Editing Medicare (Canada) (section)

==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.

===User premiums===
Currently in Ontario, people with an annual taxable income above $20,000 must pay an annual health care premium ranging from $60–$900.<ref>{{cite web|url=http://www.rev.gov.on.ca/en/tax/healthpremium/rates.html |title=Ontario Health Premium Rate Chart |publisher=Ontario Ministry of Finance }}</ref> Funding for health care in Ontario also comes in part from a dedicated Employer Health Tax (EHT) that ranges from 0.98 percent to 1.95 percent of employer payroll.<ref>{{cite web|url=http://www.rev.gov.on.ca/en/tax/eht/ |title=Employer Health Tax |publisher=Ontario Ministry of Finance }}</ref> Eligible employers are exempted from EHT on the first $400,000 of payroll.{{citation needed|date=October 2011}} British Columbia and Quebec charge similar premiums.

===Medical clinics===
Ontario has increased the number of 24-hour drop-in medical clinic networks{{Citation needed|date=February 2007}} to reduce costs associated with treating off-hours emergencies in hospital 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.{{citation needed|date=October 2011}} 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.

In 2007, the first nurse practitioner-led office to relieve waiting times caused by a shortage of primary practitioners was opened in [[Greater Sudbury|Sudbury, Ontario]].<ref>{{cite news | title=First Nurse Practitioner-Led Clinic Opens Doors in Sudbury | date=August 31, 2007 | publisher=CNW Group | url =http://www.newswire.ca/en/releases/archive/August2007/30/c3886.html | work =REGISTERED NURSES' ASSOCIATION OF ONTARIO | access-date = September 2, 2007 }}</ref><ref>{{cite news | title=1st nurse practitioner-governed clinic opens in Sudbury | date=August 31, 2007 | publisher=CBC | url =https://www.cbc.ca/news/science/1st-nurse-practitioner-governed-clinic-opens-in-sudbury-1.686287 | work =CBC News | access-date = September 2, 2007 }}</ref>

===Alternatives to fee-for-visit or service===
Ontario has also attempted to move the system away from bill for service or visit and toward preventive and community-based approaches to healthcare. The Ontario government in the early 1990s 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|date=February 2007}} they have had a lower cost than the traditional fee-for-service approach.{{Citation needed|date=February 2007}} 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 practitioner]]s, who reduce the workload on the doctors and increase efficiency.

===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|date=February 2007}} 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).

===Privatization===
Currently, privately owned and operated hospitals that allow patients to pay [[Out-of-pocket expenses|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|date=February 2007}} allowing public funding for these hospitals. Workers' Compensation Boards, the [[Canadian Forces]], the RCMP, federally incarcerated prisoners, and medical care for which an insurance company has liability (e.g., motor vehicle accidents) all pay for health care outside of the public systems in all provinces.<ref name="Canada Health Act Overview"/><ref>[http://www.taxpayer.com/main/news.php?news_id=1833 B.C. Canadian Taxpayers Federation] {{webarchive |url=https://web.archive.org/web/20071108232550/http://www.taxpayer.com/main/news.php?news_id=1833 |date=November 8, 2007 }}</ref>

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)]].<ref>{{Citation
| title = Chaoulli v. Quebec (Attorney General), 2005 SCC 35
| access-date = July 11, 2011
| date = June 9, 2005
| url = http://www.canlii.org/en/ca/scc/doc/2005/2005scc35/2005scc35.html
}}</ref>

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 Blue Shield Association|Blue Cross]], [[Green Shield Canada|Green Shield]] and [[Manulife]] have been available for many years to cover services not covered by the Canadian health care system, such as dental care and some eye care. Private insurance is provided by many employers as a benefit.

The Canadian Medical Association (CMA) released a report<ref>{{cite web |url=http://www.canada.com/nationalpost/news/story.html?id=fe42e2be-077a-4193-a7c0-d6fc2e242269&k=12821 |title=Doctors' group prescribes private health care |publisher=Canada.com |date=July 30, 2007 |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20121026020309/http://www.canada.com/nationalpost/news/story.html?id=fe42e2be-077a-4193-a7c0-d6fc2e242269&k=12821 |archive-date=October 26, 2012 }}</ref> in July 2007 endorsing private healthcare as a means to improve an ailing healthcare system. [[Brian Day|Dr. Brian Day]], who acted as President of the CMA in 2007/2008, is the owner of the largest private healthcare hospital in Canada and a proponent of mixed public and private healthcare in Canada.

