By Michelle Beavington, Association of Workers’ Compensation Boards of Canada
(Editor’s note: This is a two-part article. In this issue, we’ll examine health care and worker’s compensation in Canada; next quarter, we’ll as look at health care reform and legislative trends in the United States.)
Overview of the Canadian Health Care System
In general, each of Canada’s 10 provincial and three territorial governments deliver the majority of health care services and are, in turn, significantly funded by the federal government. General revenue, raised through federal, provincial and territorial taxation (such as personal and corporate taxes, sales taxes, payroll levies, and other revenue sources) is used to finance publicly funded health care.
Some key features of the Canadian Health Care system are:
- Universal Coverage: Universal coverage is provided for medically necessary health care services on the basis of need, rather than the ability to pay.
- Publicly funded but (mostly) privately provided: Health care services are funded by the provincial and territorial governments with assistance from the federal government. Most hospitals are owned by nonprofit organizations, and most physicians are independent entrepreneurs.
- Responsibility is divided between provincial/territorial and federal governments.
- Single-payer system in each province: All necessary medical and hospital care is paid for by the provincial medical services plans.
- Administered pursuant to the Canada Health Act: The Canada Health Act is federal health care legislation that basically serves as a funding agreement between the federal government and the provinces and territories. The Act establishes the rules and criteria that the provinces/territories must meet to receive full healthcare funding from the federal government.
For more information on the Canadian Health Care System, visit www.hc-sc.gc.ca/hcs-sss/index_e.html
Workers' Compensation and Health Care in Canada
Each province and territory has its own Workers’ Compensation Board (WCB) and its own workers’ compensation legislation (generally referred to as the jurisdiction’s Workers’ Compensation Act). All WCBs have exclusive jurisdiction over the administration of workers' compensation in their respective jurisdictions.
Workers' Compensation is explicitly excluded from the definition of "insured health services" in the Canada Health Act. This is why WCBs are billed for – and pay for – health care expenses of injured workers, not the government. But ultimately, it is employers who pay for the medical costs of work injuries, as their premiums fund the WCBs.
The percentage of workers' compensation coverage for Canadian workers varies from WCB to WCB, ranging from 67 percent to 100 percent. Workers employed by the federal government are covered under the Government Employees Compensation Act). Workers’ compensation claims are administered by the WCBs and costs are reimbursed by the federal government.
Here are some examples of medical care that are paid for by the majority of WCBs:
- medical and other services provided by a person licensed to practice the healing arts (e.g., physicians, surgeons, dentists, chiropractors, optometrists, practitioners, chiropodists, nurses)
- hospitalization
- drugs and dressings
- x-rays
- artificial appliances or apparatuses (and replacement or maintenance of items such as dentures, eyeglasses, artificial eyes or limbs, or hearing aids)
- ambulances
- clothing allowances (relating to artificial apparatuses or wheelchairs)
What is paid for by the WCBs in the above categories varies from jurisdiction to jurisdiction, according to each specific Workers' Compensation Act. Some provinces/territories also pay for special or alternative treatments.
Each province/territory has its own fee schedule for how much its WCB pays health care providers, as well as rules concerning which providers the WCB can contract with. Depending on the jurisdiction, payment of fees may be made (a) directly to the practitioner or facility or (b) by the provincial health care organization, which is then reimbursed by the WCB.
Additionally, each WCB can establish rules concerning the need, type and amount of treatment for different workplace injuries or illnesses. WCBs may also limit to which health care providers injured workers can go to for treatment. Some WCBs have even constructed (and operate) hospitals, clinics or resident facilities for injured workers, such as Alberta’s Millard Health Centre and New Brunswick’s Workers' Rehabilitation Centre.
For more information on the Canadian workers' compensation system, visit www.awcbc.org.
(Be sure to read part two of this article in next quarter’s issue of AASCIF News.)
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