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加拿大医疗保健系统:谁应该为所有有益的医疗治疗付费?一个亟待解决的问题。

Canadian Health Care System: Who Should Pay for All Medically Beneficial Treatments? A Burning Issue.

机构信息

1 Department of Statistics, 113074 Shahjalal University of Science and Technology , Sylhet, Bangladesh.

2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

出版信息

Int J Health Serv. 2018 Apr;48(2):289-301. doi: 10.1177/0020731417738976. Epub 2017 Nov 2.

Abstract

The Canadian health care system can be characterized as a mix of public and private participation, although it is often described as a publicly funded system. In Canada, "medically necessary" services are covered with public funds; however, the Canada Health Act provides no formal definition of medical necessity. The provincial and territorial health care insurance plans decide which services are medically necessary. As a result, coverage of hospital and medical services differs among provinces. Outpatient prescription drugs are not covered by public plans. The coverage for diagnostics and medications for rare diseases is also limited. Private insurance plans, often provided by employers, are an expensive solution, although coverage is not sufficient. Those who are unemployed, self-employed, or informally employed and those with rare diseases that require expensive treatments and drugs frequently are not covered by any plan and face financial difficulty paying for their prescriptions and treatments. As a result, many Canadians are struggling and facing inequality in acquiring medical services for rare diseases and outpatient prescription drugs due to an unfair Canadian health care system. This paper proposes some recommendation to make medical services more accessible and affordable to every Canadian.

摘要

加拿大的医疗保健系统可以被描述为公共和私人参与的混合体,尽管它通常被描述为公共资助的系统。在加拿大,“必要的医疗服务”由公共资金支付;然而,《加拿大健康法案》没有对医疗必要性提供正式的定义。各省和地区的医疗保险计划决定哪些服务是必要的医疗服务。因此,各省之间的医院和医疗服务的覆盖范围不同。门诊处方药不在公共计划的覆盖范围内。罕见疾病的诊断和药物的覆盖范围也有限。私人保险计划通常由雇主提供,这是一个昂贵的解决方案,尽管覆盖范围不足。那些失业、自雇或非正式就业的人以及那些患有需要昂贵治疗和药物的罕见疾病的人通常没有任何计划覆盖,他们在支付处方和治疗费用方面面临困难。因此,由于加拿大不公平的医疗保健系统,许多加拿大人在获得罕见疾病和门诊处方药的医疗服务方面面临困难和不平等。本文提出了一些建议,以使每个加拿大人都能更容易获得和负担得起医疗服务。

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