The Canadian Healthcare System - How it Works
Health Care in Canada is delivered through Medicare, which is a national publicly funded health care system made up of 10 provincial and 3 territorial programs administered and delivered by each provincial & territorial government. Each program is required to meet the general guidelines laid out in the federal Canada Health Act. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP.
There are no co-pays except in British Columbia. Private insurance is available to Canadians to cover drugs, optometry and dentistry if they do not qualify for coverage under their provincial/territorial plans.
Hospitals are publicly funded although there are some specialized private hospitals and eating disorder treatment providers which Canadians may access with private insurance coverage or pay out of pocket.
Out of Province Treatment
All 10 provinces have similar policies for out of province care.
Eating Disorder treatment is considered elective treatment, and to obtain treatment out of province, prior approval by your provincial health care system is required.
For emergency care, most physicians in other Canadian provinces and territories (except Quebec) participate in reciprocal billing and will bill their own provincial health plan for services provided when you present your valid provincial health care card. The provinces recover the funding monthly.
Out of Country Treatment
“There must be documentation that the requested services are not available in Canada and the health services available in Canada have been fully utilized.”
Psychiatrists/ED experts in Ontario liaise with the Ministry of Health officials who oversee the out of country applications to devise/streamline a process to optimize appropriate referrals and decrease the inappropriate ones. For example, on some occasions, an OCC referral is made by a physician who is not aware of the provincial network of specialized eating disorder services when in fact there is a bed/inpatient spot available in Ontario. The MOHLTC (Ministry of Health and Long Term Care) is working towards a future goal of having a bed registry in Ontario for eating disorders and a provincial coordinator who can be a liaison person between the community (families, physicians etc.) and eating disorder services to improve communication and flow of referrals/discharges back into the community.
This may be similar in other provinces/territories.
Relevant Websites by Province
Ontario: Ontario Health Insurance (OHIP)
British Columbia: Health Insurance BC
Alberta: Alberta Health (AHCIP)
Saskatchewan: Saskatchewan Health Benefits
Manitoba: Manitoba Health
Quebec: Regie de l’assurance maladie (RAMQ)
For Quebec residents on work or student visa abroad:
New Brunswick: Medicare
Nova Scotia: MSI
Prince Edward Island: Health PEI - Medicare
Newfoundland: Medical Care Plan (MCP)
Yukon: Yukon Health Care Insurance Plan
Leave of Absence from Employment for Caregivers
1. Compassionate Care Benefits (Unemployment Insurance):
“Compassionate care benefits are Employment Insurance (EI) benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 26 weeks (six months).” It provides for a maximum of 6 weeks of benefits only.
A physician treating the ill family member must sign a “Medical certificate for Employment Insurance Compassionate Care Benefits” and confirm significant risk of death within 26 weeks.
The usual rules for Unemployment Insurance apply: you need 600 insured hours of work in the last 52 weeks, a 2 week unpaid period must be served first. What’s different is that the benefits can be shared between different family members. Only the first family member to claim benefits must serve the unpaid period.
Benefits: 55% of your average insurable earnings up to a maximum payment of $485/wk. Over 8 weeks, the maximum benefit is $2,910. Not a lot of money!
2. Sick Benefits from an Employer:
For Canadians who are eligible for sick benefits from their employer, it would seem that a better option would be to apply for sick or stress leave benefits while caring for their loved one.
Involuntary Admission to Hospital
Each Provincial Mental Health Act aims to strike a balance between two sets of principles:
the rights given to all citizens under The Canadian Charter of Rights and Freedoms; and,
Society’s obligation to provide care and treatment to those individuals who, at times, may not appreciate their need for treatment due to their mental illness.
An adult patient may be admitted involuntarily to a psychiatric facility on a Form due to a mental illness, with a designated substitute decision maker. Each province may have a different procedure for an involuntary admission and a different time frame for holding a patient.
The hospital emergency is used for patient stabilization only, not for eating disorder treatment.
Canadian Pediatric Hospitals and Emergency Room Guidelines
Canadian Pediatric Hospitals:
Pediatric emergency room eating disorder guidelines & management from BC children's hospital:
Government Funded Provincial Eating Disorder Programs and Services
http://www.bcmhas.ca/ProgramsServices/Eating%2BDisorders/default.htmhttp://www.keltyeatingdisorders.ca/http://www.bcmhas.ca/ProgramsServices/Eating+Disorders/Referrals.htm (Referrals by physician only)
Alberta Disordered Eating service, prevention & counseling:
http://www.albertahealthservices.ca/ps-1018201-eating-disorder-referral-form.pdf (Referrals by physician includes required lab/medical tests)
https://myhealth.alberta.ca/find-health-care/services/Pages/profile.aspx?SERVICEID=5777 (Alberta Zones)
Prince Edward Island:
Newfoundland & Labrador: