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Thursday, 15 January 2015

What do we mean by universal medicare coverage?

by Gregory P. Marchildon

The three factors that determine universal health coverage:

1.     The first factor is the extent of the population covered. Ideally, a universal system should include all citizens of a country or, in the case of Canada, all provincial residents.

2.     The second factor is the extent to which access is not impaired by direct costs – those user fees and other costs that are imposed at the point of delivery. Full financial coverage is commonly termed first-dollar coverage because all costs are prepaid in advance through taxes or social security contributions.

3.     The third factor is the size of the basket of health services that is universally covered, a determination that is constrained by cost and shaped by the unique historical developments. Universal coverage of health care in Canada is best described as deep (first-dollar coverage) but narrow because it is limited to hospital and medical care services which are deemed to be medically necessary.

Three myths about the universal health coverage (popularly known as medicare) in Canada:

Myth #1: “Registered Indians” as defined under the Indian Act receive medicare services from the federal government and are not defined as provincial residents for the purposes of provincial medicare programs.

The reality is that all provincial governments must provide medicare services to all Aboriginal residents including those defined as registered Indians. However, non-insured services are bifurcated such that the federal government provides coverage for non-universal health services for registered Indians.

Myth #2: Medicare in Canada has never had user fees.

The reality is that modest user fees were prevalent in a few provinces until 1984 when the federal government introduced the Canada Health Act and discouraged provincial governments from permitting user fees.

Myth #3: Provincial governments cannot opt out of the universal provision of insured services as defined under the Canada Health Act.

The reality is that any provincial government could deny universal health coverage to its residents tomorrow. While the province could lose its cash share of the Canada Health Transfer, the federal government does not have the constitutional or legal right to stop the provincial government.

Gregory P. Marchildon is former Deputy Minister to the Premier and Cabinet Secretary in the Government of Saskatchewan and Executive Director of the federal Royal Commission on the Future of Health Care in Canada. Currently, he is Canada Research Chair and Professor in the Johnson-Shoyama Graduate School of Public Policy at the Universities of Regina and Saskatchewan.

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