Let’s Benchmark! Health insurance premiums are not based on risk factors, instead everyone is covered under the same risk pool, making insurance relatively more expensive for healthy individuals so that those with high risk profiles do not have to pay as much as they would under a risk-based pricing system. Those who cannot afford health insurance are subsi-
dized through a system of allowances based on income. Insurance regulators oversee the entire process, ensuring all insurance providers offer the same services and that collusion between insurers does not happen. Insurance companies receive forty-five percent of their income from consumer
premiums, and so have incentive to compete on price. They can negotiate with hospitals and doctors to maintain costs in order to offer lower premiums. However, even with competition, insurance companies have no incentive to avoid payments to policy holders because the government will compensate insurers whose payouts exceed income.
Canada nizations to coordinate the overall healthcare system so that it is equitable everywhere. The provincial and tribal units are responsible for local administration, hospital planning and funding, payment for and negotiation of pricing for professional services, and for the promotion of the general public health. Primary care providers are the first point of contact, ensuring continued care and ease of movement throughout the system, even when the patient requires specialized services. This comprehensive service covers a range of areas—disease and injury prevention and treatment, emergency services, referrals to coordinated and specialized care, etc. Private practice doctors are paid based on a fee-for-service schedule. Those in public practice are paid salaries or blended payments.
The Canada Health Act was designed to ensure reasonable access to all necessary medical services. It discourages user fees and, through equalization payments, tries to ensure access to all by leveling the playing field between prosperous provinces and those that are less so. In remote areas, primary care and emergency services, community-based health programs, and non-insured
health benefits programs are offered in collaboration with Aboriginal organizations and other provincial and territorial systems. Canada’s federal government sets and administers the public healthcare system so that it meets national standards throughout the country. As mentioned above, it works with smaller governing orga-
Secondary or specialized care refers to care in hospitals, community, or long-term care facilities. In Canada, the majority of hospitals are managed by regional health authorities or voluntary organizations under the watchful eyes of a board of trustees. The government does not fund home-based medical care but it does pay for care in long-term care facilities, and it provides coverage to seniors, low-income patients, and children.
Issue 5 - MAY 2015
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