Medicare (Canada)
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- This article refers to medicare, a name for Canada's public health insurance system. For similarly named programs in other countries, see Medicare.
The term medicare (in lowercase) (French: assurance-maladie) is the unofficial name for Canada's universal public health insurance system. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces. However, the word has been used with respect to Canadian public health insurance since the early 60's[1][2]
Under the terms of the Canada Health Act, the provinces provide all residents with health insurance cards, which entitle the bearer to receive free medical care for almost all procedures. Patients are free to choose their own doctor, hospital, etc. Health institutions are either private and non-profit (such as university hospitals) or provincially run (such as Quebec's CLSC system). Most all doctors are in private practice as entrepreneurs and bill the medicare system for their fees. The so called public system is merely publically funded, with most all services provided by private enterprises, as in clinics or doctors who are paid a fee-per-visit, unlike some countries where doctors are on a salary system. Canadians can change doctors any time they wish.[3]
The Health Care System in Canada is a universal system, (some items are not covered) while often called a socialized-public system it is in fact merely publically funded. Most all services are provided by private enterprises, and doctors are not on a government salary, but operate like hardware stores, as capitalistic entities.[4]
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[edit] Services covered
Canada's healthcare system provides diagnostic, treatment and preventive services to every Canadian regardless of income level or station in life.
Each province in Canada manages its own healthcare system. For example, each province issues its own healthcare identification cards and negotiates with the federal government for money to cover healthcare costs. Each province also provides its own prescription drug benefit plan, available to every Canadian regardless of income level. The prescription drug benefit is, however, adjusted for income, with a higher co-payment required for those with higher personal incomes. The prescription drug benefit is very comprehensive and rarely excludes a medication. Where a medication is excluded that is needed by a patient, the patient applies for coverage under the plan for that drug using a Section 8 form.
Dental care is not covered by any government insurance plans. Canadians rely on their employers, individual private insurance, or simply pay cash themselves for dental treatments.
The range of services for vision care coverage varies widely among the provinces. Generally, vision care is covered (cataract surgery, diabetic vision care, some laser eye surgeries required as a result of disease); the main exception is the standard vision test, which patients pay for if they have their eyes tested more than once within a two-year period. In Alberta you are charged for every vision test that is taken.
Naturopathic services are covered in some cases, but homeopathic services are generally not covered. Chiropractic is partially covered in some provinces. Cosmetic procedures are not typically covered.
[edit] Opinions on Medicare
Polling data in the last few years have consistently cited medicare as the most important political issue in the minds of Canadian voters. Along with peacekeeping, the CBC ran a poll that found medicare to be one of the most defining characteristics of Canada[citation needed].
It has increasingly become a source of controversy in Canadian politics. Due to massive healthcare transfer payment cuts at the hands of recent federal governments, and the resulting shortfalls in provincial government budgets, combined with rising costs due to an aging population, quality of care provided has decreased through the past two decades[citation needed].
Researchers examining the quality of the Canadian healthcare system cite[citation needed] several problems with the system: limited access to diagnostic equipment (such as MRIs and CT Scanners) and lengthy wait times for surgeries and serious physician shortages, which are particularly prevalent for general practitioners (GP) / family doctors. In some parts of the country waiting times to acquire a GP have been as long as several years[citation needed]. There have been some wait-time improvements through 2005 and 2006[citation needed].
Some politicians and think tanks have proposed removing barriers to the existence of a parallel private healthcare system. Though polling suggests support for such reforms has been increasing[citation needed], it has yet to be adopted as official policy by any of the main federal political parties. There have been private clinics opened and operating in Canada, but they are few and far between. Canadians who pay for their own services at private clinics are not penalized or prevented from using the public healthcare system simultaneously.
Despite wait times and funding cuts, Canadians do receive a very high standard of care, on par with what a privately insured US citizen would get in most cases[citation needed]. The Canadian system is much more affordable for certain items such as patented drugs and this difference in price has created a large prescription drug exporting industry in Canada. Older off-patent medicines tend to be somewhat more expensive due to less competition as entry into the Canadian market suffers from government barriers[5].
