Canadians Seeking Healthcare Outside the National System?

Canada's healthcare system, often referred to as Medicare, is a publicly funded and nationally insured program available to all Canadian citizens and permanent residents. However, some medical clinics have chosen to opt out of the National Health Insurance (NHI) and offer services on a private pay basis. This raises questions about how and whether Canadians can seek medical care outside the National Health Insurance (NHI) system.

Medical Clinics Charging Out-of-Pocket Fees

Indeed, some medical clinics have decided to opt out of the Medicare system and charge patients a yearly fee for access to their services. These clinics serve patients who desire the convenience of private medical care or who have specific financial incentives to do so. Importantly, patients can keep their Medical Services Plan (MSP) card in case they develop a terminal or expensive illness and need to revert to the public healthcare system.

Opting Out of the Medicare System

Canadians can opt out of the NHIs, but with limitations. The Medical Services Plan (MSP) permits a 12-month renewable ‘opt-out’ period. During this time, patients are personally responsible for all healthcare expenses they incur. It's crucial to note that the Medicare Protection Act clearly states that minors cannot be 'opted out' of the system on their own or by a parent or guardian.

Special Considerations for GPs and Specialists

While it is possible for Canadians to opt out of the Medicare system, the situation is more complex for General Practitioners (GPs). In provinces such as Alberta, there is at most one GP who has left the Medicare system and charges a fee for their services. These GPs cannot provide services to those who remain within the Medicare system, and vice versa. As a patient, the reasoning to choose an opt-out GP might be limited because most GPs still operate within the public healthcare system.

Legal and Economic Considerations

The Canada Health Act (CHA) strictly regulates the National Health Insurance (NHI) and prohibits private payment for medically necessary services. Historically, provinces have had to ensure that their healthcare systems remain financially sustainable. In the past, there were instances of fee-for-service medical practices, but these were phased out in the early 1980s.

While it is true that not all medical services in Canada are petitioned for (paid for), many remain covered under Medicare. For example, dental and vision services are often covered under supplementary medical insurance, which employers provide even after retirement. While this supplementary insurance might come at a cost, it significantly reduces the financial burden of certain medical procedures such as root canals or dental implants.

Services that are not covered by Medicare, and which individuals must pay for out-of-pocket, include elective cosmetic surgeries (like plastic surgery), minor procedures such as wart and tag removal, laser eye surgery, and tattoo removal. These services are increasingly sought after and are available to those who choose to pay for them directly.

In summary, while Canadians retain the option to access private healthcare, the system is designed to be comprehensive. The choice to opt out of the NHIs is limited and often not practical, given the Canada Health Act (CHA) and the structure of the public healthcare system.