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Medicare (Canada)

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From Wikipedia, the free encyclopedia

Medicare (French. assurance-maladie ) is the unofficial name for Canada 's publicly funded universal health insurance system. [ 1 ] The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.

Under the terms of the Canada Health Act, all "insured persons" (basically, legal residents of Canada, including permanent residents ) are entitled to receive "insured services" without copayment. Such services are defined as medically necessary services if provided in hospital, or by 'practitioners' (usually physicians). [ 2 ] Approximately 70% of Canadian health expenditures come from public sources, with the rest paid privately (both through private insurance, and through out-of-pocket payments). The extent of public financing varies considerably across services. For example, approximately 99% of physician services, and 90% of hospital care, are paid by publicly funded sources,

whereas almost all dental care is paid for privately. [ 3 ] Most physicians are self-employed private entities which enjoy coverage under each province's respective healthcare plans.

Services of non-physicians working within hospitals are covered; but provinces can, but are not forced to, cover services by non-physicians if provided outside hospitals. Changing the site of treatment may thus change coverage. For example, pharmaceuticals, nursing care, and physical therapy must be covered for inpatients, but there is considerable variation from province to province in the extent to which they are covered for patients discharged to the community (e.g. after day surgery). The need to modernize coverage was pointed out in 2002 by both the Romanow Commission and by the Kirby committee of the Canadian Senate (see External links below). Similarly, the extent to which non-physician providers of primary care are funded varies; Quebec offers primary health care teams through its CLSC system.

Category: Insurance

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