===Canadian Health Practitioner standards===
It is generally accepted that physicians arriving in Canada from other countries must meet Canadian Health Practitioner standards. So there is concern that doctors from other countries are not trained or educated to meet Canadian standards. Consequently, doctors who want to practise in Canada must meet the same educational and medical qualifications as Canadian-trained practitioners.  Others suggest that the [[Canadian Medical Association]], the [[Ontario Medical Association]], and the regulatory bodies (the provincial [[Royal College of Physicians and Surgeons of Canada|Colleges of Physicians and Surgeons]]) have created too much red tape to allow qualified doctors to practise in Canada.<ref>{{cite journal |pmid=10763392|pmc=1232340|year=2000|last1=Mahim|first1=A|title=Red tape is strangling foreign-trained physicians|journal=CMAJ |volume=162|issue=7|pages=972}}</ref> Canada's health system is ranked 30th in the world, suggesting the logic of the doctor shortage defies the statistics.<ref>{{cite web|url=http://cthealth.server101.com/Old%20Universal%20Health%20Care/united_states_spends_most_on_health,_but_france_no__1_in_treatment.htm |title=Universal Health Care – Canada ranks 30th |publisher=Cthealth.server101.com |date=June 20, 2000 |access-date=June 6, 2011}}</ref> In fact according to a report by Keith Leslie of the Canadian Press in the Chronicle Journal, November 21, 2005, over 10,000 trained doctors are working in the United States, a country ranked 37th in the world. It would suggest money or the perception of better working conditions, or both, are resulting in an exodus of Canadian doctors (and nurses) to the USA.<ref name="ReferenceA">Ont. Medi Scare – Chronicle Journal, Thunder Bay, November 21, 2005 – Physician shortage puts stability of health-care system at risk. OMA</ref>

It is important to recognize that many consider the doctor shortage in Canada to be a very severe problem affecting all sectors of health care. It may relate in part to the details of how doctors are paid; a detail often misunderstood. In Canada, almost all doctors receive a fee per-visit, not per-service. It has been suggested that this type of "fee-for-visit" payment system can encourage complexity, volume visits, repeat visits, referrals, and testing.<ref>{{cite web|url=http://epe.lac-bac.gc.ca/100/200/300/fraser/health_reform/improving.html |title=Improving health care for Canadians |publisher=Epe.lac-bac.gc.ca |access-date=June 6, 2011}}</ref><ref>{{cite web|url=http://www.benefitnews.com/feedback/views34.cfm |title=Health Care Costs Nobody Talks About |date=April 8, 2007 |access-date=June 6, 2011 |archive-url=https://web.archive.org/web/20070408035710/http://www.benefitnews.com/feedback/views34.cfm |archive-date=April 8, 2007}}</ref>

One consequence of the shortage in Canada is that a great many patients are left without family doctors, and trained specialists, making early intervention very difficult. 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."<ref>{{cite web |url=http://triec.ca/index.asp?pageid=41&int=newsite/news-media/inthenews/MediaClippings/StarAug1904.htm |title=What doctor shortage? – Toronto Star, August 19, 2004 |publisher=Triec.ca |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20070929211116/http://triec.ca/index.asp?pageid=41&int=newsite%2Fnews-media%2Finthenews%2FMediaClippings%2FStarAug1904.htm |archive-date=September 29, 2007 }}</ref>

A CBC report [6](August 21, 2006) on the health care system reports the following:

<blockquote>Dr. Albert Schumacher,<ref>{{cite web|url=http://www.cbc.ca/news/background/healthcare/public_vs_private.html |title=Private verses Public – Dr. Albert Schumacher |publisher=Cbc.ca |date=2006-12-01 |access-date=2011-06-06}}</ref> former president of the Canadian Medical Association estimates that 75 percent 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.</blockquote>

In a report by Keith Leslie of the Canadian Press in the Chronicle Journal, November 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 affecting the doctor shortage in one province over another.<ref name="ReferenceA"/> Essentially, privatized healthcare is not a choice of interest for lower income Canadians, it is most likely to be unaffordable and unfair to those who suffer on a social standard.