Canada Health Insurance (CHI) is the major health-care system of Canada and provides universal access to a range of health care services. CHI covers most people in Ontario, Quebec, British Columbia, Yukon, Alberta and Saskatchewan as well as Manitoba. Since 1965, CHI has been funded by federal sources. In 2018, CHI had 2,821,000 members and reported net income of $8,946 million.
Medicare, which has been extended over time, now covers an estimated 56% of the population. The majority of Canadians today are covered under a provincial or territorial form of Medicare, while about 55% are eligible for CHI’s “grandmother” plan for seniors, children, and those with disabilities. More than half of CHI members are women. Under the government, it was announced that women would be able to choose which family member their child will be enrolled under in the baby-planning program. While this option is not available at all CHI facilities, one can find maternity coverage within the newborns’ plans. This allows mothers to have an additional baby if they were already pregnant under another family member’s plan and then transfer her son/daughter when she starts the process of applying for the full-time hospital care. With CHI’s other two forms of coverage (Medical Advantage and Preferred Provider Organization), there is also an opportunity for individuals to get additional coverages on top of what they currently pay for their employer-provided private medical aid.
CHI works to improve health access through several initiatives, including free dental care and coverage for vision exams and eye surgeries for anyone on a low income. Additionally, CHI offers a wide variety of benefits including vision screening, hearing aids, prescription drugs, etc., along with annual wellness checks. As of September 2017, there were 48,000 people in its network of clinics, and 4,000 in long-term care homes. A majority of its patients are from middle-class families, but in recent years, a growing number of immigrants were added to their networks. The average age of new enrollees is 57 in 2019.
CHI relies on three pillars that ensure accessibility to all Canadians regardless of location, income levels, gender or ethnicity. These include the Canadian Medicare Fee Schedule (CMFS), which serves as the standard fee structure used to charge patients, the Employer Provident Fund (EPF), a social insurance scheme covering 1.9% of gross wages paid by employers, and the Interprovincial North American Free Trade Agreement, which includes provisions for interprovincial trade and movement, protection against imports, tariffs, duties, and taxes. In addition to these foundations, CHI has partnered with many different agencies such as the Office de assurance du Québec et des Droits de la Ville, CERB, Social Security Board, Royal Commission d’Ethique en Santé, National Programmed Sobers pour les Popularizes, Battalion Society, CIUSSS (Service Environments and Human Rights Council), among others.
History [ edit ]
Origins and early beginnings [ edit ]
In 1907, as part of efforts to implement a national health service system for the first time, the federal government created the General Hospital System of Montreal. Within 10 years it grew into the country’s largest general hospital system. By 1920 the nation’s only federal psychiatric hospital opened, and Quebec became home to more than 100 hospitals by 1924.
By 1940, six hospitals had closed during war. Between 1942 and 1945, almost every hospital in Quebec closed before it could be rebuilt, leaving between 100 and 200 hospitals. New hospitals opened in 1946 and 1947. Despite its large size, the province never needed to hire enough staff. Instead, the provinces took responsibility for the costs of running hospitals after World War II.
In 1950, Parliament created an independent Medical Assistance Plan to take advantage of certain health-care institutions and workers to manage specific areas of the system. Its purpose was to provide better access to the country’s doctors but did little to tackle the acute care system.
By 1960, CHI was formed under federal tax dollars and began providing services to employees. It was formally named the Government Employees Medical Benefits Scheme [GEBS] in 1966. Under the CMFS, employees of federally regulated health institutions would receive a fixed amount of a pre-set amount for hospital stays, treatment and physician consultations. An increase of five per cent per year resulted in increases in their benefit from 3 to 5 per cent per month.
