluded that "Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes" (p.S33).

Not only must the Canadian elderly have physical access to healthcare services for their chronic diseases to experience positive health outcomes, but also the quality, nature and appropriateness of such services need to be considered. Salzman Collins & Hajjar (2012) point out that, modes of in urban locales are not effective in remote and rural locales. The quality and nature of services are affected by the timeliness of the service. The most notable impact of systemic obstacles to healthcare access such as lack of health specialists and long waits is that early diagnosis of chronic illness is inhibited (Bradley-Springer, 2012). Naturally, given that the elderly cannot feel that they can access care regularly to manage their chronic illness or trust their medical specialists, they will be less expected to pursue help when they experience signs. Belanger, Gosselin Valois and Abdous (2014) agreed that chronic diseases in the elderly cannot be detected early, and treatable diseases are discovered when complete recovery is impossible. Researchers have also discovered that Canada's elderly with chronic disease are to be diagnosed at later stages of the diseases hence leading to higher mortality rates. These studies attribute such rates to restricted access to treatment and screening.....

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