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How the Canadian Healthcare System is Setup

By: Ronda Payne

Published On: January 14, 2020

Healthcare, especially when someone is in urgent need of it, can be challenging to understand. A few years ago, when my dad’s cancer had progressed and our family needed help, I got a crash course in how Canada’s (specifically BC’s) healthcare system works, what was available and how to make contact with those who could lend a hand. I spoke to a number of people who I’m sure had taken a medical office assistant course as these people were compassionate, knowledgeable and able to guide me in the right direction.

For those looking for assistance as I was, or others who want to provide that help, it’s important to understand the overall picture of how healthcare works in our country and in your specific region. In this post, I’ve broken down the basics of how the system is set up.

Universal Coverage

Canada has long been the envy of other countries in that it offers universal healthcare. This means that insured individuals have access to medically-necessary health care services regardless of their ability to pay. An individual (Canadian citizen or permanent resident) is insured through their provincial or territorial program which may charge a healthcare premium (a fee), though most don’t. Some provinces and territories have a wait until residents can be included, so it’s important to check with your regional government to find out how to become enrolled and if there is a wait. You’ll need private health insurance until your universal care kicks in.

This standard of universal care is mandated by the Canadian Constitution. Individual provinces and territories take the majority of the responsibility for their health care systems with the federal government playing a smaller role in the delivery of services. That being said, the federal government provides financial support to provinces and territories along with providing principles for the healthcare system under the Canada Health Act.

The Canadian Institute for Health Information notes that the total health expenditure in Canada is expected to have reached $264 billion in 2019. About $7,068 per person.

The BC Model of Healthcare

Because I’m located in BC and that’s the system I understand, I’ll use that as the example of how healthcare works. With each province and territory managing the majority of its own healthcare system, the models will differ, so it’s important to look up your regional health ministry.

BC’s health insurance program is called the Medical Services Plan (MSP) and residents of the province were charged a premium for the service until that payment was eliminated in January, 2020. Residents must be registered if they and/or their dependents are eligible. Those who are eligible include BC residents who are Canadian citizens or permanent residents who make their home in BC and are in the province at least six months in a calendar year (or five months if for vacation purposes). Dependents are also eligible such as a spouse (legally married or common-law) and children (minors without a spouse who are supported by the beneficiary or those between 18 and 25 who are in full-time attendance at a post-secondary school) so long as they also follow the standards of residency.

First Nations’ residents of BC are eligible for MSP providing they are not receiving health benefits through a First Nations’ organization through other Government of Canada agreements. Enrollment is done through the First Nations Health Authority.

Tourists and visitors to Canada are not eligible, though those in BC through one of the many programs of the Immigration and Refugee Protection Act may be eligible.

What is Covered by MSP in BC

While universal healthcare means everyone has access to the coverage they need, this doesn’t include every procedure, medication or other forms of therapy. The definition of what is covered is “medically-necessary services provided by physicians and midwives, dental and oral surgery performed in a hospital, eye examinations if medically required and some orthodontic services. Diagnostics, like X-rays, are included as well.

For example, recently, I had some basic symptoms that seemed to indicate a possible heart attack, so I contacted my doctor’s office immediately and they told me to go to emergency. All of the analysis I went through (x-ray, blood tests, ECG, etc.) was covered by MSP. I can’t imagine what it would have cost to pay for all of the services I received that day. In the end, it wasn’t my heart or anything life-threatening. I wouldn’t have had those answers without our medical system.

Some supplementary benefits like acupuncture, chiropractic, massage therapy and others might be covered as well for those who have MSP and receive supplemental benefits. It’s best to ask your health care provider upfront.

What is not Covered by MSP

It’s hard to define “medically necessary” and what we may feel is necessary to us for our well-being isn’t necessarily covered by MSP.

• services that are not medically required, such as cosmetic surgery;
• dental services (except hospital-performed surgeries);
• routine eye examinations for persons 19 to 64 years of age;
• eyeglasses, hearing aids, and other equipment or appliances;
• prescription drugs (some may be covered by PharmaCare);
• acupuncture, chiropractic, massage therapy, naturopathy, physical therapy and non-surgical podiatry services (except for those who receive supplementary benefits);
• preventive services and screening tests (for example, routine annual “complete” physical examinations, whole-body CT scans, prostate-specific antigen (PSA) tests);
• services of counsellors or psychologists;
• medical examinations, certificates or tests.

It’s important to know what isn’t covered because you may have coverage and not know it. Additionally, those who take a medical office assistant course may end up working in an environment where the services are covered for some individuals, but not others.

Medical Office Assistant Course Students

It’s a lot to understand! For those looking to enter the health care field who want to take a medical office assistant course, this information is important because it will establish whether a person has universal care or not. Those working as medical office assistants need to ask questions and determine eligibility before they can establish how a medical treatment will be managed administratively. Students in health care programs should make sure their courses include an explanation of insurance coverages and how billing works in order to learn to correctly manage various types of potential patients.

This brief explanation of how Canada’s health care system is setup, with a focus on BC doesn’t even begin to touch on the various programs and help available to those enrolled in BC’s MSP program. As noted, healthcare is extremely complex and the best thing to do is reach out to someone in the system to get a better understanding of what is offered.


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