Symptom Relief Medications - Funding and Costs

Funding and Costs

EMS services in Canada are generally funded, at least in part, and to varying degrees, by the government of the province or territory in which they operate, through the Ministry of Health or Health Department of that level of government. However, paramedics and ambulance services are not mentioned in the Canada Health Act and are therefore not an insured service. Provinces may choose to subsidize some of the cost, usually just for patients with a valid provincial health card. Health insurance in Canada is universal and publicly funded, therefore the cost of emergency ambulance services is covered to some degree. The degree to which individual use of EMS is subsidized by provincial health insurance varies by province, and may be supplemented by either partial fees for service, or from the property tax revenues of local municipalities operating such services. The approach to such systems varies, as well. In some jurisdictions, funding is at the 100 percent level, and occurs without the patient being aware of its existence. Other jurisdictions fund at varying levels, but may require 'up front' payment for service, which is subsequently reimbursed. This may be particularly true of out of jurisdiction services, with an individual from one province, who requires EMS service in another province, being required to pay for that service and then submit the receipt to their own provincial health insurance scheme for reimbursement. In some jurisdictions, such as Ontario, a 'deterrent fee' scheme is used to discourage the medically unnecessary use of EMS by the public. In such cases, the provincial health insurance scheme will pay the majority of the cost of EMS service (around 80%) for medically necessary EMS service (when a physician decides that the service was not medically necessary, they can cause the patient to pay the full, uninsured amount of the charge), with the patient receiving a bill for the additional 'deterrent fee' at some point after the emergency is over. Within Ontario, for example, such deterrent billing occurs through the receiving hospital, despite the fact that the hospital neither provides nor oversees EMS in most cases.