Governments in Canada spend a smaller amount per capita on healthcare than governments in the United States[citation needed], while almost every Canadian citizen is fully covered[citation needed]. In the United States a high percentage of the population is uncovered or only marginally covered, despite higher proportional spending along with large private investment. Even more are just a job loss away from not having coverage (although in most cases the employer must maintain health care with copayment of the patient for a period of time after employment in the United States has gone down not up.)
[edit] Proposed reforms
One proposed solution for improving the Canadian healthcare system is to increase funding. Proponents of this approach point to[citation needed] the rise of neo-conservative economic policies in Canada and the associated reduction in welfare state expenditure (particularly in the provinces) from the 1980s onwards as the cause of degradation in the system. In fact, there is evidence[citation needed] that the percentage of total government expenditures spent on healthcare has been increasing, in part due to a higher percentage of older Canadians.
Other critics of healthcare state[citation needed] that increased funding will not solve systematic problems in the healthcare system including a rising cost of medical technology, infrastructure, and wages. These critics say[citation needed] that Canada's proximity to the United States causes a "Brain Drain" or migration of Canadian-trained doctors and nurses (as well as other professionals) to the United States, where private hospitals can pay much higher wages and income tax rates are lower. Some of these critics[citation needed] argue that increased privatization of healthcare would improve Canada's health infrastructure.
Critics of the systematic reform approach state[citation needed] that healthcare should be kept public, in part because it separates Canadians from Americans by mandating equality and fairness in health care. Truth is that the system is not a true public system, as in Italy, where doctors are on a per capita salary. The Canadian Health care system is merely publically funded, which most Canadians appreciate and desire. Making the system a true public system is an alternative to the current half public, half private system.
Much of the political discourse concerning the health care system, as it stands in the year 2006, appears to be politically motivated. Firstly, there is a failure to appreciate and acknowledge that the system is not a true public system, secondly there is a failure to appreciate the system is also private, in that most services are provided by a private sector; the system is merely publically funded. While the majority of discussions focus on whether to privatize or not, the question implies that the system is not private, which ignores the privatized component of the system, and more importantly falsely implies that the system is a true public system, which it is not; most doctors are self employed incorporated entities, they are not on a public salary. [6]
[edit] Ontario's reform experiments
Since the early 1990s, Ontario has implemented several systematic reforms to reduce health care costs. Similar reforms have been implemented in other provinces.
[edit] User premiums
Currently in Ontario, people who earn salaries above CN$20,000 must pay an annual health care premium ranging from $300-$900. Funding for medicare in Ontario also comes in part from a dedicated Employer Health Tax (EHT) that ranges from 0.98%-1.95% of employer payroll. Eligible employers are exempted from EHT on the first $400,000 of payroll. British Columbia, Quebec, and Alberta charge similar premiums. Alberta charges $44 a month or $88 per family, though as Alberta approaches debt-free status, there has been talk of removing them.
[edit] Medical clinics
Ontario has increased the number of 24-hour drop-in medical clinic networks[citation needed] to reduce costs associated with treating off-hours emergencies in emergency rooms.
Many Family Doctor Practices have created their own clinics, offering 24 hour service for their patients if needed. Each Doctor in the Practice takes a turn at being "on call" on a rotating basis. Patients who have family doctors belonging to these practices are able to have a doctor come to their home in extreme situations. There is no additional charge for these services as they are billed to the Province, the same as an office visit.
Hospitals in some major Canadian cities, such as London, Ontario, have restructured their Emergency services to share emergency treatment among several hospitals. One hospital may provide full emergency room care, while another sees patients who have broken limbs, minor injuries and yet another sees patients suffering cold, flu, etc.
[edit] Alternatives to fee-for-service
Ontario has also attempted to move the system away from bill for service and toward preventive and community-based approaches to healthcare. The Ontario government in the early 1990's helped develop many community health care centres, often in low-income areas, which provide both medical and social support which combines health care with programs such as collective kitchens, Internet access, anti-poverty groups and groups to help people quit smoking.
While funding has decreased for these centres, and they have had to cut back[citation needed], they have had a lower cost than the traditional fee-for-service approach[citation needed]. Many of these centres are filled to capacity in terms of general doctors, and there are often fairly long waiting lists and the centres also utilize nurse practitioners, who reduce the workload on the doctors and increase efficiency.
