Medical Assistance: The Extensive Guide to Using the Healthcare System in Canada

Canada boasts a national healthcare system, which is delivered and governed by every provincial jurisdiction. The services of Canada’s healthcare system are provided by a variety of private entities. Doctors in all provinces handle the insurance claims against the provincial insurers while patients aren’t involved in reimbursements and billing. Unlike the healthcare system of the United States and some European countries, insured patients aren’t charged for insured services in Canada. How does it work? Read on to learn everything about the healthcare system in Canada in this little guide.

 How does it work?

The regional health systems and hospitals are considered to be nonprofit corporations, which are primarily funded by provincial governments. Physicians and doctors get salary compensation and are paid through a variety of the fee-for-service. The publicly funded service financing comes from provincial taxes and federal monetary allocations. There are numerous private clinics in Canada, too. However, they require the province approval and are prohibited to bill insured patients for over the pre-determined fee.

75 percent of the population in Canada has private supplemental health insurance through employers and secondary insurers. 30 percent of Canada’s annual healthcare spending is private spending on drugs, insurance, and occasionally out-of-pocket costs. There are no deductibles on primary healthcare in Canada, and co-pays are either nonexistent or ridiculously low. Therefore, there’s a declining reinsurance market for healthcare.

 What’s Medicare?

Perhaps, you’ve heard of Medicare, but do you know what does it mean? This term refers to the publicly funded healthcare system of Canada. Rather than having one national plan, Canada has the whopping 13 territorial and provincial healthcare insurance plans. For example, Nova Scotia provides these plans. Due to this system, people have fairly good access to medicare advantage plans that offer medically essential physician and overall hospital services and they don’t have to pay out-of-pocket like residents of most countries do.

The responsibilities and roles for the healthcare services are shared between the federal government and territorial and provincial governments. The territorial and provincial governments are generally responsible for the delivery, organization, and control of the healthcare services for each resident.

The federal government is generally responsible for providing multiple health-related functions, supporting the healthcare service delivery to specific groups like eligible veterans, serving members of the Canadian Forces, Inuit, etc., ensuring funding support for territorial and provincial healthcare services, as well as setting and managing the national standards for the healthcare system according to the Canada Health Act.

How to access Canada’s healthcare

In order to access the healthcare system of Canada, it’s important to apply for a provincial health card first. The Canada Health Act requires each resident of a territory or a province to be accepted for health coverage, except certain members of the RCMP, the Canadian Armed Forces, and inmates. New immigrants should wait a certain period of time that can’t exceed 3 months.

As soon as you receive a health card, you can use it when visiting a healthcare provider or physician. The health card features an identification number used to access a patient’s medical information.

Once you get health coverage, you can register with a primary care provider. Whenever visiting a physician, you only need to show your health card. No individual service fees are necessary and in most cases, you don’t need to fill out any forms. The physician’s availability greatly depends on the current demand for healthcare services and the number of doctors. Nowadays, there’s usually one primary care doctor for every 1000 people in Canada.

 What’s provincial health insurance?

As mentioned above, Canadian health insurance is managed by individual territories and provinces. New residents should apply for health coverage in a territory or a province they start living. While receiving health coverage, residents also get a health card that provides coverage in that certain territory or province.

New residents should wait a certain period of time before they receive health coverage. The timeframe is different, but don’t exceed 3 months according to the Canada Health Act. There are provinces, such as Ontario, Alberta, and British Columbia that demand healthcare premiums for services. But, according to the Canada Health Act, health services can’t be rejected because of inability to pay healthcare premiums.

Besides the Canada Health Act’s standard health coverage, some provinces can offer additional healthcare services, such as prescription medicines, dental coverage, and physiotherapy. Provinces aren’t required to provide healthcare services not mentioned in the Canada Health Act. These healthcare services can be influenced by altering government policies.

 What’s private health insurance?

Even though the healthcare system in Canada usually covers all the basic health services, such as hospitals and primary care physicians, there are lots of services that aren’t covered, such as dental services, optometrists, and prescription medications.

Typically provided as part of any employee benefit packages, private health insurance plans are available in plenty of companies. Dental care and vision are usually included in these plans. Thus, people in Canada can buy health insurance packages from legal private insurance providers.

The statistics show that the majority of residents opt for private insurance since it supplements primary health coverage. Plus, it can cover home care, medications, or corrective lenses, which aren’t covered by provincial health insurance. Yet, many people who don’t have any certain needs opt for the public health system to save cash.

The healthcare system in Canada has many perks and drawbacks, but it tends to be cheaper when compared with other countries worldwide. Depending on your well-being and any special needs, you can choose any health insurance plan. There are numerous options to consider, even if you’re on a very tight budget. No wonder Canada has one of the lowest infant mortality rates and the highest life expectancy (around 80 years) of industrialized countries. Experts claim that is all thanks to Canada’s well-developed healthcare system, which provides accessibility, portability, universality, comprehensiveness, and public administration – the major principles listed in the Canada Health Act.


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