About Canada's health care system

Learn about Canada's health care system, including Medicare, funding, accessing health care services and delivery.

On this page

• About Medicare
• Federal funding for health care
• Accessing health care services

About Medicare

Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.

Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government.

The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents.

The federal government is responsible for:

• setting and administering national standards for the health care system through the Canada Health Act
• providing funding support for provincial and territorial health care services
• supporting the delivery for health care services to specific groups
• providing other health-related functions

Canada Health Act

Provincial and territorial health care insurance plans must meet the standards described in the Canada Health Act. This is necessary to get their full payment under the Canada Health Transfer.

These standards include:

• public administration
• comprehensiveness
• universality
• portability
• accessibility

Public administration

The provincial and territorial plans must be administered and operated on a non profit basis by a public authority.

Comprehensiveness

The provincial and territorial plans must insure all medically necessary services provided by:

• hospitals
• physicians
• dentists, when the service must be performed in a hospital

Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes.

If a service is considered medically necessary, the full cost must be covered by the public health care insurance plan.

Universality

The provincial and territorial plans must cover all residents.

Portability

The provincial and territorial plans must cover all residents when they travel within Canada. Limited coverage is also required for travel outside the country.

When a resident moves to another province, they can continue to use their original health care insurance card for 3 months. This gives them enough time to register for the new plan and receive their new health insurance card.

Accessibility

The provincial and territorial plans must provide all residents reasonable access to medically necessary services. Access must be based on medical need and not the ability to pay.

Federal funding for health care

The federal government provides health care funding to the provinces and territories through the Canada Health Transfer.

Provinces and territories receive additional federal funding support through other fiscal transfers.

Delivering health care services to specific groups

We provide certain direct health care services to some population groups, including:

• First Nations people living on reserves
• Inuit
• serving members of the Canadian Forces
• eligible veterans
• inmates in federal penitentiaries
• some groups of refugee claimants

Other federal health-related functions

We are responsible for the regulation of products, such as:

• food
• consumer products
• pharmaceuticals
• cosmetics
• chemicals
• pesticides
• medical devices
• radiation-emitting devices like cellphones

The federal government also supports:

• health research
• health promotion and protection
• disease monitoring and prevention

The government also provides tax support for health-related costs:

• tax credits for:
• disability
• medical expenses
• caregivers and disabled dependents
• tax rebates to public institutions for health services
• deductions for private health insurance premiums for the self-employed

Accessing health care services

Canadians most often turn to primary health care services as their first point of contact with the health care system.

In general, primary health care:

• delivers first-contact health care services
• coordinates patients' health care services to support:
• continuity of care, which means receiving high quality care from diagnosis to recovery
• ease of movement across the health care system when more specialized services are needed from specialists or in hospitals

The provinces and territories also provide supplemental coverage to certain groups of people, such as:

• seniors
• children
• social assistance recipients

This helps pay for health care services that are not generally covered under the publicly funded health care system. These services include:

• vision care
• dental care
• prescription drugs
• ambulance services
• independent living (home care)

Those who do not qualify for supplementary benefits under government plans pay for these services through:

• out-of-pocket payments
• private health insurance plans