Canadian Healthcare System: What You Need to Know

Ask a Filipino, and they’d tell you that one of their reasons for choosing to migrate to Canada is the Canadian Healthcare System. But what’s so great about it? We’ll look into what comprises this efficient healthcare system and how it fares against the world’s best.

Also Read: Canadian Education System: What to Know

Canada’s Healthcare System is ranked 10th in the Health care system performance rankings by Statista for 2021. This is a very impressive rank given that it was only ranked 12th in 2016 and 15th in 2015. The healthcare system is managed by the provincial governments, but they are all inspired by the same principles. Keep on reading to find out what these principles are and how they benefit all of its residents

Contents

Overview

The Canadian healthcare system is a single-payer, publicly funded and managed system that aims to provide universal health coverage to all citizens and permanent residents of Canada.

The Canadian health-care system is decentralized and publicly funded by tax receipts from the federal, provincial, and territorial (FPT) governments.

Medicare is the term given to Canada’s universal health care system, which provides free medically necessary care at the point of service but does not cover prescriptions, dentistry, or eye care.

Despite having one of the most expensive universal healthcare systems in the OECD, Canada falls short of the mark regarding resource availability and access. Still, compared to other parts of the world, such as the Philippines, Canada is much more efficient and has better health outcomes.

Evolution of Canada’s Health Care System

The powers of the territorial and federal governments are outlined in the Constitution of Canada. In 1867, the provinces were given the authority to establish, manage, and maintain hospitals, asylums, charitable institutions, and charitable shops. The federal government was also given the power to quarantine and marine hospitals.

The federal government was given the power to borrow and tax money. This was done to ensure that the spending would not violate the province’s powers. The Agriculture Department had also covered the health responsibilities of the federal government from 1867 until 1919.

Prior to the Second World War, most of Canada’s health care was privately-funded and delivered. In 1947, the province of Saskatchewan introduced a universal hospital care plan. Two years later, Alberta and British Columbia followed suit. In 1957, the federal government passed a hospital insurance and cost-sharing act. This act provided the government with a cost-share on the portion of the hospital and diagnostic services that the territorial and provincial governments spend.

The Act provided for the universal availability of certain services, such as inpatient and diagnostic facilities. After four years, all the territories and provinces agreed to provide these services.

In 1962, the province of Saskatchewan introduced a universal medical insurance plan for its residents. The following year, the federal government introduced the Medical Care Act, which provided for the reimbursement of up to 50% of the costs associated with the services of a doctor outside a hospital. Within six years, all the territories and provinces had similar insurance plans for physicians.

From 1957 to 1977, the portion of the federal government’s contribution to the health care system that was allocated for the provinces and territories was determined based on the percentage of the total expenditures on physician and hospital services. In 1977, the cost-sharing act was replaced by a block fund, which involved tax points and cash payments.

A block fund is a type of financial arrangement that allows the federal government to provide a specific amount of money to the provinces and territories for a specific purpose. Through this arrangement, the federal government was able to reduce its tax rates while the provinces and territories were able to raise theirs. This new funding method allowed the territorial and provincial governments to make their own decisions regarding the health care system.

The organization of Canada’s healthcare system is determined by the Constitution of the country, which gives the provinces and territories more responsibilities when it comes to providing social services and health care. The federal government, on the other hand, is responsible for delivering certain services to certain groups of people.

The majority of the revenue that the provinces and territories use to fund their healthcare system comes from various taxes, such as corporate and personal taxes, sales taxes, and payroll levies. Although the provinces can charge a premium for their residents to help pay for healthcare services, this shouldn’t prevent people from accessing the necessary services.

Besides the healthcare system, the provinces and territories also have a variety of responsibilities when it comes to providing public health services. These include the prevention and treatment of infectious diseases, as well as sanitation. These services are usually delivered at the local and provincial levels.

The federal government

The federal government’s role in the healthcare system includes setting and administering the national principles for the system, providing financial support to the provinces, and delivering various other functions. Some of these include funding and delivering supplementary and primary healthcare services to certain groups. Some of these include Inuit, First Nations people, veterans, military personnel, inmates in federal penitentiary facilities, and refugee claimants.

The Canada Health Act provides the provinces and territories with certain conditions and criteria that they must meet in order to receive the full federal support for their healthcare system. These include providing adequate access to doctors and hospitals.

The Act also prohibits the provinces and territories from charging user fees and extra-billing. This is a type of healthcare service that’s commonly used by a medical practitioner. It’s not allowed under the health insurance plans of the provinces and territories. A user charge is a fee that’s not included in the regular fee of an insured health service.

Through the Canada Health Transfer, the federal government provides the provinces and territories with cash and tax transfers to support the Canadian healthcare system. It also provides equalization payments to the territories and less prosperous provinces. These payments are made to help the provinces and territories fund their healthcare system.

The federal government provides primary and emergency healthcare services to First Nations and Inuit people on remote and isolated reserves. It also provides community-based programs designed to improve the quality of healthcare services for these groups. In addition, it provides a non-insured program designed to help First Nations people and Inuit individuals in Canada.

