Medicare () is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.
The name is a contraction of medical and care and has been used in the United States for health care programs since at least 1953, with Medicare becoming that nation's official national health insurance program in 1965.
Under the terms of the Canada Health Act, all "insured persons" are entitled to receive "insured services" without copayment. Such services are defined as medically necessary services if provided in hospital or by practitioners (usually physicians). Approximately 70 percent of expenditures for health care in Canada come from public sources, with the rest paid privately (through both private insurance and out-of-pocket payments). The extent of public financing varies considerably across services. For example, approximately 99 percent of physician services and 90 percent of hospital care are paid by publicly funded sources, but almost all dental care is paid for privately. Most physicians are self-employed private entities that enjoy coverage under each province's respective healthcare plans.
Services of non-physicians working within hospitals are covered; conversely, provinces have the option to cover services by non-physicians if they are provided outside hospitals. Changing the site of treatment may thus change coverage. For example, pharmaceuticals, nursing care, and physical therapy must be covered for inpatients, but there is considerable variation from province to province in the extent to which they are covered for patients discharged to the community such as after day surgery. The need to modernize coverage was pointed out in 2002 by both the Romanow Commission and the Kirby committee of the Canadian Senate (see External links below). Similarly, the extent to which non-physician providers of primary care are funded varies. For example, Quebec offers primary health care teams through its CLSC system.
History
Prior to the Second World War, health care in Canada was privately funded and delivered, with the exception of services provided to the sick poor that were financed by local governments. The traumatic experience of the 1930s left many Canadians in challenging financial situations. As personal financial situations deteriorated, the municipal governments were overwhelmed. Though the provinces provided relief payments for food, clothing, and shelter, additional medical costs were beyond the capacity of most of the provincial budgets. Many Canadians were not receiving adequate medical care, and those that did were overwhelmed with the associated costs. As such, preventable diseases and deaths were still common occurrences.
Ten years of economic depression, followed by six years of worldwide war, formed the social context of ambitious federal Green Book proposals. In a bid for unprecedented cooperation between the federal and provincial governments, these initiatives formed the foundations of a national program for social security, including provisions for health insurance. However, the failure to come to a consensus on the required allocation of tax resources at the Dominion-Provincial Conference in August 1945 precluded adoption and delayed subsequent action. Although the Green Book proposals were not adopted, they effectively created an appetite for government-funded health services.
Following the Green Book proposals, Saskatchewan in 1947 and Alberta in 1950, under provincial governments led by the Co-operative Commonwealth Federation (CCF) and the Social Credit party respectively, led initiatives to implement publicly funded health care at the provincial level. The first implementation of public health care at the federal level came about with the Hospital Insurance and Diagnostic Services Act (HIDS), which was passed by the Liberal majority government of Louis St. Laurent in 1957, and was adopted by all provinces by 1961. The HIDS implemented a high degree of federal regulation of the provincial health systems.