Canadian Health Care - Co-payments based on income
The Canadian health plan remains our most popular government program. However, if we could start over, we could transform a very good system into a great one. Our main obstacle to reform is the very success of the system to date. Politicians admit privately that reforms are needed but they hesitate to speak out. This does not make for thoughtful debate.
Most problems stem from one cause. From the beginning, we ignored advice and made taxes the single source of funding.. But there never are sufficient revenues for an open-ended system. This is why we struggle with scarcity of staff and equipment. While the U.S. probably spends too much on health care, Canada needs to spend more. We have to pay the price if we want a first-class system.
Our system, while very good, is due for an upgrade. But it is not realistic to expect Canadian governments to increase their share. Health-care costs have been climbing to the point where they are crowding out other essentials such as education and welfare, which are also important determinants of health and happiness. Increasing taxes is not recommended as Canadians are already overtaxed. If we want our economy to thrive so we can afford these services, we have to be sensitive to these issues.
When the government is the only payer, it rules out market signals that improve service and efficiency. We provide free coverage for minor services so we don't always have enough resources for timely major services. A more sensible system, while excluding no one, would include co-payments for front-end costs up to a reasonable maximum, depending on the patient's ability to pay.
Only an adequately funded universal health plan can protect all of us from major and catastrophic occurrences. But there will never be adequate funding if we continue to rely solely on government to provide for every minor expense.
Co-payments based on income would introduce a new source of funding to remedy this imbalance. It would encourage improved service rather than rationing. It would offer incentives for patients and providers to do the right thing. The more affluent would pay modest co-payments so the system could provide first-class service for all, rich and poor alike. This proposal would set the top co-payment at $2,500 a year for those earning more than $100,000, tapering to zero for those with incomes less than $25,000. In comparison, US. private premiums can be $15,000 a year plus co-payments. Existing levels of tax funding should remain as a floor upon which the system can be upgraded. Funds should be distributed the same way as university funding through an impartial commission.
Government's role would then be to set standards, which it can do well, rather than to micromanage, where it is not so good. New revenue based on service provided would create an incentive for hospitals, which now receive global budgets, to provide more timely service rather than rationing it.
Ontario (ON)
Ontario Health Coverage
Eligibility
Participation
Coverage is not compulsory; participation is on an individual basis and there are no premiums.
Eligibility
All permanent residents of Ontario who are Canadian Citizens, landed immigrants and convention refugees are eligible for coverage regardless of health, age or financial status.
No coverage is provided for tourists, transients, and visitors; members of the R.C.M.P. and Canadian armed forces; and inmates of federal penitentiaries and temporary residents, primarily international students and foreign workers and their families are not eligible and will not be covered (with the following exception). However, People who come to Ontario for the primary purpose of working temporarily are eligible for OHIP coverage if, before coming to Canada, they are issued an Employment Authorization allowing them to work for a named Ontario employer, at a specific job, for a limited time and for at least six months. This exception does not apply to accompany family members.
Date Coverage Begins
Ontario Health Coverage begins on the earlier of the following dates:
the first day of the third month following residency in Ontario begins
the day a permanent resident of Ontario ceases to be:
a serving member of the Canadian forces
a serving member of the R.C.M.P.
an inmate of a federal penitentiary
the day a non-resident becomes:
a recipient of social assistance
a ward of the Children's Aid Society
Coverage Terminates
Ontario Health Coverage ends on the earlier of the following dates:
three months following departure of Ontarians who establish residence outside Canada
the last day of the second month following departure of Ontarians who establish residence elsewhere in Canada
twelve months following departure of Ontarians who remain in Canada but do not establish residence in another province or territory
the day a resident becomes:
a serving member of the Canadian forces
a serving member of the R.C.M.P.
an inmate of a federal penitentiary
the day that a non-resident's social assistance is terminated
the day a non-resident is no longer a ward of the Children's Aid Society
the end of the month following the month of expiry of a document issued by Employment and Immigration Canada
--------------------------------------------------------------------------------
Coverage Extended
Under certain circumstances, residents may apply to continue Ontario coverage while living temporarily outside Ontario.
