Health care benefits and rationing
Universal heath care benefits include, as a minimum, medically necessary hospital and Medicare
care as provided for under the Canada Health Act. There is, however, no agreed upon basic
package of services since what constitutes medical necessity has never been defined. As a result
there are some subtle variations among provinces with respect to coverage of hospital and
medical care services. For example, abortion services may be generally covered in one province,
but only those provided in hospital may be covered in others. There has been discussion among
stakeholders about the development of a "core" package of insured services, but no consensus has
been reached in this regard.
All provinces offer some additional or supplementary benefits beyond those services covered by
the Canada Health Act. But, given that they are outside of the act, they need not be universal and
may involve the payment of additional charges in the form of deductibles and/or co-payments.
Supplementary benefits are offered entirely at the discretion of each province and, therefore, vary
somewhat across the country. Most provinces provide supplementary prescription drug coverage
to the elderly and to welfare recipients. Dental care for children is offered in a few provinces.
Many provinces cover a limited number of visits for certain services or pay part of the costs of
others. For example, most provinces cover all residents for one optometrist visit per year, and pay
part of the cost of a limited number of visits to a chiropractor or subsidize the cost of ambulance
service. Alternative health care providers such as naturopaths, homeopaths, or osteopaths, are
typically not covered at all by public plans.
In recent years, there have been some reductions in publicly funded health care benefits.
Reductions in insured hospital and medical care have, however, been negligible. While a few
items have been dropped or restricted, these have tended to be services which are considered
marginal, such as tattoo removal and torn earlobe repair. The majority of reductions in benefits
have occurred with respect to discretionary supplementary coverage. Thus, a few provinces have
stopped paying for eye examinations, have increased or introduced co-payments for publicly
funded pharmacare, or have linked eligibility for certain benefits to income level.
Services not covered by provincial plans are generally available through the private sector and
are paid for out-of-pocket, through private insurance, or employer-sponsored benefit plans for
employees, their families and often retirees.
Allocation or rationing of health services in Canada is not explicit. Medically necessary hospital
and medical services are universally available and for certain specialty services where shortages
occur, such as cardiac, cataract or hip replacement surgery, queues are based solely on need.
Those with immediate need are treated before those with less urgent requirements
