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Health Systems and Policy Monitor
Canada
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Health systems in transition
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Country overview
Canada’s publicly funded decentralized health system, entitled medicare, covers all citizens and permanent residents for medically necessary hospital and physician services.
Provincial and territorial (P/T) governments have primary responsibility for financing and organizing universal health insurance programmes for their populations and regulating providers. The federal government regulates the efficacy and safety of medical devices and pharmaceuticals, and administers a range of services for certain populations. Most providers are self-governing and registered with a provincial regulatory body.
Most funding comes from taxation at the P/T government level; about one-quarter comes from federal taxes. To qualify for federal funding, P/T insurance plans must provide first-dollar coverage of medically necessary physician, diagnostic and hospital services (including inpatient prescription drugs) for all eligible residents. They also provide some coverage for other services, such as long-term care, prescription drugs for some sub-populations, and some community mental health and addictions services. As there is no nationally defined statutory benefit package, coverage decisions are made by P/T governments, and there are gaps in coverage, notably for prescription drugs.
Resources are pooled provincially and allocated to single or multiple arm’s-length health regions on a largely historical basis. The regions fund long-term care, hospital and community services, again mostly on historical global budgets. Nearly all providers are private, but provinces negotiate physicians’ fees and pay them directly. Additionally, some costs, such as prescription drugs, vision and dental care, are covered in part with employment-sponsored private health insurance.
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