Health Care Plans

Division of Powers

• Canada does not have a national Health Care plan

  • They have 10 provincial and 3 territorial single-pay insurance plans

• Universal Health Care- all eligible citizens have insured health coverage aka medicare

• Under the Constitution Act, the governments oversee matters relating to the personal health of their respective populations

Structure of the Health Plans

• Within the governments of the provinces, there is a department of health that’s assigned to manage the healthcare

  • Each is headed by an elected Member of the Parliament appointed by the premiere

  • Also appoints a deputy minister

• One of the ministries’ responsibilities is implementing and regulating the provincial or territorial health insurance plan

• All provinces have the 3 general categories of healthcare

  • Primary Care: first contact

  • Secondary Care: sent to see a specialist (consultation); short-term

  • Tertiary Care: highly specialized, referred by a specialist

    • Quandary care: experimental care

• Regional Health Authorities were the most common method of delivering care across Canada

Regionalization Initiatives Across Canada

• It was decided in the 1990s to decentralize decisions about healthcare issues through regionalization

  • To assess the need for specific types of care and deliver that care which is best suited to a population group within an area

• PEI, NS, and AB have single administrative bodies

• BC

  • The MOH works with five regional authorities

  • Minister of Health establishes performance and evaluations for health care delivery

  • Each RHA has an appointed board and is managed by a community of health councils

• AB

  • Alberta reduced 9 regional health authorities to one

  • It is responsible for the governance of the Alberta Health Services

• SK

  • Partnered with 3sHealth

  • With the purpose to improve healthcare

  • Services and spending healthcare dollars more effectively

  • Dissolved 12 regional health authorities to one

• MT

  • Manitoba’s 11 RHA’s were reassigned creating 5 regions

  • Each overseen by a board of directors

    • Headed by a chairman

• ON

  • Implemented sweeping change

    • Previously 14 corporations called the Local Health Integration Networks were responsible for healthcare services

    • These nonprofits were operating within their scope to negotiate with the ministry

  • They now have a super agency called the “Ontario Health”

    • Headed by an executive chief officer and board of directors

  • Goals of restructuring

    • Provide residents with simplified access and navigation of the healthcare system

    • To promote integrated healthcare, improve connectivity services, reduce costs, and improve efficiencies among healthcare agencies

• QC

  • MSSS is responsible for both health and social services

  • Shared responsibilities with the 18 RHA’s and the 15 health and social agencies

  • Local service networks were established within the province by merging the community health centers

• NB

  • The Department of Health is responsible for healthcare in the province

  • A board of directors oversees the operation of the two RHA’s

• NS

  • 9 health districts merged to 1

  • NSHA works with IWK Health Center

• PEI

  • One Island Health Care System

  • Overseen by a board of directors with 2 divisions

    • Frontline services

    • System supports

• NF&LD

  • Has 4 RHA’s

  • The medical services division is responsible for the delivery of medical, pharmaceutical, and dental services

• NT

  • 6 districts merged to 1

  • Goal: improve coordination and delivery of health services

• YT

  • The population of 38 641

  • Does not have RHA or anything similar

  • Department of Health manages everything

  • Total of 3 hospitals

    • Managed by the Yukon Hospital Association

• NT

  • Department of Health manages the delivery of healthcare

  • Only has one hospital

Who Pays for Health Care? Roles

Health Care Premiums

• Alberta, British Columbia, and Ontario all charge premiums

• Based on the size of the family and collectively how much they make

• Premiums paid for public plans are not tax deductible

Payroll Tax

• Certain province levy a payroll tax

  • A tax collected from employers that specifically raise funds for healthcare

  • Aka dedicated tax

Funds

• In addition, governments provide some funds for services such as preventative health care measures, medical and hospital-based services, treatment of chronic diseases, rehabilitation, long-term care

• RHA’s typically distribute the money

• Different provinces allocate money a little differently

Public/ Private Health Insurance

Provincial Insurance Plans

• Criteria must be met

  • Canadian citizen; permanent residence

  • A resident of the province

  • Physically reside in a jurisdiction for at least 5 months of the year

• No Canadian can be denied medically necessary hospital or physician care under any circumstances

• To prove citizenship

  • Proof of residency

  • Proof of personal identification

• Must wait 3 months if applying for health care

• Health Cards are given out to keep track of people

  • Cannot be used as a source of id since there is no verification on it

  • Health card fraud is a big problem costing provinces millions

Private Health Care

• Can be tailored to your lifestyle and needs

• Ex. counselling, physiotherapy, sports medicine, travel health assessment, , genetic testing,

Medical Services

• In the hospital standard procedure are included as medically necessary and are paid for by the federal government

• Provincial/territorial do not cover private nursing care

• After receiving a second opinion the patient would have to pay for further consultations

• Ambulance Services

  • Typically under regional management

  • Or costs are shared medically necessary or not

  • Trips between hospitals are covered

• Public insurance does not typically pay for supplemental services

  • Unless referred by your physician

• Optometrists are covered nationals

Extended Health Care Services

• Long-term care homes have comprehensive care

• Are accredited

• Provinces decide their own funding

• These services are also offered

  • Home care: helps individuals with basic personal care, meals, and household maintenance, allowing them to remain at home even when taking care of themself becomes hard

  • Adult Day Programs: provide community day activities as well as respite care and in-home support to individuals with disabilities

  • Respite Care: allows non-professional caregivers relief from caring for a high-needs individual

  • Assisted living accommodation: helps keep a person in their home by providing individualized support and care

  • Group Homes: allows ones with disabilities to live in an environment that provides supervision and assistance

  • Hospice Care: They receive palliative care in a home-like setting for those unable to die at home. Paid for by both the municipal and provincial governments

  • Palliative Care: provides care, medication, and some medical supplies for dying individuals

  • Medical Assistance in Dying- overseen and paid for by the provincial government

Drug Plans

• Medications come second price-wise only to hospital spending.

• Canada offers publicly offered prescriptions called PharmaCare to those unable to pay for it otherwise

• Public insurance plans typically only cover the generic brand of drug

  • Some brand names may be covered if there is not a cheaper viable option

• Most drug plans one is expected to pay a copay