Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act.
The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information on an individual's health which remain confidential to the patient and the doctor.
Canada's regionally based Medicare systems are cost effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the state insurer. There is no need for the patient to be involved in billing and reclaim, thus making the system more adminstratively simple than one in which patients are billed and then reclaim. Private insurance is only a minimal part of the overall health care system and thus competitive practices such as advertising and other forms of self promotion, lobbying activities are kept to a minimum thus maximizing the percentage of revenues going directly towards patient care.
In general, costs are paid through funding from income taxes though three provinces also impose a fixed monthly premium (e.g.,$54/month in British Columbia) which may be waived or reduced for those on low incomes. There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income).
A health card, also called a Care Card, is issued by the local Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions.
Pharmaceutical drugs are paid for by public programs for the elderly or indigent, or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs.
General practitioners (GPs) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP.
Preventive care and early detection are considered important and yearly checkups are encouraged. Early detection not only extends life expectancy and quality of life, but cuts down overall costs. Those suspected of abusing the system by over-frequent or frivolous use, can be tracked by the doctor through the ID on their health insurance card and may have to wait longer than those with more urgent needs.
Public Opinion
Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger."
A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada while a Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the U.S.. In the same poll, when asked “overall the Canadian health care system was performing very well, fairly well, not very well or not at all?” 70% of Canadians rated their system as working either "well" or "very well". A 2003 Gallup poll found only 25% of Americans are either "very" or "somewhat" satisfied with "the availability of affordable healthcare in the nation," versus 50% of those in the UK and 57% of Canadians. Those "very dissatisfied" made up 44% of Americans, 25% of respondents of Britons, and 17% of Canadians
In November 2004, Canadians voted Tommy Douglas, Canada's "father of Medicare," the Greatest Canadian of all time following a nationwide contest sponsored by the CBC.
Costs and funding
Health care spending is expected to reach $183.1 billion in 2009 ( a more than five percent increase over the previous year ) or $5,452 per person. The greatest proportion of this money goes to hospital ($51B), followed by pharmaceuticals ($30B), and physicians ($26B).
Canada's healthcare spending is expected to reach $171.9 billion, or $5,170 per person, in 2008. Health expenditures are expected to be 10.7% of the gross domestic product. Hospitals account for the largest segment in spending at $48.1 billion, however, this amount is declining. According to the OECD, spending was second amongst other countries, less than United States and more than Norway, Switzerland and Luxembourg.
Health care spending in Canada is projected to reach $160 billion, or 10.6% of GDP, in 2007. This is slightly above the average for OECD countries, and substantially below the 15.2% of GDP taken up by healthcare in the United States as of 2005.
In Canada, the various levels of government pay for about 71% of Canadians' health care costs, which is slightly below the OECD average. Under the terms of the Canada Health Act, the publicly funded insurance plans are required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. There is considerable variation across the provinces/territories as to the extent to which such costs as outpatient prescription drugs, physical therapy, long-term care, home care, dental care and even ambulance services are covered.
Considerable attention has been focused on two issues: wait times and health human resources. There is also a debate about the appropriate 'public-private mix' for both financing and delivering services.
Canada has a federally sponsored, publicly funded Medicare system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. A physician cannot charge a fee for a service that is higher than the negotiated rate — even to patients who are not covered by the publicly funded system — unless the physican opts out of billing the publicly funded system altogether. Pharmaceutical costs are set at a global median by government price controls. Other areas of health care, such as dentistry and optometry, are wholly private.
History
18th century
Hospitals were initially places which cared for the poor; others were cared for at home. In Quebec (formerly known as New France and then as Lower Canada), a series of charitable institutions, many set up by Catholic religious orders, provided such care. As the country grew, hospitals grew with them. They tended to be not-for-profit, and were run by municipal governments, charitable organizations, and religious denominations (both Catholic and Protestant). These organizations tended to be at arm's length from government; they received subsidies from provincial governments to admit and treat all patients, regardless of their ability to pay. Dr. David Parker of the Maritimes was the first to operate using anesthetic. One of the first "modern" operations, the removal of a tumour, was performed by William Fraser Tolmie in British Columbia.
19th century
The first medical schools were established in Lower Canada in the 1820s. These include the Montreal Medical Institution, which is today the faculty of medicine at McGill University; in the mid-1870s, Sir William Osler changed the face of medical school instruction throughout the West with the introduction of the hands-on approach. The College of Physicians and Surgeons of Upper Canada was established in 1839 and in 1869 was permanently incorporated. In 1834, William Kelly, a surgeon with the Royal Navy, introduced the idea of preventing the spread of disease via sanitation measures following epidemics of cholera. In 1871, female physicians Emily Howard Stowe and Jennie Kidd Trout won the right for women to be admitted to medical schools and granted licenses from the College of Physicians and Surgeons of Ontario. In 1883, Emily Stowe led the creation of the Ontario Medical College for Women, affiliated with the University of Toronto. In 1892, Dr. William Osler wrote the landmark text The Principles and Practice of Medicine , which dominated medical instruction in the West for the next 40 years. Around this time, a movement began that called for the improved health care for the poor, focusing mainly on sanitation and hygiene. This period saw important advances including the provision of safe drinking water to most of the population, public baths and beaches, and municipal garbage services to remove waste from the city. During this period, medical care was severely lacking for the poor and minorities such as First Nations <
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