How the Canadian Healthcare System Works

How the Canadian Healthcare System Works

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How the Canadian Healthcare System Works

While almost all Canadians have taken advantage of our healthcare system at some point in their lives, not all citizens understand how the Canadian Healthcare system works or what it covers. We at Skip the Waiting Room believe that a well informed public can make the best use of the healthcare system. Armed with this knowledge of how the system works, the public should be able to better understand some of the decisions that healthcare providers make with regards to their health.

The Legislation

As we have discussed in previous articles, Canadians are covered by “Medicare”. The goal of the Medicare program is to ensure that all residents have access to medically necessary physician and hospital services. Medicare is a public health insurance plan that is funded by taxes. It is not a single national plan; it is a national program made up of 13 provincial and territorial public health insurance plans. Each of these separate plans shares similar features which are outlined by the Canada Health Act.

The Canada Health Act is Canada’s federal legislation for publicly funded health insurance. It dictates the primary objective of Canadian health care policy: “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”. Through the Canada Health Act, the standards for the provincial medicare plans are established. These standards must be met in order for the provinces to receive federal funding for their insurance plans. More information on the Canadian Health care system can be found on Health Canada’s website.

The Money

It is estimated that roughly 40% of each province’s budget is allocated to healthcare. The federal government designates funds to the provinces to fund their insurance plans. The provinces then take the funds and distribute them to their various hospitals, long-term care centres, programs, and other medical facilities.

Most provinces are further broken down into regions. These regions hold the responsibility of delivering healthcare to the public. Each region has its medical facilities and programs that need funding. The most common method of funding used in the Canadian healthcare system is global budgets. Global budgets are fixed payments given to a medical facility or program to cover operating costs for a period of time. This time period is generally one year. The amount of funding that a facility or program will receive is typically determined by historical budgets, politics, and inflation.

Public vs. Private

Health care in Canada is not completely funded publicly. While about 70% of health expenses are covered by medicare’s public insurance, the other 30% are funded privately. The terms public healthcare and private healthcare can be deceiving at first glance. A person in need of medically necessary healthcare cannot pay out of their own pocket to go to a private clinic and receive better care than a person with the same illness who cannot afford to pay (this is not true in Quebec where the rules are slightly different). This is an aspect of our healthcare system that many Canadians are proud of. Private funding includes things like dentistry, optometry, prescription drugs, and cosmetic services. Approximately 75% of Canadians have some form of private insurance to help compensate for these issues.

A health care facility does not have to be publicly run to receive public funding for operations. Roughly three quarters of healthcare providers in Canada are private. Typically they are paid on a fee-for-service basis that is funded by Medicare.

What Coverage Can You Expect?

Health Canada sums up what you can expect to be covered for: “Provincial and territorial health insurance plans are required to provide insured persons with coverage of insured health services, which are: hospital services provided to in-patients or out-patients, if the services are medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness, or disability; and medically required physician services rendered by medical practitioners.” In other words, if you have a medically necessary health issue you can generally expect to be covered.

Some provinces also cover additional expenses to aid their citizens further. These additional services often target specific groups such as seniors, children, or social assistance recipients. Such services can include prescription drugs, dental care, chiropractic, or ambulance services.

What Coverage Can You Not Expect?

Health Canada also sums up what you should not expect to be covered for: “A number of services provided by hospitals and physicians are not considered medically necessary, and are not insured by provincial and territorial health insurance plans. Uninsured hospital services for which patients may be charged include preferred hospital accommodation unless prescribed by a physician; private duty nursing services; and the provision of telephones and televisions. Uninsured physician services for which patients may be charged include prescription renewals by telephone; the provision of medical certificates required for work, school, insurance purposes and fitness clubs; testimony in court; and cosmetic services.

You can expect not to be covered for services that are not medically necessary. Plastic surgery, non essential hospital services, and prescription drugs are some things that fall under this category. There have however, been cases where individuals feel that they have not received necessary medical treatment from the Canadian healthcare system. Prescription drugs can fall under this category as they can be very expensive and many Canadians cannot afford them.

Closing Remarks

Canadians are covered under the Canadian medicare program. Medicare is framed by the Canada Health Act which aims to better the lives of Canadians. This program is made up of provincial and territorial public medical insurance plans. These plans are funded through our taxes allowing all Canadian citizens to have access to medically necessary physician and hospital services.

How Skip the Waiting Room will help you

Skip the Waiting Room aims to enhance how you access healthcare services, specifically walk in clinics. Our goal is to save you time through our online appointment booking services. You will be able to book an appointment online for a walk in clinic. We will give you an estimate departure time and then contact you when it is time to depart for your appointment. A healthcare professional will see you shortly after you arrive at the clinic.



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Feel free to checkout what we feel our mandate is here at Skip the Waiting Room and how we want to change how you access healthcare. Skip the Waiting Room – Mandate

If you would like to understand more about why we are often asked to wait for so long at a walk in clinic, your family physician or other types of medical services you can check out our Skip the Waiting Room – Why you Wait

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