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mythbusters
MYTH BUSTED MAY 2011
province chooses to provide that additional coverage. The majority of these services are provided out-of-hospital by non-physician health professionals.
mythbusters
and antibiotics that do not treat the root of their problems.8 Indeed, oral diseases can lead to or be a sign of serious health issues elsewhere in the body,9,10 but the CHA only requires intervention when an oral ailment threatens overall health, and by then treatment may require a long hospital stay on the publics dime. A similar argument is made about mental health. The recent shift toward treating patients in the community (e.g. by psychologists in private practice) rather than in hospital (e.g. by hospital-employed psychiatrists)11 may lead to continued dwindling of public coverage for mental health services. As dened in the CHA, these services are not technically medically necessary since the term only applies to physician-provided care. Yet according to the World Health Organization, improving mental health is a crucial aspect of the overall health and well-being of individuals, societies and countries.12 Home care is another prime example. All provinces and territories cover some core services (e.g. short-term post-acute care), while other services are publicly insured in select jurisdictions (e.g. meal preparation). Home care is important because it ensures that lowacuity patients receive an appropriate level of care, and meets the double goal of ensuring that expensive hospital beds are reserved for those that require a higher level (and therefore higher cost) of care.13 But while home care may be more appropriate for some patients needs, they may be required to assume its costs since it takes place out-of-hospital.14 Currently the quality of home care varies greatly across the country and accessing necessary services is often challenging given available resources and funding limitations.15 Access to outpatient prescription drugs also varies widely. Each province decides who is eligible for public coverage (e.g. based on age, disease or income), the level of co-pays or deductibles, and which drugs enter the formulary.16 On average, about 40% of pharmaceuticals in Canada are covered under public insurance while the rest are paid for privately.5 An individuals access to benecial medications therefore depends on factors that have little to do with medical necessity. This has prompted calls for a national universal public drug program,17 and some provinces have already moved in that direction.18
REFERENCES
1. Angus Reid Public Opinion. (2010). Canadians truly proud of flag, hockey, armed forces and health care system. Vision Critical. Retrieved from http://www.visioncritical.com/ Gutkin, C. (2010). Paying for pain. Canadian Family Physician, 56(4), 396. Canada Health Act, R.S.C., 1985, c. C-6U.S.C. (1984). CHSRF. (2002). Medically necessary: What is it, and who decides? Ottawa, Ontario: Commission on the Future of Health Care in Canada. Canadian Institute for Health Information. (2010). National health expenditure trends, 1975 to 2010. Ottawa, Ontario: CIHI. Deber, R., & Gamble, B. (2007). Whats in, whats out: Stakeholders views about the boundaries of Medicare. Healthcare Quarterly, 10(4), 97-105. Romanow, R. J. (2002). Building on values: The future of health care in Canada final report. Ottawa, Ontario: Commission on the Future of Health Care in Canada. Quionez, C., Gibson, D., Jokovic, A., & Locker, D. (2009). Emergency department visits for dental care of nontraumatic origin. Community Dentistry and Oral Epidemiology, 37(4), 366-371. Locker, D., & Matear, D. (2000). Oral disorders, systemic health, wellbeing and the quality of life: A summary of recent research evidence. Toronto, Ontario: Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto. Canadian Dental Association. (2007). Oral health-systemic health: What is the true connection?, 73(3) 211-216. Latimer, E. (2005). Community-based care for people with severe mental illness in Canada. International Journal of Law and Psychiatry, 28(5), 561. World Health Organization. (2001). The World Health Report 2001: Mental health: New understanding, new hope. Geneva, Switzerland: WHO. Hollander, M. J., Chappell, N. L., Prince, M. J., & Shapiro, E. (2007). Providing care and support for an aging population: Briefing notes on key policy issues. Healthcare Quarterly, 10(3), 34-45. Motiwala, S. S., Flood, C. M., Coyte, P. C., & Laporte, A. (2005). The First Ministers Accord on health renewal and the future of home care in Canada. Healthcare Quarterly, 8(1), 2-10. Canadian Home Care Association. (2008). Portraits of home care in Canada. Mississauga, Ontario: CHCA. Anis, A. H., Guh, D., & Wang, X. (2001). A dogs breakfast: Prescription drug coverage varies widely across Canada. Medical Care, 39(4), pp. 315-326. Anis, A. H. (2004). National Pharmacare: A dogs tale. Canadian Medical Association Journal, 171(6), 565. Rgie de lassurance maladie du Qubec. (2010). What is the public plan? Retrieved from http://www.ramq.gouv.qc.ca/ Picard, A. (2011). The cost of drugs: Breaking the bank to stay alive http://www.theglobeandmail.com/
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CONCLUSION
A lengthy hospital stay in Canada does not pose the threat of nancial ruin, unlike in countries without universal healthcare. However, accessing certain necessary services out-of-hospital or by a non-physician can cost you. According to a recent column, a person with a $20,000 annual drug bill[not uncommon for certain conditions]would pay nothing in the Northwest Territories, roughly $1,500 in Quebec, $8,000 in Saskatchewan and $20,000 in Prince Edward Island.19 Despite the iconic status medicare has in Canada, the notion that medicare covers everything does little to prepare Canadians for all costs associated with maintaining or improving their health. The concept for this issue of Mythbusters originated from the 2011 Mythbusters Award recipient, Mrs. Sharon Melanson. Sharon is a Masters candidate at the University of British Columbia, Okanagan, British Columbia
Mythbusters articles are published by the Canadian Health Services Research Foundation (CHSRF) only after review by experts on the topic. CHSRF is an independent, not-for-profit corporation funded through an agreement with the Government of Canada. Interests and views expressed by those who distribute this document may not reflect those of CHSRF. 2011.