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The Medicare Delivery System

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This page provides information about the Medicare delivery system in regards to the public and private sectors.

There is a specific distinction between Medicare funding and Medicare delivery. Health care funding pertains to where payment comes from for medical services and treatments, while delivery refers to the manner in which they are provided and managed. The Medicare delivery system involves the vast group of physicians, nurses, and health professionals who supply Canadians with medical care. Similar to the set up in financing, the delivery system also adopts different roles with regard to the public and private sectors.

Public and Private Sector Participation
Medicare DeliveryCanada’s health care system consists of an important cross-section of both public and private influence. In most situations, the responsibility for delivering health care services to Canadian patients falls on private medical practitioners and organizations, such as physicians and hospitals. Nevertheless, the government practices significant authority over the methods used by the private sector to deliver health services since they are government-funded (through each province and territory’s public health insurance plan), with all funds going directly to the associated hospitals and medical facilities. Non-public (or non-government) participants in Medicare delivery can cover a wide spectrum of type, which commonly consist of “for-profit” companies, charitable and non-profit foundations, plus individual contributors and families.

Generally speaking, Canadian health care is not fully financed and delivered by either the public or private sector. It is characterized rather, as a joint effort, the combined participation of both public and private sectors.

For example, a patient might be admitted to a specialized long-term care facility in his or her community for medical health services. Although most hospitals in Canada are operated and regulated by their own municipality, their community’s board of trustees, or an association of volunteers, they are still funded by government. Therefore, health care services will be given in such institutions at the expense of provincial and territorial governments. However, the patient will have to pay out-of-pocket for room and board fees. There are certain instances where government subsidy is provided.

Through referrals made by physicians, hospitals, local agencies and families, Medicare delivery is available to patients in the comfort of their home, if they are partially or fully incapacitated. In-home services can include homemaking, specialty nursing, and adult day care. Each patient’s needs are assessed, and then met with a working outline to ensure continued comprehensive care.

Prescription Medication
Limited drug benefit plans are generally in place for each province and territory, as the Canada Health Act only gives full coverage of pharmaceutical drugs when used in the treatment of in-hospital patients. There are differing levels of coverage; some parts of the country provide coverage only to select age groups (seniors mostly) and individuals in receipt of social assistance, whereas other areas may be more comprehensive with their benefit criteria.

Dental and Eye Care
Medicare is not obligated to offer coverage for dental services in Canada; however, there are some exceptions as in the province of Quebec where children under 10 years of age are provided with near-full coverage. As well, several oral surgical procedures are covered for all ages. But as a general rule, Canadians must open their wallets to pay the dental bills, or turn to their employers for a group insurance plan, or buy a private insurance policy. Public health units in certain jurisdictions have created specific programs aimed at addressing the needs of children, the elderly and welfare recipients.