These services are usually delivered at various locations, such as nursing stations, health centres, and in-patient treatment centres. As the federal government and Aboriginal groups work together to integrate these services with the territorial and provincial systems, more people will be able to benefit from these programs.

The federal government also has the power to regulate various aspects of the healthcare industry. These include the safety of food and drugs, as well as the surveillance and prevention of diseases.

The federal government also supports health promotion and research. In addition, it has a variety of tax measures that are designed to help individuals and families with healthcare expenses. Some of these include tax credits for medical expenses, tax rebates for public institutions, and deductions for private insurance premiums.

The Canada Health Act

The Canada Health Act’s five principles are as follows:

Public Administration: A public entity accountable to the province or territory government must administer and operate the provincial and territorial plans without profit.

Comprehensiveness: All medically necessary treatments provided by hospitals, physicians, and dentists working in a hospital setting must be covered by provincial and territorial plans.

Universality: All insured persons must be provided with uniform coverage terms and conditions under provincial and territorial plans.

Accessibility: The provincial and territorial plans must ensure that all covered people have proper access to medically necessary hospital and physician services without financial or other impediments.

Portability: All insured individuals who relocate to a different province or territory within Canada or travel worldwide must be covered by the provincial and territorial plans. Non-emergency services rendered outside of the provinces and territories may require prior authorization and impose coverage limitations for services rendered outside of Canada.

The provincial and territorial governments

Most of Canada’s health care is handled by the territorial and provincial governments. All health insurance plans in the country are expected to meet the principles of the Canada Health Act. These plans cover the medically necessary services of doctors and hospitals on a pre-paid basis. The territorial and provincial governments are responsible for funding these services, and the federal government provides the rest.

The Canada Health Act does not define what services are medically necessary. It is up to the territorial and provincial health insurance plans to determine which services are deemed to be necessary based on consultations with their physician groups and colleges. If the full cost of the service is determined to be covered by the plan, then it must be in compliance with the act.

If a service is not considered medically necessary, it does not need to be covered by the health insurance plan of the province or territory.

The following roles are played by provincial and territorial governments in health care:

Administration of their health insurance plans; planning and funding of care in hospitals and other health facilities; services provided by doctors and other health professionals; planning and implementation of health promotion and public health initiatives; and fee schedule negotiations with health professionals are all examples of services provided by doctors and other health professionals.

Most provincial and territorial governments provide and support supplemental benefits for specific populations (for example, low-income citizens and the elderly) that are not covered by the Canada Health Act, such as pharmaceuticals prescribed outside of hospitals, ambulance fees, and hearing, vision, and dental care.

Despite the fact that provinces and territories provide these extra benefits to some populations, the vast majority of supplementary health services are paid for privately. Individuals and families who do not qualify for publicly funded coverage may pay these fees directly (out of pocket), participate in a group health plan supplied by their work, or acquire private insurance. Private insurers are forbidden by the majority of provincial and territorial legislation from providing identical coverage to government-sponsored plans, although they can compete in the market for supplementary coverage.

Furthermore, each province and territory has a self-funded independent workers’ compensation organization that provides assistance to injured workers.

Health Expenditures

The health expenditures of the provinces and territories vary depending on their respective demographics and services. This is because of various factors, such as the age of the population and the services that the territories and provinces provide. Other factors such as the size of the population residing in certain areas can also affect the cost of healthcare.

The CIHI reported that in 1975, Canada’s total health care costs consumed about 7% of the country’s GDP. In 2010, the country’s total health care expenditures were estimated to be at around $11.7% of the country’s GDP. In 2010, publicly-funded health expenditures made up about seven out of every ten dollars spent on healthcare.

Out of the total expenditures, three-quarters came from private sources. These funds covered the costs of various services, such as dental care and vision care.

The way healthcare dollars are spent has significantly changed over the past three decades. While the share of the total health expenditures that are paid to physicians and hospitals has decreased, the amount of money that is spent on drugs has increased.

Despite the decline in the number of hospitals’ healthcare expenditures, the majority of spending of the Canadian healthcare system still remains with the hospitals. In 2010, the second-largest share of the health care budget was spent on drugs, accounting for 16% of the total. The third largest portion was allocated to physicians.

How Health Care Is Delivered

The public health care system of Canada is characterized by an interlocking set of health systems that provide a variety of services to the public. Known as “medicare,” this system ensures that people have access to the best possible care.

What Happens First (Primary Health Care Services)

Most people in Canada turn to primary health care when they need help with their health care. This type of service is the first point of contact for many health care services. It also serves as a coordinator of the various health care services that are available to patients. This ensures that the people have the best possible continuity of care and that the health care system is able to accommodate the needs of more specialized patients.

In addition to providing comprehensive care, primary health care also focuses on prevention and treatment of various common ailments and injuries. It may refer patients to other services such as specialist and hospital care. Other services that are commonly offered in this type of service include mental health care, rehabilitation, and child development.

In private practice, doctors are usually paid according to a fee-for-service schedule that lists the various services that they provide.

