O Canada

We are in a series exploring the idea of a single payer healthcare system.  Click here to find the prior posts.

It must have pained our neighbors to the north the past couple of weeks to face the reality that while no Canadian hockey team was even competing for the Stanley Cup, one from the land of  SEC football was.  They can take solace in the fact that their dashing young prime minister has way better hair than does our…don’t even need to type it, do I?  Small victories.

If you ask the average person on the street what a single payer system would entail, they’d probably presume you meant the Canadian system and then ask if free ‘medicinal’ beer was covered.  So, let’s take quick fly over of the system that has been in place up there since 1984. 

The public funding all starts in Ottawa, who collects the taxes.  The feds then distribute money to the 10 provinces and three territories to administer the system.  As is the case with parents who provide the kids an allowance, rules come along with the cash. 

While the broad policy requirements are set centrally, the local governments have some flexibility in how things play out (a bit like Medicaid for the US). Central rules with some flexibility leads to some bickering between the provinces about why someone got more than them.  Like us again, both Medicaid and the allowance thing.

So right out of the gate know that there is not one Canadian healthcare system, but 15 of them.  And yes, some of you just wondered how 10+3=15 (sharp and attentive are our readers).  Two more ‘systems’ are administered by the feds – one for native peoples and one for the military. 

The provincial governments then pay providers on a fee-for-service basis according to government established rates.  Providers used to hit patients with a surcharge, but that practice was forbidden in the 1984 legislation.  Now, providers are essentially all in or all out – if you want to participate in the government system, then you can’t take private insurance or cash payments.  We’d call that a slightly restrictive provider contract.

Almost every person is covered and they generally don’t see a bill for these services, but interestingly, about 70% of Canadians carry a supplemental insurance plan to help pay for non-covered services, mostly prescriptions, dental and eye glasses. 

So in short, think universal coverage, funded centrally and administered locally, with care delivered by mostly private providers paid FFS, with no direct patient financial responsibility for covered services.  If that sentence is too long, how about ‘Medicaid for all.’  Not perfectly accurate, but close enough.

You know the complaints…bureaucrats deciding what is covered, long wait times, etc.  Here is another. Ontario, the largest province, now projects that healthcare will consume 80% of its entire provincial budget by 2030.  It turns out that caring for an aging population is just as expensive in Canada as in the US.

Which gets us to the final loop on this journey.  Next week we’ll start reflecting to see what we’ve learned in the series. 


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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