Two-tier Health Care - Canada

Canada

In Canada, there are private and public health care providers with complete patient freedom of choice between which doctors and facilities to use.

The public financing system known as Medicare consists of several different systems managed by each province or territory. The Federal government distributes funds to the provinces for health care providing the provinces design their systems to meet certain criteria which they all do. Most people receiving care in Canada do not pay for their care. The medical provider gets paid a fixed fee for the care provided. The medical provider is not allowed by law to charge top-up fees to patients to supplement their income from Medicare. Medical care providers can set their own fees that are higher than the Medicare reimbursement fee but in this case the patient must pay ALL the cost of care and not just the excess.

About 70% of Canada's health care funding is via the public system. A full 30% comes from private funding, divided approximately 50/50 between out-of-pocket funding and private insurance which may be complementary (meeting costs not covered by the public system such as the cost of prescription medicines, dental treatments and co-pays) or it may be supplementary (adding more choice of provider or providing faster access to care) There are however financial disincentives which make use of private medicine for services that ARE covered by Medicare less economic.

Six of Canada's ten provinces used to ban private insurance for publicly insured services to inhibit queue jumping in order to preserve fairness in the health care system. In a complex legal decision in 2005 the Supreme Court ruled that, in some circumstances, such bans could be illegal if the waiting period was unduly long.

Some private hospitals operating at the time when the national health care plan was instituted (for example, the Shouldice Hernia Centre in Thornhill, Ontario) continue to operate, although they may not bill additional charges for medical procedures. (The Shouldice Hospital does, however, make mandatory additional room charges not covered by public health insurance. This effectively places it in the "upper tier" of a two-tier system. Welfare recipients, for example, cannot be referred there.) Clinics are usually private operations, but may not bill additional charges. Private health care may also be supplied in uncovered fields and to foreigners.