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Medicare in Canada: An Overview

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This page provides information about the principals governing Medicare in Canada.

The Medical Care Act, more commonly known as Medicare, can be defined as the country’s publicly funded comprehensive health insurance system. Under government legislature, circa 1984, Medicare in Canada entitles individual citizens to prepaid coverage for health services, treatments and procedures deemed medically necessary, and provided by primary health care physicians. Also included in the plan are hospital care and stays, emergency dental surgeries. as well as various other health services. There are a few exceptions to the rule, but essentially, Medicare in Canada renders all residents eligible for health care benefits, regardless of financial situation, medical history or living standards.

Medicare in CanadaBoth federal and provincial/territorial governments have roles to play and responsibilities to share in keeping the Canadian health care system running smoothly. The Canada Health Act (CHA) specifies conditions to be met by the 10 provinces and 3 territories for their individual insurance plans, so that each may obtain full credit of the Canada Health Transfer (CHT) cash contribution from the federal government. Each province and territory’s government is equally responsible for managing, organizing and providing the delivery of health services for its residents.

The Five Principles Governing Medicare in Canada
Rather than creating a single nationwide health insurance plan, Canada has instead designed a system consisting of 13 separate but interwoven provincial and territorial plans, all of them sharing a commonality in their features and essential coverage guidelines. There are five principles which govern Medicare in Canada under the Canada Health Act. They are symbolic of the country’s fundamental values of unity and equity:

Public Administration: All provincial and territorial health care administration processes must be conducted free of charge by a certified public professional accountable in their province or territory. An individual’s records and accounts are open to questioning and auditing.

Comprehensiveness: Any health care service or procedure viewed as a medical necessity, including hospital visits, physician treatments, and surgical dental work must be covered by Canada’s health plan.

Universality: All Canadian residents with insurance benefits are entitled to an equal degree of health care.

Portability: Residents moving to another province or territory remain eligible for insurance coverage through their home province’s health plan until their new provincial plan takes effect (minimum waiting time). This rule also applies to residents leaving the country.

Accessibility: All insured citizens are to be given fair admission to health care facilities. Also, all doctors, hospitals, etc. must receive adequate compensation for their services.

The Fine Print
New residents coming to live in a specific province or territory must apply for its health insurance program to obtain coverage. Once their application has been approved, they are issued a health card, which is their key to accessing Medicare services in that particular part of the country. Before benefits can be granted to new residents, a certain waiting period must first elapse. Although the waiting period can vary, it cannot surpass three months, as stated in the Canada Health Act.

Medicare in Canada stipulates that health care premiums are mandatory for the provinces of Ontario, British Columbia and Alberta. Nevertheless, the Canada Health Act prevents patients from being refused health care and treatment if they are financially incapable of making premium payments.

Aside from basic insurance coverage as outlined in the Canada Health Act, some provincial governments typically fund additional services, which can include dental care, physiotherapy, and prescription drugs.

Some Benefits of Medicare
Thanks to Medicare in Canada, the country boasts as one of the highest-ranking in terms of life expectancy (an average of 80 years) and the lowest-ranking in terms of infant morality rate among western industrialized nations.