[edit] Midwives and hospital birthing reforms
Ontario and Quebec have recently licensed midwives, providing another option for childbirth which can reduce costs for uncomplicated births. Midwives remain close to hospital facilities in case the need for emergency care emerges. These births often cost much less than the traditional hospital delivery[citation needed]. Hospitals have also reformed their approach to birthing by adding private birthing areas, often with a hot tub (which is good for relieving pain without medication).
[edit] Privatization
Currently, privately owned and operated hospitals that allow patients to pay out-of-pocket for services cannot obtain public funding in Canada, as they contravene the "equal accessibility" tenets of the Canada Health Act. Some politicians and medical professionals have proposed[citation needed] allowing public funding for these hospitals.
In Quebec, a recent legal change has allowed this reform to occur. In June 2005, the Supreme Court of Canada overturned a Quebec law preventing people from buying private health insurance to pay for medical services available through the publicly funded system and this ruling does not apply outside the province. See: Chaoulli v. Quebec (Attorney General)[1].
In November 2005, the Quebec government announced that it would allow residents to purchase private medical insurance to comply with this ruling.
Private insurance from companies such as Blue Cross, Green Shield and Manulife has been available for many years to cover services not covered by Medicare, such as dental care and eye care. Private insurance is provided by many employers as a benefit.
[edit] Barriers to foreign trained practitioners
Some argue that currently, physicians arriving in Canada from other countries must meet Canadian Health Practitioner standards. Canada's health education system is above average in the world[citation needed], so there is concern that doctors from other countries are not trained or educated to meet Canadian standards. Consequently, doctors who want to practice in Canada must meet the same educational and medical qualifications as Canadian-trained practitioners, others suggest that the current regulatory bodies, the Canadian Medical Association, the Doctors Union, and the College of Physicians and Surgeons has created too much red tape to allow qualified doctors to practise in Canada.[7] It should be noted that Canada's Health system is ranked 30th in the world, suggesting the logic of the doctor shortage defies the statistics.[8] In fact according to a report by Keith Leslie of the Canadian Press in the Chronicle Journal, Nove 21, 2005, over 10,000 trained doctors are working in the United States, a country ranked 36th in the world. It would suggest money or working conditions, or both, are resulting in an exodus of Canadian doctors (and nurses) to the USA.[9]
It is important to understand the doctor shortage in Canada, is a very severe problem impacting doctors, nurses, patients and health care. It may relate in part to the details of how doctors are paid; a detail often misunderstood. While in Italy doctors receive a fee per patient per year[10], a sort of per capita salary, in Canada most all doctors receive a fee per visit. This type of "fee-for-visit" payment system rewards complexity, volume visits, repeat visits, referrals, testing and penalizes efficient and effective doctoring and good health. More importantly is a system that rewards those within the system financially rewards because of a doctor shortage; simple demand and supply economics. Worth repeating, a 'fee per visit' system penalizes efficient and effective treatments, prevention, and good doctoring. This is in most cases concerning family doctors, a fee per visit, not necessarily a fee per service, but not always.[11][12]
The consequences of the payment system, is that the or shortage in Canada, is resulting in a great many patients without family doctors, and trained specialists. Some of the results include complications caused by the lack of early intervention. As the article in the Toronto Star specially isolates, it is not so much a problem of a doctor shortage but of a shortage of 'licensed doctors'. Michael Urbanski states that Canada already has a hidden reserve of foreign-trained MDs eager to begin medical practice. "However, what's crucial to understanding the issue of doctor shortage in Ontario is that while the Liberal government is planning to go "poaching" for other countries' doctors, there are an estimated 4,000 internationally trained doctors right here in Ontario working at low-wage jobs". [13]
The Canadian system is not a true public system, it is half public and half private.(a half-truth) For the most part it is publicly funded, and in regards to the delivery of services, most are provided by private enterprises or corporations, be they clinics or doctors. It is important that most all doctors are self-employed, and do not receive an annual salary, (except some doctors who work for hospitals) but receive a fee per visit or service.
A CBC report [6](August 21, 2006) on the health care system reports the following:
"Dr. Albert Schumacher,[14] former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly. "Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics …The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. We have sort of a passive privatization."
According to Dr. Albert Schumacher' remarks, they, GP's are "small hardware stores', and this is a major reason why there is a shortage of doctors in Canada; simple economics dictates that doctors within the system benefit from a shortage in the supply of doctors.
