The healthcare reimbursement plans

Running head: HEALTH ECONOMICS
Ethical Analysis of Reimbursement Schemes for Healthcare Provider
Name of the Student
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HEALTH ECONOMICS1
Introduction
The healthcare reimbursement plans of every nations are aimed at providing
healthcare associated monetary benefit to the citizen. The reimbursement plans include the
providing financial subsidisation form medical equipment, pharmaceutical products, and
healthcare service delivery system so that citizen can receive all the required healthcare
services while avoiding spending an enormous amount of money for it (Guo et al. 2016). The
purpose of this plans is to make the healthcare services available for people from all
economic status. However, this concept of healthcare reimbursement differs based on the
reimbursement providers such as doctors, nurses and medical staffs, which could be
government or private employers. With globalisation of every industry the economic
condition of every nation of the world is currently facing a strong fluctuation. At the same
time, the increasing number of epidemic and pandemic events and different medical
conditions with increasing number of population, requires reassessment and evaluation of
healthcare reimbursement schemes to ensure citizens’ health as well as affordability and
accessibility to healthcare services.
Canada has a very transparent system for healthcare service providers such as doctors,
nurses and medical staffs as well as reimbursement profile that includes different types of
Federal and Provincial reimbursement schemes. Currently, Canada has 37,894,799 citizens
and with the GDP of $1.731 trillion (Martin et al. 2018). In this paper, the focus is the
national healthcare reimbursement schemes of the Canada. The purpose of this study is to
explore the reimbursement schemes, examine the limitations and suggest improvement
strategies. In the following section of this paper the discussion will be done in three sections
namely reimbursement schemes for the healthcare provider in Canada, the incentives of the
schemes and their foreseeable consequences and the suggestions for improvement. In

HEALTH ECONOMICS2
discussion of the reimbursement schemes for healthcare provider both hospital and private
medical practices will be considered. For the discussion of the advantage and disadvantage of
the schemes the consequences on healthcare providers, patients, insurant and overall society
will be discussed.
Reimbursement schemes for the healthcare provider in Canada
The healthcare service providers of Canada is publicly funded while it is being
delivered by private healthcare provider organisations. It implies that the vast majority of
healthcare services of Canada are provided with free of cost while they are delivered by
private healthcare organisations and independent practitioners. According to the 92.7 of the
Consitution Act 1867 of Canada, for establishment, maintenance and any kind of
administrations the provinces are constitutionally responsible (Martin et al. 2018). This laws
is not implied for Marine Hospitals is directly governed and administrated by federal
government. The role of federal government of Canada is to assist in financing provincial and
territorial healthcare service providers through fiscal transfers. The federal government also
provides and funds for other health related functions such as pharmaceutical production,
biomedical productions and others. The federal government also standardises the principles
of government to healthcare service provider transfers and contingencies under the Canada
Health Act 1984 (Hellsten and Dhalla 2019). The major roles of provincial or territorial
government are administration of the execution of health insurance plans as well as planning
and funding of care in healthcare service providing facilities. The funding for service
provided by physicians and other health professionals is also the responsibility of the
provincial or territorial governments. Another major role is negotiation of fee schedules with
healthcare service providers as well as individual health professionals.

HEALTH ECONOMICS3
The total healthcare spending in Canada for reimbursement was $242 billion in 2017
that means $6,604 for each citizens on average (Widdifield et al 2013). In Canada the
financing and health reimbursement comes from three primary sources namely Public
Sources, Private Sources and Out-of-Pocket schemes. The key factors in which the
government health reimbursement executes are reimbursement for healthcare facilities,
pharmaceutical reimbursement and reimbursement for physician services. Around 30% of
annual health reimbursement expenditures goes for all hospitals including private and public
facilities. Around 16% of annual health reimbursement expenditures goes for pharmaceutical
products so that people can easily afford the drugs for treatment. Almost 15% of annual
health reimbursement expenditures goes for independent healthcare practitioners’ services
(Martin et al. 2018). The key reimbursement stakeholders of Canada are Canadian Agency
for Drugs and Technologies in Health or CADTH, Therapeutic Products Directorate or
Health Canada, Institut National d'Excellence en Santé et en Services Sociaux or INESSS,
pan-Canadian Pharmaceutical Alliance or pCPA and Patented Medicine Prices Review Board
or PMPRB (Husereau et al. 2019). CADTH is a not-for-profit independent organization
funded by the federal, provincial, and territorial governments for providing evidence based
advice to Canadian healthcare decision makers regarding the drug related funding and
pharmaceutical reimbursement. Therapeutic Products Directorate or Health Canada is a
federal authority, which is responsible to regulate the reimbursement and funding associated
with medical devices and pharmaceutical drugs for decision making. Institut National
d'Excellence en Santé et en Services Sociaux or INESSS is an independent provisional
institution, which is responsible for decision making regarding reimbursement of healthcare
service providing and drug related funding. pan-Canadian Pharmaceutical Alliance or pCPA
is responsible for joint as well as public drug plan negotiations for brand drug reimbursement
in Canada (Skedgel, Wranik and Hu 2018). Patented Medicine Prices Review Board or