Editing Medicare (Canada) (section)

==Delivery==
Canada uses a mix of public and private organizations to deliver health care in what is termed a publicly funded, privately delivered system. Hospitals and acute care facilities, including long term complex care, are typically directly funded. Health care organizations bill the provincial health authorities, with few exceptions.<ref>{{cite web | first=Raisa | last=Deber | date=August 2002 | title=Delivering Health Care Services: Public, Not-For-Profit or Private | url=http://teamgrant.ca/M-THAC%20Greatest%20Hits/Bonus%20Tracks/Delivering%20Health%20Care%20Services.pdf | access-date=August 7, 2008 | url-status=dead | archive-url=https://web.archive.org/web/20110706204324/http://www.teamgrant.ca/M-THAC%20Greatest%20Hits/Bonus%20Tracks/Delivering%20Health%20Care%20Services.pdf | archive-date=July 6, 2011 }}</ref> Hospitals are largely non-profit organizations, historically often linked to religious or charitable organizations. In some provinces, individual hospital boards have been eliminated and combined into quasi-private [[Health regions of Canada|regional health authorities]], subject to varying degrees of provincial control.

Private services are provided by diagnostic laboratories, occupational and physical therapy centres, and other allied professionals. Non-medically necessary services, such as optional plastic surgery, are also often delivered by for-profit investor-owned corporations. In some cases patients pay directly and are reimbursed by the health care system, and in other cases a hospital or physician may order services and seek reimbursement from the provincial government.

With rare exceptions, medical doctors are small for-profit independent businesses. Historically, they have practised in small solo or group practices and billed the government Canadian Health Care system on a [[fee for service]] basis. Unlike the practice in fully socialized countries, hospital-based physicians are not all hospital employees, and some directly bill the provincial insurance plans on a fee-for-service basis. Since 2000, physicians have been allowed to incorporate for tax reasons (dates of authorization vary province to province).

Efforts to achieve ''primary health care reform'' have increasingly encouraged physicians to work in multidisciplinary teams, and be paid through blended funding models, including elements of capitation and other 'alternative funding formulas'. Similarly, some hospitals (particularly [[teaching hospital]]s and rural/remote hospitals) have also experimented with alternatives to fee-for-service.

In summary, the system is known as a "public system" due to its public financing, but is not a nationalized system such as the UK's [[National Health Service|NHS]]: most health care services are provided privately.<ref>{{cite web|url=http://www.cbc.ca/news/background/healthcare/public_vs_private.html |title=CBC Health Care Private versus Public |publisher=Cbc.ca |date=December 1, 2006 |access-date=June 6, 2011}}</ref>

An additional complexity is that, because health care is under provincial jurisdiction, there is not a "Canadian health care system". Most providers are private, and may or may not coordinate their care. Publicly funded insurance is organized at the level of the province/territory; each manages its own insurance system, including issuing its own healthcare identification cards (a list of the provincial medical care insurance programs is given at the end of this entry). Once care moves beyond the services required by the ''Canada Health Act''—for which universal comprehensive coverage applies—there is inconsistency from province to province in the extent of publicly funded coverage, particularly for such items as outpatient drug coverage and rehabilitation, as well as vision care, mental health, and long-term care, with a substantial portion of such services being paid for privately, either through private insurance, or out-of-pocket.<ref>{{cite web |url=http://www.pharmacists.ca/content/cpjpdfs/sept04/Commentary-Sept04.pdf |title=Neil MacKinnon. Commentary: Provincial drug plans. 2004 |access-date=June 6, 2011 |archive-url=https://web.archive.org/web/20110706200303/http://www.pharmacists.ca/content/cpjpdfs/sept04/Commentary-Sept04.pdf |archive-date=July 6, 2011 |url-status=dead }}</ref><ref>{{cite web |url=http://www.intl.pdx.edu/ISP/canadian/canadian_healthcare.pdf |title=Mark Kaplan. Myths and Realities of Canadian Medicare. Fall 2004 |publisher=Intl.pdx.edu |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20080720012741/http://www.intl.pdx.edu/ISP/canadian/canadian_healthcare.pdf |archive-date=July 20, 2008 }}</ref> Eligibility for these additional programs may be based on various combinations of such factors as age (e.g., children, seniors), income, enrollment in a home care program, or diagnosis (e.g., HIV/AIDS, cancer, cystic fibrosis).

According to a 1958 study, Provincial governments have been responsible for providing necessary medical and hospital care "to indigent residents of municipally unorganized territory".<ref>[https://babel.hathitrust.org/cgi/pt?id=mdp.39015007712352&view=1up&seq=3 Health care series. : Memorandum. no.3 1958, P.19]</ref>

