Morneau - Hospital and Medical Plans

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  1. Health care legislation
    • falls under provincial jurisdiction
    • Canada Health Act (April 1st, 1984) gave federal government power to impose financial penalties on provinces that do not allow reasonable access to essential health care
    • in the 90s, provinces faced cuts in federal payments; responded by scaling down coverage
  2. Canada Health Act criteria
    • public administration: non-profit by public authority responsible to provincial govt
    • comprehensiveness: must cover all necessary hospital and medical services
    • universality: all eligible residents must be covered for insured health services
    • portability: waiting period ≯ 3 months; cover out-of-province Canadians for emergency
    • accessibility: uniform terms for all; reasonable access not precluded or impeded
  3. Hospital services covered
    • nursing care provided in a hospital
    • drugs and antibiotics administered in a hospital
    • laboratory and diagnostic services in a hospital
    • radiotherapy and physiotherapy in a hospital
    • out-patient services for emergencies
    • no time limit on medically necessary stays
    • all user fees were abolished by Canada Health Act except chronic care situations
  4. Supplementary benefits
    • not mandatory for compliance, but offered by many provinces
    • dental care for children
    • annual eye examinations
    • coverage for prescription drugs for residents over age 65 or in receipt of social assistance
    • those are all expendable services when it comes to reducing provincial care costs
    • RAMQ is unique to QC: forces residents to be covered unless under private drug plan
  5. Out-of-province benefits
    • for all jurisdictions except Quebec, benefits are paid when provided in other jurisdiction
    • non-residents who receive services in Quebec must pay and then seek reimbursement
    • meant for emergency hospital and medical costs, including outside Canada, but only up to the amount that would have been paid in the province of residence
  6. Wait times
    • Chaouilli decision - in Quebec, can seek treatment in private clinics for pre-determined and approved services when reasonable wait times cannot be met in public plan
    • other provinces have found ways to reduce wait times without using the private sector
  7. Financing - federal vs provincial
    • federal and provincial used to share costs approximately equally
    • in recent years the federal portion has fallen below half
    • Canada Health and Social Transfer implemented in 1995 is a transfer that supports health care, post-secondary education, social assistance and social services, making it difficult to determine how the money is being spent
  8. Provincial financing methods
    • ON, BC - direct cost sharing by residents and employers
    • ON, QC - taxation of insurance plans
    • MB, QC, NL - payroll tax on employers
    • all other provinces - general revenues
  9. Taxation
    • can’t deduct premium from income
    • if employer pays a portion, contribution is taxable as income to the employee
    • can claim medical expenses as a non-refundable tax credit if above a certain threshold
    • refundable tax credit for working individuals with low income and high medical expenses
    • except in Quebec, employer contribution to a private plan ≠ taxable benefits
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Morneau - Hospital and Medical Plans
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