The various agreements that govern the provision of primary health care services are negotiated between the territorial and provincial governments and the medical professions.

Doctors working in other settings, such as community health centers, group practices, and clinics, are more likely to receive payments through different payment schemes. These include salary arrangements, fee-for-service payments, and incentives for certain services.

Most health professionals, such as nurses and other healthcare workers, are paid according to the terms and conditions of their contracts with their employers.

When patients require further evaluation or treatment, they are referred to other healthcare services such as diagnostic testing and allied health professionals, which include nurses, physicians, and other healthcare workers.

What Happens Next (Secondary Services)

A patient may be referred to specialized care at a hospital, long-term care facility, or in the community. Most hospitals in Canada are operated by local community boards of trustees or other voluntary organizations.

Most hospitals are funded through global budgets that set their own expenditure limits or targets, which are typically negotiated with the territorial and provincial ministries of health. This method is different from fee-for-service arrangements.

Several provinces in Canada are experimenting with different funding methods for hospital reimbursement. Although the main method of funding hospitals in the country is global funding, other approaches are being considered.

Services for secondary health care can also be provided in the community or at home. Family members, hospitals, physicians, and other healthcare providers can refer patients to these types of services. These are usually coordinated with the help of volunteers and formal caregivers. The goal of these services is to provide the best possible care for the patient.

Although the Canada Health Act does not cover home and continuing care services, the provinces and territories pay for some of these. This means that patients in different areas can still receive these types of care services. The federal government also provides these services to veterans who are not able to receive them in their home province or territory.

The federal government also provides home care services to some aboriginal people and individuals living on reserves.

A type of care known as palliative care is delivered in various settings, such as hospitals, long-term care facilities, and hospices. It focuses on the emotional and physical support that patients and their families need during the final stages of their illness.

Additional (Supplementary) Services

Some people, such as seniors and children, are not covered by the public health care system. However, the territories and provinces can provide them with supplemental health benefits, which include prescription drugs, dental care, vision care, and medical equipment. These include devices such as wheelchairs and prostheses. The level of coverage varies depending on the province.

Those who do not qualify for government-sponsored insurance plans are forced to pay for these services through private insurance or out-of-pocket payments. Canadians generally have varying levels of coverage depending on their plan purchased.

Trends/Changes in Health Care

The number of procedures being performed on an out-patient basis and day surgeries has increased due to the technological advancements that have occurred in the Canadian Healthcare System over the years. The nights Canadians spend in acute-care hospitals per capita has also decreased.

In Canada, the public health care system has changed the way people receive their health care. Previously, most services were provided by hospitals and doctors. Today, they are delivered through various forms of care, such as primary health care centres, home care, and clinics.

In the past few years, the Canadian healthcare system has experienced various changes. These include the increasing cost of new technology, the aging population, and the lack of proper funding for mental health and substance abuse services.

During the 1990s, the provinces and territories started to control the costs of providing health care by delegating decision-making regarding the delivery of services to the local or regional board level. These regional health authorities are responsible for overseeing the operations of various health facilities and services in their areas.

In the past few years, some provinces have started to shift away from a decentralized model of providing health care. Instead, they have centralized decision-making structures and more health authorities.

Frequently Asked Questions

1. What is Medicare in Canada?

The term Medicare refers to Canada’s publicly-funded health care system. Unlike the US, Canada doesn’t have a single national health insurance plan. Instead, it has 13 territorial and provincial insurance plans. All residents have access to necessary physician and hospital services without out-of-pocket expenses.

2. What is the role of the provincial and territorial governments in Canada?

The territorial and provincial governments are responsible for providing health care services to their residents. The national standards for the system are set through the Canada Health Act. The federal government also provides financial support to the provinces.

3. What is the first point of contact for Canadians?

Primary health care is often the first point of contact for many Canadians when it comes to accessing the health care system.

4. Do provincial health insurance plans have to meet the health care standards?

Health insurance plans for provinces and territories must meet the standards of the Canada Health Act in order to receive their full payment.

5. Who must insure all medically necessary services?

The territorial and provincial plans must ensure that all medically necessary services are covered by insurance. Some of these include hospitals, physicians, and dentists. However, the Canada Health Act does not define what medically necessary services are.

6. Does public health insurance cover medical services?

If a service is deemed medically necessary, then the full cost of the service must be covered by the insurance plan for the public.

7. Does Canada have a provincial and territorial plan?

All residents in Canada are required to have coverage when traveling within the country. This includes those who live outside the country.

Final Thoughts

If you’ve plans on living in Canada, then one of the things that you should at least have an idea about is the health care system. A lot of people are not aware that Canada has a universal healthcare system, and it is important to know what exactly that means.

The Canadian healthcare system is one of the best in the world, as it is designed to cover all residents and visitors. The Canadian healthcare system has evolved over time, but it has always been there to provide coverage for all Canadians.

We hope this article has helped you learn more about the Canadian healthcare system and how it works. If you are planning to move to Canada, it is good to know that you can access medical services without having any financial burden on yourself.