HealthManagement, Volume 10 - Issue 3, 2010
Canada's publicly funded healthcare system, known as medicare, consists of ten provincial and three territorial health insurance plans. It provides access to universal, comprehensive coverage for hospital and physician services administered and delivered by the provincial and territorial governments, free of charge.
The provincial and territorial governments have most of the responsibility for delivering health and other social services. The federal government is also responsible for some direct delivery of services for certain groups of people. Publicly funded healthcare is financed with general revenue raised through federal, provincial and territorial taxation, such as personal and corporate taxes, sales taxes, payroll levies and other revenue. Three provinces, British Columbia, Alberta and Ontario, charge healthcare premiums, but non-payment of a premium does not limit access to medically necessary services. The competitive advantage that publicly financed healthcare provides to Canadian business is significant. Public financing spreads the cost of providing health services equitably across the country. In addition, financing health insurance through the taxation system is cost-efficient because it does not require a separate collection process.
The Canada Health Act lists five basic principles, which state that healthcare plans must be available to all eligible residents of Canada; comprehensive in coverage; accessible without financial and other barriers; portable within the country and during travel abroad; and publicly administered. The federal government provides cash and tax transfers to the provinces and territories in support of health through the Canada Health Transfer. To support the costs of publicly funded services, including healthcare, the federal government also provides equalisation payments to less prosperous provinces and territorial financing to the territories.
Primary healthcare services often include prevention and treatment of common diseases and injuries; basic emergency services; referrals to and coordination with other levels of care, such as hospital and specialist care; primary mental healthcare; palliative and end-of-life care; health promotion; healthy child development; primary maternity care; and rehabilitation services.
Services provided at the first point of contact with the healthcare system are known as primary healthcare services and form the foundation of the healthcare system. In general, primary healthcare serves a dual function. First, it provides direct provision of first-contact healthcare services. Second, it coordinates patients' healthcare services to ensure continuity of care and ease of movement across the healthcare system when more specialised services are required.
A patient may be referred for specialised care known as 'secondary services' largely provided by hospitals funded via global budgets negotiated with the provincial and territorial ministries of health, or with a regional health authority or board. Referrals can be made by doctors, hospitals, community agencies, families and potential residents. Needs are assessed and services are coordinated to provide continuity of care and comprehensive care.
