Question

The Canadian Constitution assigns different responsibilities and authority to the federal and provincial governments. Essentially, it assigns the responsibility for funding and providing health services to the provincial governments. How has this division of responsibilities and powers affected the development of health programs across the country? What do you consider to be the advantages and disadvantages of this division of power?

Answer 1

The provinces and territories administer and deliver most of Canada's health care services, with all provincial and territorial health insurance plans expected to meet national principles set out under the Canada Health Act. Each provincial and territorial health insurance plan covers medically necessary hospital and doctors' services that are provided on a pre-paid basis, without direct charges at the point of service. The provincial and territorial governments fund these services with assistance from federal cash and tax transfers.

Medically necessary services are not defined in the Canada Health Act. It is up to the provincial and territorial health insurance plans, in consultation with their respective physician colleges or groups, to determine which services are medically necessary for health insurance purposes. If it is determined that a service is medically necessary, the full cost of the service must be covered by the public health insurance plan to be in compliance with the Act. If a service is not considered to be medically required, the province or territory need not cover it through its health insurance plan.

The roles of the provincial and territorial governments in health care include:

1.) administration of their health insurance plans;

2.) planning and funding of care in hospitals and other health facilities;

3.) services provided by doctors and other health professionals;

4.) planning and implementation of health promotion and public health initiatives; and

5.) negotiation of fee schedules with health professionals.

Advantage:

Most provincial and territorial governments offer and fund supplementary benefits for certain groups (e.g., low-income residents and seniors), such as drugs prescribed outside hospitals, ambulance costs, and hearing, vision and dental care, that are not covered under the Canada Health Act.

Although the provinces and territories provide these additional benefits for certain groups of people, supplementary health services are largely financed privately. Individuals and families who do not qualify for publicly funded coverage may pay these costs directly (out-of-pocket), be covered under an employment-based group insurance plan or buy private insurance. Under most provincial and territorial laws, private insurers are restricted from offering coverage that duplicates that of the publicly funded plans, but they can compete in the supplementary coverage market.

As well, each province and territory has an independent workers' compensation agency, funded by employers, which funds services for workers who are injured on the job.

Disadvantage:

Within the publicly funded health care system, health expenditures vary across the provinces and territories. This is, in part, due to differences in the services that each province and territory covers and on demographic factors, such as a population's age. Other factors, such as areas where there are small and/or dispersed populations, may also have an impact on health care costs.