School of Public Policy Report shows limits of medicare placing Canadians at risk

CALGARY, Oct. 16, 2013 /CNW/ - The majority of Canadians believe that our health-care system is universal, comprehensive and equitable, but is it? The truth is that although Canadians strongly support medicare, few actually know what it covers - and what it doesn't.

In a report published today by The School of Public Policy, authors Herb Emery and Ron Kneebone look at the term "medically necessary", which, as defined by The Canada Health Act (CHA), determines what medical services are paid for by the government, and which ones will come out of the pockets of patients. Canadians assume that they, unlike uninsured Americans, are fully protected from catastrophic medical events. Today's report says otherwise.

"Most Canadians would be surprised to find that the public system does not pay the full and potentially catastrophic costs of rehabilitation services following a stroke or brain injury, but it does fully cover low-cost and regularly incurred services, such as annual physicals and receiving advice on dealing with cold symptoms."

The authors go on to explain that what is deemed "medically necessary" is mainly determined at the provincial level, and that, for the most part, governments have been unclear about the definitions around "medically necessary". Further, the report suggests that those who help make the definitions have a fundamental conflict of interest.

"The line drawn between unnecessary and necessary medical treatments has been determined by the financial self-interest of medical stakeholders, by hospitals rationing global budgets, and by financially-constrained provincial governments. The result is a relatively narrow definition that undermines the equality goals the CHA is often claimed to uphold."

The authors don't attempt to determine what constitutes "medically necessary services," they instead advocate the need for a clearer and publicly understood definition of which health services are publically funded, and which are not.

"It is important for Canadians to understand clearly what services and levels of care our system provides so they can prepare for, and possibly insure against, outcomes that are not covered."

The report can be found at http://www.policyschool.ucalgary.ca/?q=content/challenge-defining-medicare-coverage-canada.

SOURCE: The School of Public Policy - University of Calgary

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