Canada - World Health Organization Regional Office for Europe

70
Health systems in transition Canada
At the same time, some provinces receive unconditional transfers from the
federal government through what is called equalization, while the territories
receive unconditional transfers through another federal programme called
Territorial Formula Financing. The specific purpose of equalization is to ensure
that Canadians, wherever they live, “have access to reasonably comparable
services at reasonably comparable levels of taxation”, a purpose that is stated
and protected in the Canadian Constitution (Expert Panel on Equalization and
Territorial Formula Financing 2006, 18).
3.3.1 Coverage
The breadth, depth and scope of coverage for broadly defined insured services
under the Canada Health Act (CHA), although not identical, are remarkably
similar from province to province. In effect, 100% of the resident Canadian
population, including landed immigrants, receive full (first dollar) coverage for
“medically necessary” hospital, diagnostics and medical services, commonly
summarized as “medicare” (Marchildon, 2009). These insured services are not
defined in either the CHA or provincial and territorial medicare laws. However,
the principle of comprehensiveness in the Canada Health Act presumes that
provincial and territorial governments will err on the side of inclusion in their
respective determinations of what services are included in medicare.
Similarly, at the provincial level, there is neither a positive list of inclusions
nor a negative list of exclusions in the pertinent medicare laws and regulations.
Instead, provincial governments have, from the time that medicare was
first introduced, tended to include all services provided in a hospital with
the exception of a few medically unnecessary (e.g. cosmetic) surgeries. As
to which physician services are included, this has largely been a matter of
negotiation between the provincial governments and the provincially based
medical associations, but in practice almost all physician services are included.
Ontario has one of the more formal mechanisms, involving three administrative
bodies for determining which physicians services are universally covered:
(1) the Physicians Services Committee, a joint committee of officials drawn
from the provincial health ministry and the Ontario Medical Association; (2)
Medical Directors – physicians employed by the provincial health ministry who
determine claims for public funding; and (3) the provincial Health Services
Appeal and Review Board (Flood, Stabile & Tuohy, 2006).
In terms of medicare, there has been no major reduction in, or expansion of,
universally insured services by any level of government in Canada in recent
years. Instead, most decisions involving new listings or delistings are highly