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8 min read
Understanding healthcare in Canada is vital for anyone new to the country. From the fundamental aspects of how healthcare functions in Canada to ensuring newcomers are well-equipped to navigate their healthcare journey, we’ve got you covered. Whether you're a recent immigrant or a seasoned resident, our guide will equip you with the knowledge to understand your rights, responsibilities, and options within Canada's healthcare framework.
Uncover the ins and outs of Canada's healthcare system, from coverage to registration, ensuring newcomers are equipped with the knowledge to access their healthcare needs confidently in their new Canadian home.
Healthcare in Canada
The Canadian Constitution plays a significant role in the organization of Canada's health care system. It divides roles and responsibilities between the federal, provincial, and territorial governments. Canada's provincial and territorial governments are mainly responsible for delivering healthcare and other social services. The federal government also delivers services to certain groups of people. This division of responsibilities ensures a comprehensive and efficient Canadian healthcare system.
Medicare refers to Canada's publicly funded health care system. Medicare regulates and administers 13 provincial and territorial health care insurance plans. Under Medicare, Canadian residents and citizens can access hospital and physician services without paying out-of-pocket medical costs. It ensures your healthcare needs are met, no matter where you are in Canada.
Canada's health care system is financed publicly via federal, provincial, and territorial taxation. Provinces may charge a health premium on their residents to help pay for publicly funded healthcare. Still, non-paying premiums must allow access to medically necessary health services.
Learn more about healthcare in Canada.
Who is Covered by Canada's Healthcare System?
Canadian citizens and permanent residents are entitled to public health insurance coverage. Some temporary residents, like refugees and asylum seekers, may also be eligible for provincial/territorial health insurance plans after meeting residency requirements.
What Services Are Covered?
Public health insurance plans cover a broad range of medically necessary services, including:
- Hospital stays (inpatient and outpatient services),
- Medically necessary physician services,
- Diagnostic tests (e.g., X-rays, blood work),
- Certain surgeries, and
- Preventive care services.
Canada's public health insurance plans generally do not cover:
- Prescription drugs (though some provinces offer limited coverage for seniors and low-income individuals),
- Dental care,
- Vision care,
- Ambulance services (may vary by province/territory),
- Private or semi-private hospital rooms.
Payment For Uncovered Services
Canadians often have private health insurance plans to cover services not included in public health plans, such as prescription drugs, dental care, and vision care. These plans can be employer-sponsored or purchased individually. You can also pay out-of-pocket for services not covered by public or private insurance.
How Does Healthcare Coverage Work in Canada?
Every Canadian permanent resident and citizen living in Canada has access to medically necessary healthcare services, regardless of income levels, employment status, or pre-existing medical conditions, via Canada's publicly found Medicare system.
Primary Healthcare Services
Canadians often turn to primary health care services when they need health care. Primary health care serves a dual function. First, they provide direct, first-contact health care services. Secondly, primary healthcare services in Canada coordinate patient healthcare services, ensuring continuity of care across the healthcare system when specialized services from specialists of hospitals are required.
Primary healthcare services in Canada cover many prevention and treatment services for common diseases and injuries. Primary healthcare services in Canada also have:
- Essential emergency services,
- Referrals to and coordination with other levels of care,
- Primary mental health care,
- Palliative and end-of-life care,
- Health promotion,
- Healthy child development,
- Primary maternity care, and
- Rehabilitation services.
Doctors in private practice are generally paid via fee-for-service schedules that itemize each service. These fees are negotiated between each provincial and territorial government and the medical professional associations in their respective legal jurisdictions. Doctors in other practice settings, such as community health centers, clinics, and group practices, will likely be paid through an alternative payment scheme, such as salaries or a blended payment.
Secondary Services
A patient may be referred for specialized care at a hospital, long-term care facility, or community. Most Canadian hospitals are administered and operated by voluntary organizations, community boards of trustees, or regional health authorities. Canadian hospitals are mostly funded through annual, global budgets with overall expenditure targets or limits negotiated with provincial and territorial ministries of health or regional health authorities or boards.
Although global funding remains Canada's principal hospital reimbursement approach, many provinces are experimenting with supplementary funding approaches. Secondary healthcare services may offer long-term and chronic healthcare services at home, in communities, and in institutions. Medical professionals assess patient needs, and services are coordinated to provide continuity of care. Care is provided by various formal, informal (often family), and volunteer caregivers.
Many home and continuing healthcare services are not provided under the Canada Health Act. However, Canada's provinces and territories pay for certain home and continuing care services. Canada's federal Department of Veterans Affairs Canada provides home care services to certain veterans when unavailable in a particular province or territory. Furthermore, the government provides home care services to people on reservations and Inuit in particular communities. The provincial and territorial governments pay for health care services in long-term care facilities. In contrast, room and board costs are paid for by the individual.
