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Dose of reality: How Canada's health care system really works

by Jon Davis ~ August 2018 ~ Stateline Midwest »
The reality of Canada’s health care system is different from the single-payer model sought by some U.S. liberals or the kind of government-controlled system often feared by U.S. conservatives, and different even from what many Canadians believe, Manitoba’s top health officials told lawmakers during a session at this year’s Midwestern Legislative Conference Annual Meeting.
“Myths are misunderstandings that aren’t just for Americans, but Canadians who don’t really understand how the system works,” said Kelvin Goertzen, Manitoba’s minister for health, aging and senior living. (Since the meeting, Goertzen has become the provincial minister of health and training.) He was joined by Adam Topp, Manitoba’s director of health transformation and CEO of the Benchmark Intelligence Group.
According to the two MLC speakers, the most persistent myths are that the system bars private payments, and that Canadian doctors and patients are fleeing to the United States.
Under the Canada Health Act of 1984, provinces have their own taxpayer-funded insurance for hospital care and certain doctors’ services, supplemented by private insurance and out-of-pocket payments for other services. While the system is publicly funded, care delivery is in the private sector — health care organizations are private (though not-for-profit), and doctors are mostly independent entrepreneurs, Topp said.
Canada’s current health care system began in 1947, when Saskatchewan introduced universal hospital coverage. The federal Hospital Insurance and Diagnostic Service Act of 1957 then reimbursed provinces and territories half of their costs for specified hospital and diagnostic services; nine years later, the Medical Care Act began providing a 50 percent federal reimbursement for medical services provided by doctors outside of hospitals.
Today, there are gaps in coverage, the most obvious of which is routine dental care; Canadians must pay for that with private insurance, Topp and Goertzen said.
According to Goertzen, one growing problem is that models of care — including for mental health — are shifting to home care, which is more effective but removes them from the Canada Health Act’s purview. As a result, he said, the federal cost share has slid from 50 percent to 17 percent in Manitoba, while health care has increased to 44 percent of the province’s budget.
Moreover, the cost of drugs, which already accounts for 16.4 percent of provincial health care expenses, is rising, creating discussion of a national “pharma-care” plan, Goertzen said. Provincial premiers are seeking to meet with Prime Minister Justin Trudeau to discuss health care because “the system is unsustainable; it will collapse in on itself” without changes, he said.
Even so, Canadians are not flocking across the U.S. border for medical care, nor are doctors abandoning the system. The Canada Institute of Information found that, in 2016, just 154 of the 84,063 physicians in Canada moved abroad, while 212 returned to Canada. And in a 2002 survey of 18,000 Canadians, only 20 of them said they had voluntarily sought treatment at a U.S. hospital.


Jon Davis is CSG Midwest staff liaison to the Midwest Legislative Conference Health & Human Services Committee.