Provinces and territories in Canada have primary responsibility for organizing and delivering health services and supervising providers. Many have established regional health authorities that plan and deliver publicly funded services locally. Generally, those authorities are responsible for the funding and delivery of hospital, community, and long-term care, as well as mental and public health services. The federal government cofinances provincial and territorial programs, which must adhere to the Canada Health Act (1985), which in turn sets standards for “medically necessary” hospital, diagnostic, and physician services.1 The act states that to be eligible to receive full federal cash contributions for health care, each provincial health care insurance plan needs to be: publicly administered, comprehensive in coverage, universal, portable across provinces, and accessible (for example, without user fees).
The federal government also regulates the safety and efficacy of medical devices, pharmaceuticals, and natural health products; funds health research; administers a range of services for certain populations, including First Nations, Inuit, members of the Canadian Armed Forces, some veterans, resettled refugees and some refugee claimants, and inmates in federal penitentiaries; and administers several public health functions.
Publicly financed health care: Total and publicly funded health expenditures were forecast to account for an estimated 11.1 percent and 8.0 percent of GDP, respectively, in 2016; by that measure, 69.8 percent of total health spending comes from public sources.2 The provinces and territories administer their own universal health insurance programs, covering all provincial and territorial residents in accordance with their own residency requirements.3 Temporary legal visitors, undocumented immigrants, those who stay in Canada beyond the duration of a legal permit, and those who enter the country “illegally,” are not covered by any federal or provincial program, although provinces and territories provide some limited services.
The main funding sources are general provincial and territorial spending, which was forecast to constitute 93 percent of public health spending in 2016.4 The federal government contributes cash funding to the provinces and territories on a per capita basis through the Canada Health Transfer, which will total an estimated CAD36 billion (USD28.8 billion) in 2016–2017, accounting for an estimated 24 percent of total provincial and territorial health expenditures.5
Private health insurance: Private insurance, held by about two-thirds of Canadians, covers services excluded from public reimbursement, such as vision and dental care, prescription drugs, rehabilitation services, home care, and private rooms in hospitals. In 2014, approximately 94 percent of premiums for private health plans were paid through employers, unions, or other organizations under a group contract or uninsured contract (by which a plan sponsor provides benefits to a group outside of an insurance contract).6 In 2014, private insurance accounted for approximately 12 percent of total health spending.7 The majority of insurers are for-profit.