Ontarians who spend more than 183 days outside Canada will face a 3 month waiting period after their return before Ontario Health Coverage resumes, unless prior approval was given for the extended absence.
Most problems stem from one cause. From the beginning, we ignored advice and made taxes the single source of funding.. But there never are sufficient revenues for an open-ended system. This is why we struggle with scarcity of staff and equipment. While the U.S. probably spends too much on health care, Canada needs to spend more. We have to pay the price if we want a first-class system.
Our system, while very good, is due for an upgrade. But it is not realistic to expect Canadian governments to increase their share. Health-care costs have been climbing to the point where they are crowding out other essentials such as education and welfare, which are also important determinants of health and happiness. Increasing taxes is not recommended as Canadians are already overtaxed. If we want our economy to thrive so we can afford these services, we have to be sensitive to these issues.
When the government is the only payer, it rules out market signals that improve service and efficiency. We provide free coverage for minor services so we don't always have enough resources for timely major services. A more sensible system, while excluding no one, would include co-payments for front-end costs up to a reasonable maximum, depending on the patient's ability to pay.
Only an adequately funded universal health plan can protect all of us from major and catastrophic occurrences. But there will never be adequate funding if we continue to rely solely on government to provide for every minor expense.
Co-payments based on income would introduce a new source of funding to remedy this imbalance. It would encourage improved service rather than rationing. It would offer incentives for patients and providers to do the right thing. The more affluent would pay modest co-payments so the system could provide first-class service for all, rich and poor alike. This proposal would set the top co-payment at $2,500 a year for those earning more than $100,000, tapering to zero for those with incomes less than $25,000. In comparison, US. private premiums can be $15,000 a year plus co-payments. Existing levels of tax funding should remain as a floor upon which the system can be upgraded. Funds should be distributed the same way as university funding through an impartial commission.
Government's role would then be to set standards, which it can do well, rather than to micromanage, where it is not so good. New revenue based on service provided would create an incentive for hospitals, which now receive global budgets, to provide more timely service rather than rationing it.
Ontario (ON)
Ontario Health Coverage
Eligibility
Participation
Coverage is not compulsory; participation is on an individual basis and there are no premiums.
Eligibility
All permanent residents of Ontario who are Canadian Citizens, landed immigrants and convention refugees are eligible for coverage regardless of health, age or financial status.
No coverage is provided for tourists, transients, and visitors; members of the R.C.M.P. and Canadian armed forces; and inmates of federal penitentiaries and temporary residents, primarily international students and foreign workers and their families are not eligible and will not be covered (with the following exception). However, People who come to Ontario for the primary purpose of working temporarily are eligible for OHIP coverage if, before coming to Canada, they are issued an Employment Authorization allowing them to work for a named Ontario employer, at a specific job, for a limited time and for at least six months. This exception does not apply to accompany family members.
Date Coverage Begins
Ontario Health Coverage begins on the earlier of the following dates:
the first day of the third month following residency in Ontario begins
the day a permanent resident of Ontario ceases to be:
a serving member of the Canadian forces
a serving member of the R.C.M.P.
an inmate of a federal penitentiary
the day a non-resident becomes:
a recipient of social assistance
a ward of the Children's Aid Society
Coverage Terminates
Ontario Health Coverage ends on the earlier of the following dates:
three months following departure of Ontarians who establish residence outside Canada
the last day of the second month following departure of Ontarians who establish residence elsewhere in Canada
twelve months following departure of Ontarians who remain in Canada but do not establish residence in another province or territory
the day a resident becomes:
a serving member of the Canadian forces
a serving member of the R.C.M.P.
an inmate of a federal penitentiary
the day that a non-resident's social assistance is terminated
the day a non-resident is no longer a ward of the Children's Aid Society
the end of the month following the month of expiry of a document issued by Employment and Immigration Canada
--------------------------------------------------------------------------------
Coverage Extended
Under certain circumstances, residents may apply to continue Ontario coverage while living temporarily outside Ontario.
Ontarians who spend more than 183 days outside Canada will face a 3 month waiting period after their return before Ontario Health Coverage resumes, unless prior approval was given for the extended absence.
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