Hospital Financing in Seven Countries (Part 4 of 11)

anada is often described as having a national health insurance system; this is not entirely accurate, however, since each of the 10 Canadian provinces (and two territories) administers its own health insurance plans. Although the hospital and medical components of those plans are subject to federal guidelines, the provincial governments make their own decisions about health care financing and payment of providers, benefits other than hospital and medical care, and the organization of health services. Despite some heterogeneity among provinces , however, the provincial health systems have several features that are common across the provinces. To qualify for federal contributions, provincial hospital and medical insurance plans must fulfill federal eligibility and coverage standards, which include public nonprofit administration, portability of benefits across provinces, comprehensive coverage defined as " all medically necessary services, " accessibility, and universal coverage. All 27 million Canadian residents, regardless of age or financial or health status, are entitled to participate in their respective provincial plans. Provinces can insure benefits in addition to hospital and physician services, but they are left to each province's discretion and vary among provinces. Among the Organisation for Economic Cooperation and Development (OECD) countries, Canada is unique in having no private sector involvement in hospital and medical insurance. Private insurers cannot compete with the public medical and hospital insurance programs, but can only cover services not covered by provincial plans (e.g., outpatient prescription drugs, dental care, cosmetic surgery, optometry, physiotherapy). A large percentage of the population has some private coverage, usually paid by employers. Hospitals (and physicians) are largely prohibited from | 21