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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
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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
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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
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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
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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
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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
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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
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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
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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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