Canada: Where Have We Been?

Abstract

Although touted as having a system of “National Medicare,” Canada does not have one national system of publicly funded (government as payer) health care. Canada is a confederation of (at the present) ten provinces and three territories. The provision of health care is a responsibility of provincial or territorial governments. Therefore, it is more appropriate to state that all Canadians are covered, in the province or territory in which they reside, by a publicly funded universal health care insurance program. Publicly funded insured health services include, broadly defined, all medically necessary hospital services, medically required physician services, and surgical dental services performed in hospital. What distinguishes Canadian medicare is that insured services are similar and equitable between provinces. In particular, “catastrophic” costs that might be associated with serious acute illness or injury (those that might necessitate ICU care) are completely covered. However, not all Canadians’ health care is covered by the government-funded single payer system. The share of health care funding that is “private” or not funded by the public payer system is ∼30 % [1]. The increasing proportion of provincial government expenditures that are directed towards health care may threaten the viability of the single payer publicly funded system. In the interim, as funding restrictions limit budget expenditures, programs will fight for the allocation of dollars within the system, and these threats will contribute to problems in managing ICU programs.