The health care system in Canada is often lauded for its accessibility and quality. From primary to secondary and supplementary services, the Canadian healthcare system aims to provide comprehensive care for its diverse population. However, like any complex system, it faces significant challenges, including long wait times, a shortage of healthcare professionals, and geographic disparities in service provision. This overview will explore the structure, coverage, and challenges of Canada’s healthcare system. It will also provide steps for applying for a health card to be able to access the available medical care.
Universal Healthcare in Canada
Canada’s universal healthcare system, known as Medicare, is a publicly funded and primarily publicly administered system. It ensures access to necessary medical services for all residents without direct charges at the point of care. Medicare is funded through general taxation, including federal and provincial taxes. The federal government provides funding to the provinces and territories through the Canada Health Transfer (CHT), which ensures they have sufficient funds to deliver healthcare services.
Healthcare services are delivered through a network of public and private providers, including hospitals, clinics, and healthcare professionals. Hence, physicians may operate as private practitioners but are paid through public insurance plans administered by the provinces and territories. Additionally, all Canadian citizens and permanent residents are covered for medically necessary hospital and physician services. Coverage includes services such as doctor visits, hospital stays, and surgeries.
Guiding Law: The Canada Health Act (1984)
The Canada Health Act (CHA) is the federal legislation that sets the national standards for publicly funded healthcare insurance plans. It is designed to ensure that all eligible residents of Canada have reasonable access to medically necessary services without direct charges. The Act outlines five main principles:
- Public Administration: Provincial and territorial health insurance plans must be administered on a non-profit basis by a public authority accountable to the provincial or territorial government.
- Comprehensiveness: The plans must cover all insured health services provided by hospitals, physicians, and dentists (when the service must be performed in a hospital).
- Universality: All insured persons in the province or territory must be entitled to the insured health services provided by the plan on uniform terms and conditions.
- Portability: Residents moving from one province or territory to another, or traveling within Canada or abroad, must continue to be covered for insured health services.
- Accessibility: Health services must be provided based on medical needs and not the ability to pay. There should be no financial or other barriers that impede access to necessary healthcare.
Provincial Health Insurance Plans
In the health care system in Canada, public healthcare services are administered on a provincial level. Each province and territory has its own healthcare insurance plan that must adhere to the principles of the Canada Health Act. While the specifics of coverage and administration can vary, the core principles ensure a degree of uniformity across the country. Moreover, residents must register with their provincial or territorial health insurance plan to receive a health card, which they must present to access healthcare services. Eligibility typically requires proof of residency and citizenship or permanent residency status. Also, waiting periods for new residents vary by province and territory. The different provincial health insurance plans across Canada are:
- Alberta: Alberta Health Care Insurance Plan (AHCIP)
- British Columbia: Medical Services Plan (MSP)
- Manitoba: Health and Seniors Care
- New Brunswick: Medicare Registration
- Newfoundland and Labrador: Health and Community Services (MCP)
- Northwest Territories: Health and Social Services
- Nova Scotia: Medical Services Insurance (MSI)
- Nunavut: Nunavut Health Care Plan
- Ontario: Ontario Health Insurance Plan (OHIP)
- Prince Edward Island: PEI Health Card
- Quebec: Québec Health Insurance Plan
- Saskatchewan: eHealth Saskatchewan
- Yukon: Yukon Health Insurance Plan
Which Healthcare Services Are Covered or Not Covered in Canada?
The core of the health care system in Canada focuses on providing essential medical and hospital services without direct charges to patients. However, many supplementary health services are not covered by Medicare. Hence, they may require private insurance or out-of-pocket payments. The extent and availability of coverage for non-core services can vary significantly by province and territory. So, it is essential to be aware of the specific services covered in the region where you reside.
Covered Healthcare Services in Canada
- Physician and Hospital Services: Inpatient care, including necessary nursing services, diagnostic procedures, medications administered in the hospital, and surgical services. As well as outpatient services, such as day surgeries and diagnostic tests.
- Prescription Drug Coverage: Provinces and territories have programs to subsidise drug costs for specific groups, such as seniors, low-income individuals, and those with certain medical conditions. However, the basic health care coverage in Canada does not cover prescription drugs provided outside hospitals.
- Home Care and Long-Term Care: Basic home care services and long-term care are often subsidised but are not fully covered. Residents may need to pay for additional services or accommodations.
- Public Health Nursing: Services like public health nursing are included in the coverage in specific provinces.
- Ambulance Services: Ambulance services are generally covered in various provinces under specific circumstances.