In 1972, the GEBS was extended to cover all federal public sector employees, and in 1988, it added all municipal employees. During the 1990s, some physicians saw increased benefits, such as the ability to treat any medical condition that might affect someone’s daily life without requiring a physical examination and treatment. They could receive treatment for minor illnesses or injuries that affected a person’s ability to perform day-to-day activities, including mental disorders. Physicians could not refuse treatments because they were considered necessary and important to patient safety. At the same time, some states reduced the reimbursement rates it charged physicians (known as “reimbursement caps”) through legislative action. Before 1982, physicians were given no choice of where to work or where they wanted to go. However, since 1977, both the U.S. Department of Health Care and the Supreme Court ruled that the cap was unconstitutional and allowed governments to reduce the cost of treating patients.
In 1999, Ottawa raised the maximum amount of compensation paid out by providers and administrative staff (known as “ceiling amounts”) to $1 million, up from $200,000 for physicians in 2004. In 2006, Prime Minister Stephen Harper introduced legislation allowing doctors to obtain higher levels of payment based on past experience rather than quality of care. For instance, he lowered the cap on the total rate paid to physicians and lowered the amount that doctors could earn. Over the course of his tenure, he repealed a series of laws and reformed regulations to encourage greater adoption of clinical and technological innovations in hospitals, clinics, pharmacies, schools and the like.
In 2002, the former Conservative government brought forward proposals to expand the overall system by consolidating multiple parts of it into four major elements: the Emergency Department; ambulatory surgical centers; community hospitals; primary health organizations, and a 24 hour system for emergency room visits. A consultation process was initiated to select a candidate for consolidation and six vendors were selected by the end of the following year to start construction on the new facility, which is expected to open in 2013.
In 2005, the government passed law regulating the expansion of the existing healthcare system (known as the Affordable Care Act) to cover the remainder of the provinces with commonality around 2010. According to the bill, each province was required to set up individualized regional systems of affordable coverage. There were three phases to accomplish this: the first phase was the creation of 10 regional exchanges and eight regional markets, starting with BC; the second phase was the establishment of 18 regional Health Centers and Regional Hospital Networks, with Newfoundland and Labrador being the last one to complete; and the third phase the formation of 11 regional Family Centers, with Nova Scotia being the last to be established. Most of the regions’ centers and resources were established by June 2015, except the Community Health Centre of Quebec City located in Montreal, which opened in January 2016.
In 2016, the Province of Manitoba implemented amendments to the federal law to allow for more local system-specific arrangements. Two provinces, Newfoundland and Labrador and Newfoundland and Prince Edward Island, joined together to form a single territory. This meant that both Nova Scotia and Newfoundland and Labrador were placed outside the jurisdiction of the Federal Register, making them separate jurisdictions of the Northwest Territories with overlapping administrative divisions and responsibilities.
In December 2015, Ontario, Quebec, and British Columbia entered into definitive agreements to join the Commonwealth. Following the separation, changes were made to how the three countries would be governed in the future. Each region would be treated by itself, but their combined economies would be integrated.
In January 2016, the Canadian government amended the act to specify that the territories would not be joined until 2040, so a unified federation is planned.
In April 2016, the Confederation Papers revealed that there are discussions underway to adopt Ottawa’s proposal to combine Ottawa, Montreal and Toronto into a united entity. One possible outcome could be a single exchange rate with no change in the structure of the federal structure. Another is the possibility that Ottawa assumes control of a significant portion of the economy. After weeks of debate, the proposed deal was successfully adopted by a Liberal caucus on May 31, 2016, after opposition to the agreement from Conservatives.
In April 2016, Prime Minister Justin Trudeau unveiled a timeline for integration of all seven provinces, including Ottawa, Montreal, and Toronto. He stated that the union would begin in late 2020, but later expanded the date for completion to 2025.
As of July 2017, no concrete dates on integration have ever been set and the federal government has said no further specifics will be made public.
On October 16, 2017, the United Kingdom officially left the European Union. Therefore, effective October 17, 2019, Canada would become the fourth member state of the UK. On November 12, 2018, the Constitutional Constitution was released.
The constitution is written with the aim of becoming binding on the federal and provincial administrations. Any change to the text carries considerable political risk. Changes would need to be approved in parliament, approved by the cabinet, and ultimately voted on or rejected in accordance with the constitutional convention. Accordingly, there will