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Canadian National Health Insurance Program

  • Synopsis: The Canadian National Health Insurance Program referred to as Medicare is designed to ensure all Canadians have access to hospital and physician services.

Definition: Defining the Meaning of Health Care

Health care - (healthcare) is defined as the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry, pharmacy, psychology and other health professions. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Primary care - Refers to the work of health professionals who act as a first point of consultation for all patients within the health care system.

Secondary care - The health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

Tertiary care - Specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Quaternary care - The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed.

Home and community care - Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance and distribution of needle-exchange programs for the prevention of transmissible diseases.

Main Document

The Canadian National Health Insurance Program is also often times referred to as, 'Medicare,' and is designed to ensure that all Canadians have reasonable access to hospital and physician services which are medically necessary on a pre-paid basis. Instead of a single, National plan, Canada has a national program composed of thirteen interlocking provincial and territorial health insurance plans. These plans share specific features, as well as some basic standards of coverage. The principals they share have been framed by the Canada Health Act and are governed by the Canadian Health Care System. They are symbolic of the underlying Canadian values of solidarity and equity.

Federal and Provincial-Territorial Governments share the responsibilities and roles for Canada's health care system. In order for territorial and provincial health care insurance plans to qualify for their full share of federal cash contributions under the Canada Health Transfer (CHT), they must meet with the legislation, conditions and criteria set by federal health insurance under the Canada Health Act (CHA). Provincial and territorial governments bear the responsibility for organizing, delivering and managing health services provided to their residents.

Canadian Prescription Medications

Under the Canada Health Act, all drug therapy deemed necessary is administered through a Canadian hospital setting which is both publicly funded and insured. Outside of hospital settings, territorial and provincial governments bear the responsibility for administration of their own publicly funded prescription drug programs. The majority of Canadians have access to insurance coverage for prescription drugs via either private or public plans. Federal, Territorial and Provincial governments offer various levels of coverage for medications, each with different eligibility requirements, premiums and deductibles. Publicly funded medication programs commonly provide coverage for persons who are most in need based upon age, medical condition and income.

Primary Care

Primary healthcare is considered to be the foundation of the Canadian Healthcare System. Primary care is the first point of contact people have with their healthcare system, usually through a doctor, nurse or other professional, or possibly through either a phone or computer-based service. Primary care, and the services involved, includes teams of healthcare professionals who provide services to individuals, families and communities. These services also involve a proactive approach to the prevention of health issues, better management, and follow-up care once a health problem has happened. Primary care services are publicly funded in Canada, from general tax revenues, without direct charges to the patient.

Specialized Care

Patients could be referred for specialized care to a hospital or long-term care facility, or to services in the community. Many of Canada's hospitals are run by Community Boards of Trustees, Voluntary Organizations, or Municipalities. Health care provided by long-term care facilities are largely paid for by territorial and provincial governments, with room and board being covered by the individual. In some cases, the person's provincial or territorial government may subsidize these payments.

Healthcare services may also be provided on an in-home or community basis. Referrals regarding persons who desire these services can be made by hospitals, doctors, community agencies, families and potential residents. Services such as specialized nursing care, adult day care, and homemaker services, are provided for persons who are either partially or completely incapacitated. The person's needs are assessed, after which services are coordinated in order to provide a continuity of both care and comprehensive care.

Canadian provinces and territories also provide coverage to specific groups of persons such as seniors, social assistance recipients, and children for health services which are not usually covered under the publicly funded healthcare system. Supplemental health benefits could include dental care, prescription medications, medical equipment and appliances, vision care, independent living services, as well as chiropractors and podiatrists. A number of Canadians have supplemental insurance coverage through group plans.

The Pan-Canadian Health Human Resource Strategy

The Pan-Canadian Health Human Resource Strategy aims to ensure that Canadians have access to health providers they need, both now and in the future. The key goals of this strategy are to develop a healthcare workforce with the right number and mix of health professionals in order to serve Canadians in every region of the country. The strategy involves one of the primary initiatives to come out of the 2003 First Ministers' Accord on Health Care Renewal. The initiative set out an action plan to ensure that all Canadians can receive healthcare services in a reasonable amount of time based upon their need and not their ability to pay, despite where they live in Canada. It also states a desire to make healthcare services available to Canadians which are safe, high-quality, effective, and that focus on the needs of the patient. The initiative also desires to establish a healthcare system that is affordable, stable, and one that will be there for Canadians and their children in the future.

In order to meet these goals, Health Canada continues to work with the territories, provinces and additional, key health-related organizations to improve Health and Human Resources coordination and planning. The Health and Human Resources strategy guides efforts in three significant areas which include ensuring that Canada has enough of the right kinds of healthcare providers to meet the needs of Canadians, and encouraging people to enter the healthcare field while improving working conditions in order to keep them there. The strategy also involves changing the way Canada educates healthcare providers so that Canadians will have faster and better access to providers when they need one.

Latest Canadian Health Care Publications

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