| Chapter 1: | Examining Provincial Variability |
third-party payments for private care. Furthermore, three provinces (Nova Scotia, Ontario, and Manitoba) have opted to limit fees paid for private care to the corresponding amounts on the public schedule. Nevertheless, as our case studies indicate, during the last fifteen years these prohibitions have been increasingly ignored or challenged by many providers and provincial governments, as well as by private third-party payers and insurers.
Even if, as mentioned earlier, prescription drugs are not considered a necessary health service under the Canada Health Act unless they are provided in a hospital, the provinces are providing increasing coverage for such services. In 1975 only 20.5 percent of prescription drugs were provided by the public sector; by 2008 some 47.5 percent of such costs were covered by the public sector (CIHI 2008). For the time being, there can be no doubt that retail pharmacies in which most licensed pharmacists are employed are for-profit private organizations. But some measures are being discussed with respect to the integration of pharmacists’ professional services into the continuum of care and regarding expanding their scope of independent practice to allow them to assess, prescribe, and manage patients with chronic conditions for private and selected public payment, in order to improve access to primary care services for patients—a road upon which Alberta has already embarked. Ontario also provides remuneration for retail pharmacists’ reviews of patients with complex medication regimes.
The funding of health care is done either indirectly through (public or private) third-party insurance or directly by the individual or family, through out-of-pocket spending, premiums, coinsurance, copayment, or deductibles (Madore 2005). Until recently British Columbia, Alberta, and Ontario were the only provinces that charged premiums for public health care coverage. Ontario’s premiums are administered through the income tax system and vary with individual income. Such payments ended up in these provinces’ consolidated tax revenues (Sullivan 2008). British Columbia bases premiums on family size and provides subsidies based on