Healthcare: What’s left of Canada’s Health Act?

What makes Canada so different? Besides donuts and Air Farce, of course.

According to Canadians, it’s our healthcare system — universal coverage for all, rather than the "pay as you go" system which bleeds the life-savings of so many south of the border and in other parts of the world. Or at least that’s the way it’s supposed to be. An in-depth CARP survey of the services and treatments of most importance to our aging population reveals a startling fact: things aren’t what they used to be.

The Canada Health Act was designed to ensure our healthcare system met five basic criteria: universality, comprehensiveness, accessibility, portability, and public administration, to which all provinces and territories must adhere. Prior to 1977, the federal government matched provincial funding for health, a system changed by the Trudeau government when it introduced a complex formula called "block funding" — and over time, Ottawa reduced its contribution to provincial healthcare, arriving at today’s set-up with the provinces picking up the lion’s share of costs and demanding a greater say in how funds are spent.

But much has changed in recent years, and ovincial governments are continually at odds with their federal counterparts over how best to utilize limited financial resources. A case in Hand: The federal government came down hard on Alberta when that province charged "facility fees" for patients using private clinics, withholding $3.5 million of the funds it allots provinces for health, education and welfare. On another front, British Columbia had to back down when it tried imposing residency requirements on people seeking welfare — Ottawa suspended almost $100 million in funding.

Over the past four years the provinces have lost $6.5 billion in block funding — all in the name of deficit reduction. Provinces, engaged in their own deficit reduction battles, have responded by closing and merging hospitals, increasing co-payments on drugs, chronic care beds, and other measures — in effect, down-loading costs onto patients and their families.

Conflicting reports after the latest federal-provincial first ministers’ conference have left Canadians confused and concerned. How can Ottawa maintain the five pillars of Medicare if they don’t put more money into the system? Are we heading for a two- or even three-tiered system? Provinces already have a great deal of leeway in deciding which services — beyond basis hospital care and doctor visits — must be paid for by the individual, or via co-payment.

Example: While annual medical check-ups are still an insured service in most provinces, Nova Scotians are covered for one only if it’s deemed medically necessary.

Example: Exams for obtaining certificates of health, for insurance or other purposes, are uninsured services.

Example: If you need a chiropractor in Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick or the North West Territories, you’ll pay for treatments yourself, although seniors are partially covered under New Brunswick Blue Cross.

Example: Need physiotherapy? In Prince Edward Island, Nova Scotia and the North West Territories, it’s only available to those admitted to hospital. In New Brunswick, seniors with Blue Cross are covered; in Ontario coverage is only extended in approved clinics; B.C. has pre-determined maximums; Manitoba covers only hospital in or out-patients; Saskatchewan only has 10 clinics with government contracts; and in Alberta, regional authorities determine who does and who does not receive this treatment.

Example: Sore feet? Need a podiatrist? Only Ontario, Saskatchewan, Alberta and B.C. fund this service, but with restrictions.

Example: Osteopathy is funded only in B.C., Ontario and Alberta. Seniors with New Brunswick Blue Cross are partially covered.

Example: Optometrists’ services are covered in Nova Scotia for those under 19 and over 65, once every two years. Elsewhere, coverage is as follows: New Brunswick — only seniors with N.B. Blue Cross; Quebec — those under 18 or over 64; Ontario — only for checking vision; Manitoba — one routine complete eye exam within a 24-month-period for those under 19 or over 65; Saskatchewan — routine eye exams are limited to those under 18; Alberta — only for those under 19 and over 65; B.C. — one eye exam every two years; Yukon — those 65 and over are entitled to one pair of lenses and $50 toward frames once every two years.

Example: Dental services. In Quebec, for children under 10; in Alberta, with limitations, for seniors under Extended Health Benefits Program.

Example: Drugs. B.C., Yukon, NWT, Saskatchewan and Ontario have geared-to-income programs for those with extremely high drug bills, and most provinces offer help for people with AIDs, cystic fibrosis, immune problems, etc. Programs for the general population: Quebec and Manitoba, based on income and complicated formulas. In Quebec, maximum premium is $175 per year, and up to $62.49 per month in deductible and co-payment. In Manitoba, premium is based on income, adjusted according to family size, with a small deductible, after which there is no charge to the patient. Other provinces have programs for seniors requiring approved drugs: In Newfoundland, seniors pay the dispensing fee; PEI: seniors must go to provincial pharmacies; Nova Scotia has an optional Pharmacare program, with an annual premium of $215, and 20 per cent co-payment to a maximum of $200: New Brunswick, geared to income with top co-payment of $9.05 per prescription of $250 for GIS recipients. Others can subscribe to the Blue Cross Prescription Drug Program. Ontario single seniors with income under $16,108 or couples with an income of under $24,175 per prescription — others pay the first $100 and up to $6.11 per prescription. Saskatchewan: income tested for all residents. Co-payment of $850 per family for six-months, after which the province pays $35 per cent. Those on low income pay no more than $2 for any covered prescription. Alberta has no-premium Blue Cross Coverage for Seniors, paying 70 per cent of prescription drugs, including insulin, to a maximum of $25 per prescription or refill. British Columbia: Maximum dispensing fees, $200 per year. NWT and Yukon plan has 100 per cent coverage for seniors.

Example: Home care Despite the fact that this area of healthcare is becoming a dramatic and growing need, services are spotty. The federal government proposal to make home care an insured service has met with an outcry from the provinces due to the costs involved, and the intrusion of the federal government into provincial jurisdiction. In Alberta and Ontario, for example, home care is available at no charge for limited nursing care. In Alberta there may be a fee for other support services; in Saskatchewan, home care is based on need and income. In New Brunswick there are programs outside of Medicare, with co-payment. However, the ever-increasing demand, particularly as hospitals close or downsize, will force governments to face this problem.

Example: Most necessary Lab tests are covered. Ontario is alone in not covering PSA tests to help detect prostate cancer unless a diagnosis of cancer has already been made, and then only in hospitals, not in private labs.

Example: In the area of assistive devices, oxygen is not available in Prince Edward Island, but is covered in most other provinces. Quebec, Ontario, Saskatchewan, Alberta and B.C. have the most extensive assistance, including hearing aids, prosthetics, wheelchairs, etc., some with co-payment and every one different in services and equipment available.