Canada is renowned for its universal national health insurance national insurance (NI) system, a collection of systems often referred to globally as medicare. It covers all medically necessary physician and hospital services, as guaranteed by the Canada Health Act (CHA). Healthcare has changed dramatically since the CHA was passed in 1984. With technological innovation, medically necessary care is no longer provided solely in hospitals, but may be provided in the home, community or other settings.
The social insurance (SI) model, common in Europe and used in Canada to finance public pensions and employment insurance, has been suggested as a way to raise revenue to improve access to non-CHA services. Unlike NI systems, which are funded primarily from general tax revenues, SI systems are usually funded by mandatory payroll deductions. This paper examines the implications of using the SI model to expand coverage to services such as pharmaceuticals and long-term care. It does not attempt to establish which model, NI or SI, might be superior, only whether such a change might be better than the status quo.