The Canadian healthcare system (“medicare”) can be difficult to comprehend. One of the key concepts to understand is the division between federal and provincial/territorial responsibilities. As the Canadian government summarizes:
Medicare is a term that refers to Canada’s publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.
The Medicare system covers hospital and physician care well, despite this fragmented delivery model. When a Canadian goes to the hospital, or has an appointment with their physician, they will generally not be required to pay for these services. This coverage creates a sense of security, but there are gaps in Medicare, notably the lack of dental and drug coverage. The responsibility for these services are again in the are in the provincial/territorial domain. Unlike Medicare however, there is no federal law requiring provinces to provide coverage. The resulting patchwork of dental and pharmacare policies and programs are confusing and difficult to navigate. In many cases, Canadians are forced to rely on private insurance.
Some interesting quirks of Canadian Medicare include:
- the cost of drugs and dental work provided in-hospital are covered by the government (life-hack: find a dentist who works in a hospital?)
- when travelling within Canada, Canadians are covered by their home province or territory. When a resident of Ontario requires hospital services in Alberta, the hospital will bill the Ontario health insurance plan (or may bill the patient directly, who will be reimbursed by their home province)
- the coverage ordinarily provided by provinces and territories are provided by the federal government for some groups of people, including veterans, inmates in federal prisons, and First Nations people living on reserves, among others
- the federal government provides some of the funding provinces and territories need to meet their Medicare obligations
It’s all pretty weird.