Medicare (Canada)

The term medicare (in lower case) (assurance-maladie) is the unofficial name for Canada's universal public health insurance system. Under the terms of the Canada Health Act, the provinces provide all residents with health insurance cards, which entitle the bearer to receive free medical care for almost all procedures. Patients are free to choose their own doctor, hospital, etc. Health institutions are either private and not-for-profit (such as university hospitals) or state-run (such as Quebec's CLSC system), and doctors in private practice are entrepreneurs who bill the medicare system for their fees.

Many Canadians highly value their medicare programme. Polling data in the last few years have consistently cited it as the most important political issue in the minds of Canadian voters. Consequently, it has increasingly become a source of controversy in Canadian politics, mostly due to the common perception that the quality of care provided has been steadily decreasing, particularly throughout the past two decades. Commonly referenced problems include: limited access to diagnostic equipment (such as MRIs and CT Scanners), lengthy wait times for surgeries and serious physician shortages, which are particularly prevalent for General Practitioners(GP)/Family Doctors. In some parts of the country waiting times to acquire a GP have been quoted at several years. As a result some pundits and think tanks have proposed introducing a two-tier healthcare system.

While complaints or a steadily worsening system are common, statistical justification for this is hard to locate. Despite growing wait lists and some funding cuts there has been no sign of any decrease in the overall health and well being of Canadians, and Canadians who experience the healthcare system still rate the experience as highly as anywhere else in the world. Canada has been maintaining its high level of health care relative to other developed nations.

Though most Canadian politicians and citizens acknowledge that there are some problems with the system, the proposed solutions often spark passionate debate. On one hand there are those who believe that the problem is simply one of underfunding. They point to the rise of neo-conservative economic policies in Canada, and the associated reduction in welfare state expenditure (particularly in the provinces) from the 1980s onwards as the cause of degradation in the system. However, it is commonly estimated that costs associated with the medicare system have still been creeping upwards as a percent of total government expenditures. Again, many critics argue that neo-conservative governments merely made huge cuts to other programs as a reason for health care creeping to high percentages of government spending. Still, serious funding increases are generally believed to require an increase in taxation.

On the other hand there are those who argue that the system in its current form is simply financial unsustainable. They suggest that the rising cost of medical technology, infrastructure and wages are partly to blame. Moreover, it is the lack of financial accountability and bureaucratic inefficiency associated with administering a service that is almost entirely state-run that has led to spiralling costs and an ingrained resistance to reform. Canada's proximity to the United States is also cited as a serious problem, on account of the infamous "Brain Drain" - a phenomenon which describes the migration of Canadian-trained doctors and nurses (as well as other professionals) to the United States, where private hospitals can pay much higher wages and income tax rates are lower.

In recent years some have called for an increased role for the private sector in the delivery of hosptial medicare services. Currently, privately owned and operated hospitals that allow patients to pay out-of-pocket for services cannot obtain public funding in Canada, as they contravene the "equal accessibility" tenets of the Canada Health Act. Currently Canada has the most public hospital system in the world: 98% of all Canadian hospital care is paid for by the state, while no other country covers more than 80%.

Many political scientists believe that removing the "equal accessibility" clause could be political suicide. Some have suggested relaxation of the rules of the Act to allow such facilities to open and operate in tandem with the publicly funded system. It is believed that this would lessen the burden on the publicly funded system as many citizens would simply choose to pay out-of-pocket or through private insurers for services rather than deal with the troubled public system. However, such proposals have been met with a large degree of public hostility. As a compromise, some provincial governments have experimented with the concept of "public-private partnerships" (P3 Projects) or the contracting out of health services to private providers, whose services are paid for out of the public purse.

In a P3 project situation, a private company is granted licence to build a hospital, or other facility, and to manage maintenance and infrastructure services upon its completion. However, all health services in the facility continue to be paid for and administered solely by the public system. Advocates for P3 projects in Canada often cite the successful implementation of such facilities in the National Health Service (NHS) of the United Kingdom. A significant report by the UK National Audit Committee released in early 2003 reported much success with the P3 system. In the Canadian province of Ontario, the government signed deals for the construction of several P3 facilities, including one for the William Osler Hospital in Brampton and the Royal Ottawa Hospital. However, the defeat of the Progressive Conservative government of Ernie Eves in Ontario on October 2, 2003 placed the status of these projects in jeopardy, as the newly elected Liberal premier, Dalton McGuinty, had campaigned against the use of P3 hospitals.

Due to the decentralized nature of the Canadian federation, the degree of privatization varies from province to province.

Now, in Ontario, people with a high enough income must pay an annual health care premium. It can range from $300-$800, depending on one's annual income. This payment is charged for those having salary above CN$38,000. Premiums also exist in British Columbia and Alberta, though as Alberta approaches debt-free status, there has been talk of removing it.

One of the main issues regarding medicare is the resistance offered by the Canadian health system for foreign trained doctors called IMGs (i.e. international medical graduates). This is the opposite of what is happening in the US which is absorbing doctors from all over the world. In practice, little has been done to solve this issue all across Canada.

While care from a doctor or a hosptial is covered by the state to a greater degree than any other country in the world, Canada compensates by having one of the most limited public health systems. Dental care is still almost wholly private, drugs are only partially covered, optometry is only partially covered and only in certain provinces. As a result the fraction of health spending that is done by the government is lower in Canada than the average for a developed country.

Canadian health care in comparison

Despite the high costs of providing health care in Canada's hinterland and the high wages necessary to compete with those given in the United States Canada spends no more than the G7 average on health care as a percent of its GDP. Most health statistics in Canada are about average for the G7, and vastly better than the world average.

Country	Life expectancy	Infant mortality rate	Per capita expenditure on health (USD)	Healthcare costs as a percent of GDP	% of government revenue spent on health	% of health costs paid by govenrnemt	% of health costs paid by private sector
Australia	80.0	5.6	1,741	9.2	16.8	67.9	32.1
Canada	79.3	5.6	2,163	9.5	16.2	70.8	29.2
France	79.3	5.7	2,109	9.6	13.7	76.0	24.0
Germany	78.2	5.2	2,412	10.8	16.6	74.9	25.1
Japan	81.4	4.1	2,627	8.0	16.4	77.9	22.1
UK	77.5	5.9	1,835	7.6	15.4	82.2	17.8
USA	77.0	6.4	4,887	13.9	17.6	44.4	55.6

See also: Canadian and American health care systems compared

Source: , note that these figures include all areas of health care including dentistry and optometry and drugs.

See also:

• OHIP