===Drug coverage===
Unlike every other country with universal health insurance systems, Canada lacks a universal pharmaceutical subsidy scheme, with co-payment, cost ceilings, and special subsidy groups varying by private insurer and by province.<ref>{{cite journal | pmc = 4401594 | pmid=25780047 | doi=10.1503/cmaj.141564 | volume=187 | issue=7 | title=Estimated cost of universal public coverage of prescription drugs in Canada | year=2015 | journal=CMAJ | pages=491–7 |vauthors=Morgan SG, Law M, Daw JR, Abraham L, Martin D }}</ref><ref>{{cite journal|url=https://www.academia.edu/17685108|title=From the city to the bush: increases in patient co-payments for medicines have impacted on medicine use across Australia|journal=Australian Health Review|first1=Kemp|last1=Anna|first2=Glover|last2=John|first3=Preen, David|last3=B.|first4=Bulsara|last4=Max|first5=Semmens|last5=James|first6=Roughead, Elizabeth|last6=E.|volume=37|issue=1|pages=4–10|doi=10.1071/AH11129|pmid=23157851|year=2013}}</ref> Each province may provide its own prescription drug benefit plan, although the ''Canada Health Act'' requires only coverage for pharmaceuticals delivered to hospital inpatients.<ref>{{cite web |url=http://www.drugcoverage.ca/default.asp |title=Prescription Drug Coverage in Canada |publisher=Drugcoverage.ca |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110621032832/http://www.drugcoverage.ca/default.asp |archive-date=June 21, 2011 }}</ref> Provincial prescription drug benefit plans differ across provinces. Some provinces cover only those in particular age groups (usually, seniors) and/or those on social assistance. Others are more universal. Quebec achieves universal coverage through a combination of private and public plans. Co-payments also vary.<ref>{{cite web|url=http://www.oecd.org/dataoecd/21/40/37868186.pdf |title=Valérie Paris and Elizabeth Docteur. Pharmaceutical Pricing and Reimbursement Policies in Canada. OECD Health Working Papers 24, 2006. |access-date=June 6, 2011}}</ref> Provinces maintain their own provincial formularies, although the [[Canadian Agency for Drugs and Technologies in Health|Common Drug Review]] provides evidence-based formulary listing recommendations to the provincial ministries. Note that there is ongoing controversy in Canada, as in other countries, about inclusion of expensive drugs and discrepancies in their availability, as well as in what if any provisions are made for allowing medications not yet approved to be administered under "exceptional drug" provisions.<ref>{{cite web |url=http://www.drugcoverage.ca/p_rejected_claims.asp?language=1 |title=on rejected claims |publisher=Drugcoverage.ca |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110514101531/http://www.drugcoverage.ca/p_rejected_claims.asp?language=1 |archive-date=May 14, 2011 }}</ref> Drug costs are contentious. Their prices are controlled by the [[Patented Medicine Prices Review Board]] (PMPRB).<ref>{{cite web|url=http://www.pmprb-cepmb.gc.ca/english/home.asp?x=1 |title=PMPRB Home page. Accessed Dec 26, 2007 |publisher=Pmprb-cepmb.gc.ca |access-date=June 6, 2011}}</ref> The PMPRB's pricing formula ensures that Canada pays prices based on the average of those charged to selected countries; they are neither the highest, nor the lowest.

Since Medicare has been adopted, there have been regular pushes to add universal pharmacare to it. This came to a head in 2022, when the New Democratic Party and the governing Liberal Party negotiated a supply and confidence agreement, with pharmacare being one of the core concessions the Liberals made in exchange for the NDP's confidence. As a result of this coalition, Canada's pharmacare act received royal assent on October 10, 2024, with the first phase creating a single payer system for contraceptives and diabetic medications, as well as the creation of a government agency to identify which drugs will be added next. Since becoming law, the federal government has begun negotiating with the provinces on how it will be implemted, with British Columbia becoming the first province to sign on to the program.<ref>{{Cite web |title=Canada's pharmacare bill is now law. What this means for you - National {{!}} Globalnews.ca |url=https://globalnews.ca/news/10807237/canada-pharmacare-plan-what-to-know/ |access-date=2024-11-13 |website=Global News |language=en-US}}</ref><ref>{{Cite web |last=Canada |first=Health |date=2024-10-10 |title=Government of Canada Passes Legislation for a First Phase of National Universal Pharmacare |url=https://www.canada.ca/en/health-canada/news/2024/10/government-of-canada-passes-legislation-for-a-first-phase-of-national-universal-pharmacare.html |access-date=2024-11-13 |website=www.canada.ca}}</ref>

===Dental care, eye care, and other services===
[[Dentistry|Dental care]] is not required to be covered by the government insurance plans. In Quebec, children under the age of 10 receive almost full coverage, and many oral surgeries are covered for everyone.<ref>{{cite web|url=http://www.ramq.gouv.qc.ca/en/citoyens/assurancemaladie/serv_couv_queb/serv_dent_sc.shtml#tous |title=RAMQ – Health Insurance – Dental Services – Services Covered |publisher=Ramq.gouv.qc.ca |date=April 14, 2011 |access-date=June 6, 2011}}</ref> Canadians rely on their employers or individual private insurance, pay cash themselves for dental treatments, or receive no care. In some jurisdictions, public health units have been involved in providing targeted programs to address the need of the young, the elderly or those who are on welfare. The Canadian Association of Public Health Dentistry tracks programs, and has been advocating for extending coverage to those currently unable to receive dental care.<ref>{{cite web |url=http://www.caphd-acsdp.org/Welcome.htm |title=Canadian Association of Public Health Dentistry home page |publisher=Caphd-acsdp.org |access-date=June 6, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20100126045927/http://www.caphd-acsdp.org/Welcome.htm |archive-date=January 26, 2010 }}</ref>

The range of services for vision care coverage also varies widely among the provinces. Generally, "medically required" vision care is covered if provided by physicians (cataract surgery, diabetic vision care, some laser eye surgeries required as a result of disease, but not if the purpose is to replace the need for eyeglasses). Similarly, the standard vision test may or may not be covered. Some provinces allow a limited number of tests (e.g., no more than once within a two-year period). Others, including Ontario, Alberta, Saskatchewan, and British Columbia, do not, although different provisions may apply to particular sub-groups (e.g., diabetics, children).

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. Psychiatric services (provided by physicians) are covered, fee-for-service psychology services outside of hospitals or community based mental health clinics are usually not. Physical therapy, occupational therapy, speech therapy, nursing, and chiropractic services are often not covered unless within hospitals. Some provinces, including Ontario include some rehabilitation services for those in the home care program, those recently discharged from hospitals (e.g., after a hip replacement), or those in particular age categories. Again, considerable variation exists, and provinces can (and do) alter their coverage decisions.