Supplementary Services
The provinces and territories cover seniors, children, and low-income residents for health services not generally covered under Medicare. Supplementary health benefits often include:
- Prescription drugs outside hospitals,
- Dental care,
- Vision care,
- Medical equipment and appliances (prostheses, wheelchairs, etc), and
- Services of other health professionals such as physiotherapists.
Note that the level of coverage varies across the country.
If you don't qualify for supplementary benefits under government plans, you must pay for those services through out-of-pocket payments or private health insurance.
What is the Role of Government in Healthcare in Canada?
The Canadian government plays a crucial role in ensuring universal access to healthcare through a single-payer system often referred to as Medicare. Here's a breakdown of the key responsibilities of the government in the Canadian healthcare system.
Federal
Canada's federal government sets and administers national principles for the nation's healthcare system via the Canada Health Act. It also provides financial support to the healthcare systems of provinces and territories. Other functions include funding and delivery of primary and supplementary services to qualifying groups of people.
These groups include:
- First Nations people living on reserves and Inuit,
- Serving members of the Canadian Armed Forces,
- Eligible veterans,
- Inmates in federal prisons, and
- Certain refugee claimants.
The Canada Health Act establishes the conditions for health insurance plans that provinces and territories must fulfill to receive full federal cash transfers supporting their healthcare systems.
Provinces and territories must provide reasonable access to medically necessary hospital and doctors' services. The Canada Health Act also discourages extra-billing and user fees.
The federal government provides cash and tax transfers to the provinces and territories to support healthcare via the Canada Health Transfer program. The federal government is also responsible for health regulating:
- Pharmaceuticals,
- Food,
- Medical devices,
- Consumer safety, and
- Disease surveillance and prevention.
It also provides support for health promotion and health research.
Provincial
Canadian provinces and territories administer most of the Canadian healthcare systems services using health insurance plans expected to meet national principles under the Canada Health Act.
The roles of the provincial and territorial governments in health care include
- Administration of their health insurance plans;
- Planning and funding of care in hospitals and other health facilities;
- Services provided by doctors and other health professionals;
- Planning and implementation of health promotion and public health initiatives; and
- Negotiation of fee schedules with health professionals.
Canada's provincial and territorial governments fund supplementary benefits for certain groups, such as low-income residents and seniors. These benefits include drugs prescribed outside hospitals, ambulance costs, and hearing, vision, and dental care not covered by the Canada Health Act.
Individuals and families not qualifying for Medicare coverage may pay these costs directly (out-of-pocket), buy private insurance, or get coverage via an employment-based group insurance plan. Under Canada's provincial and territorial laws, private insurers are restricted from offering coverage similar to publicly funded plans. Still, they can compete in the supplementary coverage market.
Trends and Changes in Canadian Healthcare
Canada's healthcare system, a source of national pride, faces a dynamic landscape with evolving trends and ongoing challenges. Understanding these will be crucial for policymakers and patients navigating the future of healthcare in Canada. The changing healthcare trends in Canada include the following.
Primary Care
Canada's aging population, rising chronic disease rates, and other changing health trends have increased Canada's need to maintain and develop its healthcare system's capacity to respond to Canada's care needs. Reforms have focused on primary healthcare delivery, including setting up more community primary healthcare centers that provide on-call services around the clock, creating primary healthcare teams, and emphasizing health more.
eHealth
eHealth is technologies like telehealth, and electronic health records are drivers of innovation, sustainability, and efficiency in Canada's healthcare system. Electrical healthcare improves access to services, patient safety, quality of care, and productivity. Implementing and using eHealth records has contributed to the renewal of Canada's primary health care by facilitating effective coordination and integration of services amongst Canada's healthcare providers.
Wait Times Reduction
Canadian provincial and territorial efforts to reduce healthcare care wait times include:
- Training and hiring more health professionals,
- Clearing backlogs of patients requiring treatment,
- Building capacity for regional centers of excellence,
- Increasing ambulatory and community care programs, and
- Developing and implementing tools to better manage wait times.
Patient Safety
Patient safety, including avoiding medical errors, poses major challenges to the global health system and is an aspect of Canada's efforts to improve health care quality in the country.
The federal, provincial, and territorial governments are continuing to work with healthcare professionals, organizations, and institutions to understand better and mitigate the risks involved in the delivery of healthcare. This includes developing and implementing measures to improve the quality of care and patient safety.
FAQs
Can I Use My Foreign Health Insurance in Canada?
Yes, while some foreign health insurance plans may offer coverage in Canada, it's essential to review the terms and conditions of your policy, as additional coverage or out-of-pocket expenses may still be required for certain medical services.
What is the Role of the Canada QBank in Medical Education?
The Canada QBank plays a vital role in medical education by providing comprehensive question banks and study materials to help medical students and professionals prepare for licensing exams, residency programs, and ongoing medical education.
What Percentage of Canadians Have Private Health Insurance?
Approximately 60% of Canadians have private health insurance via employment benefits, according to Statistics Canada. Private health insurance often covers expenses such as prescription medications, dental care, and vision care that are not fully covered under the public healthcare system.