Not Covered Healthcare Services in Canada
- Dental Care: Routine dental care services are generally not covered. However, some provinces like Prince Edward Island provide partial coverage for children and low-income adults.
- Physiotherapy: The public healthcare plans in Canada do not typically cover physiotherapy, chiropractic care, massage therapy, and other similar services. Nonetheless, provinces like Saskatchewan cover them.
- Vision Care: Routine vision care services are often not covered, including eyeglasses and contact lenses. But some provinces like Manitoba take care of them for children and seniors.
- Mental Health and Addiction Services: While psychiatrist services are covered, counselling and therapy provided by psychologists, social workers, or other mental health professionals are often not covered, or coverage is limited.
- Cosmetic Procedures: Non-medically required surgeries like cosmetic procedures are usually not covered.
- Alternative Medicine: Services such as acupuncture, naturopathy, and other forms of alternative or complementary medicine are typically not covered.
Structure of Health Care System in Canada
Primary Health Care: Primary healthcare is the first point of contact within the healthcare system and focuses on providing comprehensive, accessible, and community-based care. Also, it emphasizes prevention, health promotion, and early intervention. It includes services like physical exams, vaccinations, management of chronic diseases (like diabetes or hypertension), minor surgical procedures, and health education. Primary Care Physician (PCP) in Canada who provide these services are family physicians and general practitioners (GPs).
Secondary Health Care: Secondary health care services in Canada are specialized medical services provided by hospitals, long-term care facilities, or in the community. It includes hospital visits, surgical procedures, medical or surgical abortions, and some in-hospital dental surgeries.
Supplementary Health Services: These are additional services not covered under the publicly funded healthcare system. Supplementary benefits are often provided for certain groups like low-income residents and seniors, including prescription drugs, dental care, vision care, and services of health professionals like physiotherapists.
Applying for a Health Card in Canada
Eligibility Requirements
- Permanent Residents: If you are a permanent resident, you are eligible for healthcare coverage in your province or territory of residence.
- Temporary Residents: Some temporary residents, such as those on work or study permits, may also be eligible for coverage depending on the province or territory. It’s important to check the specific criteria in your area.
Waiting Period
The wait times in Canadian healthcare vary for different provinces. So, inquire about the expected timeline when you apply. Some provinces and territories have a waiting period of up to three months before new residents are eligible for coverage. During this waiting period, you are responsible for your own healthcare costs. So, it is advisable to obtain private health insurance to cover any medical needs while you wait.
Steps to Register
- Determine Your Province or Territory: Healthcare coverage is administered at the provincial and territorial levels. So, you will need to register with the health insurance plan in the province or territory where you reside.
- Gather Required Documents: Commonly required documents include proof of identity (passport, PR card, work permit, etc.), proof of residency (rental agreement, utility bill, etc.), and immigration documents. Still, each province or territory may have specific document requirements.
- Visit the Registration Office: Visit the health insurance registration office or the designated service location in your province or territory. Many provinces also allow you to apply online or by mail.
- Submit Your Application: Complete the health insurance application form and submit it along with the required documents. Ensure that all information is accurate to avoid delays in processing your application.
- Receive Your Health Card: Once your application is processed and approved, you will receive a health card. This card must be presented whenever you access healthcare services.
Challenges Facing the Health Care System in Canada
- Long Wait Times: Canadians often experience long wait times for medical procedures, specialist consultations, and diagnostic tests. This is due to the high demand for services combined with limited healthcare resources.
- Shortage of Healthcare Professionals: There is a shortage of doctors, nurses, and other healthcare professionals, particularly in rural and remote areas. Hence resulting in reduced access to primary and specialized care in underserved regions.
- Ageing Population: Canada’s population is ageing, leading to a higher prevalence of chronic diseases and increased demand for healthcare services. Hence, greater strain is put on healthcare resources and systems.
- Geographic Disparities: There are significant differences in healthcare access and quality between urban and rural/remote areas. Hence, rural and remote residents often have limited access to healthcare services, leading to poorer health outcomes.
Conclusion
The health care system in Canada stands as a model of universal healthcare, providing essential medical services to its citizens without direct financial barriers. The structure, which emphasises primary, secondary, and supplementary care, ensures a broad spectrum of health needs are met. It is important for you to understand the intricacies of the Canadian healthcare system to be able to make the most of the services. As a newcomer, one of the first things you should try to get is your health card. This way, you will have little worries about the outrageous cost of health services.
