The healthcare system in Canada has its advocates and opponents but it is a matter of fact that the country has a low infant mortality rate compared to other developed countries. What is more, one of the highest life expectancies is precisely in Canada. The average life expectancy is 82.2 years while the life expectancy in the U.S. and Mexico is 79.3 and 76.7 years respectively. Long wait times are a major problem according to opponents, with wait times of about 4 weeks for specialist appointments.
The healthcare system is based on different insurance plans that cover medical care and hospital and dental care. All residents and Canadian citizens are offered coverage regardless of their personal or family income, conditions, and medical history. Emergency medical care is free but restrictions may apply based on immigration status. The different health insurance plans are offered and administered by the territorial and provincial governments. Basically, there are 13 different plans under Medicare, and the territorial and provincial governments cooperate with and share roles and responsibilities with the federal government. The federal government offers support to ensure that certain categories of people have access to medical services. These include inmates, eligible veterans, Inuit and First Nations people (provided that they live on reserves), and others. The federal government is also tasked with regulating and setting standards for medical devices, pesticides, chemicals, pharmaceuticals, food, and other products. In addition, the government offers funding for health-related research and medical services under the different insurance plans. The territorial and provincial plans, on the other hand, offer coverage to all residents as well as supplemental coverage and services to social assistance recipients, children, and seniors. The latter includes independent living, ambulance services, medications, and dental and vision care.
Coverage and eligibility requirements vary by province. In British Columbia, for example, dependents of beneficiaries, residents, and First Nations residents meet the eligibility criteria. Dependents include postsecondary students, children, and spouses. Certain services are not covered under the plan, for instance, medical exams for immigration purposes, sports and recreational activities, school and university enrollment, life insurance, employment, and others. There are other exclusions such as preventive care, acupuncture, hearing aids and eye glasses, and dental care. Non-surgical podiatry, physical therapy, and naturopathy are not covered as well. The plan offers coverage for orthodontic services, oral and dental surgery, and maternity care. In addition, there is coverage for diagnostic services by oral and dental surgeons, podiatrists, midwifes, and registered physicians. In New Brunswick, the healthcare plan covers insured hospital care, including surgical supplies, radiotherapy, medications in hospital settings, and hospital meals and accommodation. Residents are also offered diagnostic services such as X-ray and laboratory tests. The plan provides coverage for audiology and speech therapy, occupational therapy, physiotherapy, and nursing services. There are certain exclusions such as gastric bypass and stapling, dentures, comprehensive medical examinations, artificial insemination, ambulance services, acupuncture, and others. The health insurance plan in Quebec offers coverage for pharmaceutical services, optometric and dental care, and medical services. The list of insured medical services includes radiology services, anesthesia, surgery, psychiatric treatments, and therapeutic and diagnostic tests and procedures. The same goes for consultations and examinations. Medical services are covered when offered in the patient’s home, rehabilitation facilities, long-term care and residential centres, community service centres, and hospitals and medical clinics. When it comes to pharmaceutical services, there are uninsured and insured services as specified under the Public Prescription Drug Insurance Plan. Medications in a pillbox, for example, are not covered under the plan.
Exclusions and Limited Coverage
While maternal care is covered under Medicare, this does not apply to infertility treatment. Quebec is the only province that offers full coverage for infertility treatment. The same goes for home care and mental healthcare which are not covered under Medicare. The coverage for certain medical services is limited, including massage and occupational therapy, physiotherapy, chiropractic, chiropody and podiatry, and others. When it comes to dental care, there is coverage for dental surgeries in hospital settings but routine exams are not covered. There is limited coverage for assistive devices, prescription drugs, and sex reassignment surgeries as well.
Critics claim that Canada’s public healthcare system is overloaded due to the lack of general practitioners and specialists. The pay is low compared to the U.S. while the system itself is unsustainable. Patients complain about long wait times, whether referrals or appointments. Nursing home and long-term care facilities operate at full capacity, and wait times can stretch for weeks or even months. Many believe that the public system is inefficient; so, is private healthcare Canada’s future? If so how much will this cost? Would people be forced to get loans to support relatives who need special care; see here.
Problems Inherent to the Public System
Lack of medical personnel is one of the main problems inherent to the Canadian public system. In fact, there are 2.2 medical practitioners per 1,000 population. Norway has twice this number, and patients still complain about long wait times. Furthermore, physicians in Canada are overloaded instead of sharing responsibilities and workload with other professionals, including registered nurses, occupational therapists, specialists, etc.
A significant growth in healthcare expenditures is also a serious concern mainly because of population aging. To make matters worse, the government announced a plan to cut funding to 14.3 percent. The change is expected to come into force by 2037. This could result in significant tax increases at the provincial level in an effort to fund public healthcare. The provincial governments may be forced to cut funding for welfare, education, and transportation. Alternatively, they must secure additional/external financing to provide quality services and adequate healthcare; see creditavenue.ca.
Public and Private Healthcare and Mixed Models
Proponents support the introduction of a private healthcare model or a mix of public and private when it comes to service delivery and expenditures. Some participants at the Conversation on Health’s Public Private Debate pointed to the fact that mixed systems in Europe are more efficient and wait times are significantly shorter. Opponents, on the other hand, noted that mixed models such as the British system fail to provide adequate care to all patients. The participants also discussed other models such as the healthcare systems in New Zealand, Australia, and elsewhere. They reached a conclusion that while it was helpful to evaluate different models and their effectiveness, there were different factors at play in different social contexts.
Proponents of the public healthcare system claim that an increase in funding for services, hospitals, medical centers, and other facilities would solve the problem. Opponents point to the fact that the current system is unsustainable due to the lack of public money. The main argument in favor of the private model is that competition results in improved efficiency and delivery of services. Proponents of the public model, on the other hand, claim that profit is the driving force and not efficient patient care.
Many argue in favor of a mixed healthcare model, but there are some concerns about its effectiveness. The introduction of private care could easily result in two separate systems. The private healthcare system would serve the well off and the rich while the public system would cater for the poor. Experienced physicians would move to the private sector for better pay. Private facilities would benefit from better equipment, and high-income Canadians would receive better care. Proponents, on the other hand, suggest that there are ways to resolve this. One solution out of this problem is to require that physicians, registered nurses, and other professionals work in both, the public and private healthcare sectors. Private and public hospitals must have equipment of similar quality. This is one way to improve quality of care and reduce wait times. Close cooperation between policymakers, insurers, hospitals, and other players is also part of the solution.