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