In a report by Keith Leslie of the Canadian Press in the Chronicle Journal, Nov 21, 2005, commenting on an Ontario Medical Association Report, prepared by the human resources committee states "The year 2005 finds the province in the midst of a deepening physician resources crisis". The report continues to report, "the government should make it easier for doctors from other provinces to work in Ontario and .... ". Here we have signs of inter-provincial competition impacting the doctor shortage in one province over another.[15]
[edit] Exodus of Canadian Doctors
The exodus of Canadian doctors from Canada is seldom mentioned, although according to the report by Keith Leslie of the Canadian Press in the Chronicle Journal, Nov 21, 2005, also quotes the Ontario Medical Association report continues to state, " ...and for the more than 10,000 Canadian-trained physciains working in the USA to return". This would suggest that money or working conditions, or both, has resulted in an exodus of Canadian doctors (and nurses) to the USA. It also suggests that a private medicare system, such as that in the USA, provides its principal benefits to the providers of health care, rather than consumers.[16]
[edit] Provincial insurance plans
Though the Canada Health Act provides national guidelines for healthcare, the provinces have exclusive jurisdiction over health under the constitution and are free to ignore these guidelines, although if they ignore the guidelines, the federal government may deny federal funding for healthcare. All provinces currently abide by the Canada Health Act in order to receive this funding; however the Alberta legislature has considered proposals[citation needed] to ignore the Act to allow them to implement reforms not allowed under the Act.
The federal government has no direct role in the delivery of medicine in the provinces so each province has its own independent public health insurance program. Under the Canada Health Act, each province must provide services to members of plans in other provinces.
[edit] List of provincial programs
| Province | Name of plan |
|---|---|
| Alberta | Alberta Health Care Insurance Plan |
| British Columbia | Medical Services Plan |
| Manitoba | Manitoba Health |
| New Brunswick | Medicare |
| Newfoundland and Labrador | Newfoundland and Labrador Medical Care Plan |
| Nova Scotia | Medical Service Insurance |
| Ontario | Ontario Health Insurance Plan |
| Prince Edward Island | Medicare |
| Quebec | Assurance maladie (Medicare) |
| Saskatchewan | Saskatchewan Medical Care Insurance Plan |
[edit] See also
- Father of medicare
- Ontario Health Insurance Plan
- Matthew effect
- Medicare (Australia)
- Medicare (United States)
- National Health Service
- Health care in Canada
[edit] External links
- Canada Health Act
- Commission on the Future of Health Care in Canada - the Romanow Report
- 2001 report comparing Canadian health care to that of other nations
- 2005 The conservative Fraser Institute's view of health care compared to other nations
- Canadian Health Coalition (Canadian lobby group supporting public medicare)
- Medicare: A People's Issue
- Maple Leaf Web: The Charter & Public Health Care in Canada
- CBC Digital Archives - The Birth of Medicare
[edit] References
- ^ http://encarta.msn.com/dictionary_561563313/medicare.html
- ^ Oxford English Dictionary, second edition, edited by John Simpson and Edmund Weiner, Clarendon Press, 1989, twenty vol. IX, p.547, ISBN 0-19-861186-2
- ^ CBC Health Care Private verses Public
- ^ CBC Health Care Private verses Public
- ^ http://www.cbc.ca/canada/story/2004/08/23/gen_drugs040823.html
- ^ Canada Health Care - About Health Care
- ^ Red tape is strangling foreign-trained physicians CANADIAN MEDICAL ASSOCIATION JOURNAL
- ^ Universal Health Care - Canada ranks 30th
- ^ Ont. Medi Scare - Chronicle Journal, Thunder Bay, November 21, 2005 - Physicain shortage puts stabiity of health-care system at risk. OMA
- ^ Health service/health insurance in Italy
- ^ Improving health care for Canadians.
- ^ Health Care Costs Nobody Talks About
- ^ What doctor shortage ? - Toronto Star, August 19, 2004
- ^ Private verses Pulblic - Dr. Albert Schumacher
- ^ Ont. Medi Scare - Chronicle Journal, Thunder Bay, November 21, 2005 - Physicain shortage puts stabiity of health-care system at risk. OMA
- ^ Ont. Medi Scare - Chronicle Journal, Thunder Bay, November 21, 2005 - Physician shortage puts stabiity of health-care system at risk. OMA
