0307

Introduction to Financial Security Systems

• Course Title: AS 1021B

• Date: March 7, 2025

Government Health Care Plans

Canada’s Health Care System

• Universal coverage for medically necessary health services via provincial government plans.

• Constitution Act, 1867: provinces manage health care institutions; federal government controls marine hospitals and taxation.

• Hospital Insurance Act, 1957: Federal reimbursement of half provincial costs for hospital and diagnostic services.

• Medical Care Act, 1966: Federal reimbursement of half provincial costs for medical services outside hospitals.

• Canada Health Act (CHA), 1984: Replaced previous acts; aims to protect, promote and restore resident well-being with reasonable access to health services.

• CHA allows federal government to impose penalties on provinces failing reasonable access to essential care.

Canada Health Act Principles

1. Public Administration

   • Administered non-profit by a public authority accountable to provincial government.

2. Comprehensiveness

   • Covers all medically necessary services from hospitals and practitioners; provinces may include additional services.

3. Universality

   • Entitles all insured persons uniform health coverage.

4. Portability

   • Maximum 3-month waiting period for new residents; reimbursement during temporary absence or relocation.

5. Accessibility

   • Reasonable access to necessary services without financial barriers; all provinces complied by 1971.

Scope of Coverage

• Medically necessary services not precisely defined in CHA; determined by provincial plans, categorized as:

  • Medical Services

  • Hospital Services

  • Out-of-Province Benefits

  • Supplementary Benefits

Medical Services

• Coverage includes:

  • Fees for medically required physician services

  • Diagnostic services

  • Surgical services

  • Anesthesia administration

  • Lab tests and medical imaging

• Fee negotiations between government and physicians; extra charges prohibited.

• Non-participating physicians: Patient pays directly, gets reimbursement up to standard rates (not applicable in Québec for opted-out services).

Hospital Services

• Coverage includes:

  • Basic accommodation and meals

  • Nursing services

  • Diagnostic procedures

  • Administered drugs

  • Surgical facilities

• No length limitation on necessary hospital stay.

• Exclusions:

  • Cosmetic procedures, travel medicine, private nursing, dental care, and outpatient prescription drugs.

• Note: CHA abolished "user fees" for accommodation but allows fees for chronic care.

Out-of-Province Benefits

• Most provinces (except Québec) have reciprocal agreements for healthcare services across provinces.

• Non-Québec residents pay upfront in Québec, claim back from their province; similar applies to Québec residents in other provinces.

• Emergency medical costs covered outside Canada, generally up to home province rate; pre-approval required for some non-emergency services.

Supplementary Benefits

• Coverage often expanded beyond mandatory services, examples include:

  • Basic dental care (some provinces)

  • Eye exams (not covered in Ontario)

  • Prescription drugs for seniors and low-income individuals (coverage decreased).

• Limited coverage for other healthcare professionals (e.g., optometrists, chiropractors).

Health Care Financing

• 1957-1977: Federal government funded half of provincial expenditures on healthcare.

• Post-1977: Combination of cash payments and tax points; provinces raise taxes equivalently.

• Federal funding for specific groups (e.g., RCMP, certain Indigenous programs).

• Provinces finance remaining costs using various methods including payroll taxes or premiums.

Provincial Plan Eligibility Example - Ontario (OHIP)

• Eligibility requires:

  • Canadian citizen/resident or full-time work permit holder.

  • Permanent home in Ontario.

  • Physically present in Ontario for 153 days over 12 months.

  • Previous waiting period waived during COVID.

Recent Changes to Health Care Funding

• COVID-19 funding: Over $40 billion for vaccines, testing, etc.

  • $6.5 billion in Canada Health Transfer top-ups.

  • $4 billion to improve long-term care safety.

  • $1.2 billion for mental health, substance use support.

• 2022: Canadian Dental Benefit introduced for uninsured Canadians.

• 2023: Additional $46 billion commitment for healthcare system improvements.

• 2024: National pharmacare legislation initiative.

Challenges with Government Health Care Plan

• Issues include:

  • Long waiting times

  • Limited facilities

  • Shortage of healthcare professionals

  • Technology cutbacks for cost-saving

  • Administrative inefficiencies

Quiz Questions

• Role of the Canadian federal government: A) Directly providing services, B) Setting national standards and funding, C) Regulating prices, D) Administering facilities.

• True statement about Canada’s health care: A) Physician participation optional, B) Federal government pays half, C) Services defined in CHA, D) Prescription medications always covered.

• NOT a CHA principle: A) Comprehensive, B) No premiums, C) Portable, D) Non-profit basis.

• Violation of CHA in Ontario court ruling: A) Public administration, B) Comprehensiveness, C) Universality, D) Portability, E) Accessibility.