Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 71
marginal in nature and, in fact, most of them appear to address procedures
beyond those required by medicare (Stabile & Ward, 2006). One historical
exception involved the procedure to terminate pregnancy. After considerable
debate and controversy, termination of pregnancy became an included medicare
service in all jurisdictions except Prince Edward Island. Although clinical
effectiveness is an important principle in decision-making concerning inclusion,
HTA methods are not explicitly employed in these determinations.
Provincial and territorial governments administer medicare services
through reimbursement schemes that prohibit or discourage supplementary
private insurance (Flood & Archibald, 2001; Tuohy, 2009). Since provincial
governments regulate the licensing of new facilities and work with provincial
medical associations in regulating the billing of medicare, they have the capacity
to limit or control the creation of a private (non-medicare) tier of hospitals,
surgical clinics and physician services (McIntosh & Ducie, 2009). However, in
some provinces, premium payments offered by workers’ compensation schemes,
in combination with the looser regulatory controls placed on diagnostic clinics
and the desire by most provincial ministries of health to contract out to private
medical laboratories have generated a market for private profit-making facilities
(Hurley et al., 2008; Sutherland, 2011b).
Provincial governments receive compensation from the federal government
for all medicare services provided to members of the Armed Forces, and
inmates of federal prisons. Provincial and territorial governments must provide
medicare services to all registered Indians and Inuit residents although the
federal government provides these citizens with coverage for “non-insured
health benefits” including dental care, prescription drug therapies and medical
travel.
Beyond medicare, it is up to the provincial and territorial governments to
decide the extent of coverage or subsidization for other health services. Since
there is no pan-Canadian system or standards of coverage for non-medicare
health services, it is very difficult to generalize concerning the breadth, depth
and scope of coverage for non-medicare services, although there are at least three
areas of convergence: (1) the majority of funding for long-term care is provided
by the provinces and territories; (2) all jurisdictions provide pharmaceutical
coverage for the older people and the very poor; and (3) virtually no public
coverage is provided for dental care and vision or for CAM and therapies.