Canada has public hospitals

Healthcare in Canada: divided and multifaceted


Healthcare in Canada: two-part and multi-faceted

Canada's health system is actually not one, at least not a uniform one. Today it consists of a historically grown network of the health systems of all ten provinces and the two territories of the Canadian state. Only the framework legislation is uniform across the country. This regulates the financial grants to the provinces and stipulates the qualitative conditions that must be met in order to receive funds from the Canadian federal government.

Further key points that describe the health care system in the second largest country in the world in terms of area: The country has a low population density of only three inhabitants per square kilometer, which, however, varies greatly from province to province. Around three quarters of the total of almost 29 million inhabitants live in the urban conurbations. Despite the state insurance system, there is a division into state financing and framework setting on the one hand and largely private or non-profit provision of services on the other. And: General practitioners in private practice have a key position in the Canadian health system with the role of "gatekeeper".

It took from 1947 to 1972 to introduce mandatory hospital insurance in all Canadian provinces. Canada is a federal state that consists of ten largely autonomous provinces, each with their own provincial government, and two territories that are dependent on the federal government. The Canadian federal government was only able to implement state health insurance through a policy of the "golden reins": It offered the provinces state subsidies for around 50 percent of the respective health expenditure - however, coupled with the requirement that the provinces set up compulsory health insurance for their citizens which are still administered autonomously by the provinces and territories today.

Compulsory health insurance is based on five principles enshrined in the two central federal laws (Hospital Insurance and Diagnostic Service Act of 1957 and Medical Care Act of 1966):
  • universal coverage of the population;
  • comprehensive health insurance cover for necessary services;
  • access to the necessary medical services that is reasonable for the population;
  • the transferability of the insurance cover in the event of a change of residence and
  • the public (provincial or territorial) administration of compulsory and non-profit health insurance.

In 1984, the previous health legislation for inpatient and outpatient care was merged in the Canada Health Act. In addition to the five principles, any type of deductible for health care costs has now been eliminated for services provided by mandatory health insurance.

Nonetheless, Canadian citizens have to finance just under a quarter of their health costs themselves outside of compulsory health insurance (especially for drugs outside of inpatient care, adult dental care and glasses). The state share has remained almost constant over the past two decades at around 70 percent (1970: 70.2 percent; 1992: 70.1 percent). The third and smallest financier is private health insurance with a share of 5.1 percent today (1992).

The Canadian health system is now financed almost entirely through various federal and provincial taxes. A combination of income, sales and wealth taxes is used. Around 40 percent of the tax-financed expenditure on the Canadian health care system is borne by the federal government, the remainder by the provinces and territories.

The majority of Canadian hospitals (1993 total: 1,236 with 171,700 beds) are non-profit-making, either municipal or non-profit. Medical laboratories are usually privately organized. The Canadian doctors (1993: 63.008) are either general practitioners (general practitioners; 1993: 29.361) in their own practice or as specialists (consultants; 1993: 25.794) except for the period of further training and the medical teaching staff working at the universities. active in his own practice as an outpatient as well as inpatient at the hospitals. The dentists (1990: 14,394) are all active on the private sector level in their own practice or in group practices. There are pharmacists (1991: 17.296) on the one hand in established pharmacies and on the other in hospitals. The entire field of physiotherapeutic service provision is also organized privately.

Both the general practitioners and the consultants receive an individual service fee for their medical services on the basis of contractual agreements with the compulsory health insurance. The amount of the remuneration for individual services is negotiated between the medical associations and the respective provincial government. Access to specialist outpatient and inpatient care is only possible within the social security system through the initial consultation of the general practitioner: He decides on the necessary outpatient and / or inpatient care and thus the referral to a specialist, the admission to a hospital, the necessary laboratory tests and the supply of medicines .

While in 1970 $ 698 million, or 11.2 percent of health care costs, were spent on pharmaceuticals, the corresponding expenditures in 1993 were already 10.9 billion Canadian dollars, or 15.1 percent. With around 45 percent, the consumer finances the vast majority of these costs directly, a further 34 percent are covered by private drug insurances, and state health insurance pays only about 21 percent. In parallel to the rise in drug spending, the number of active pharmacists also rose significantly; it rose by around 23.5 percent within eleven years (1980: 14,008; 1991: 17,296).

PZ title article by Uwe K. Preusker, Cologne


© 1997 GOVI-Verlag
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