The role of private insurance

Pharmacare in Quebec

Marie-Claude PrémontMarie-Claude PrémontÉcole nationale d’administration publiqueÉcole nationale d’administration publique

Pharmacare 2020- VancouverPharmacare 2020- Vancouver

26 26 FebruaryFebruary 2013 2013

Advantages of the Plan

•The entire population of Quebec is covered since 1997

•Mutualisation of risks

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Twisting universality

•Going from Universal for Medicare•To General for Pharmacare

Major differences between the two, in particular for private insurance

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The role of Private Health Insurance is redefined

•With a universal plan: duplicative Private Health Insurance is drastically limited, or prohibited (Chaoulli decision)•With a general plan: coverage is basic.•Markets are reserved for Private Health Insurance. If offered by an employer the Private Plan becomes mandatory for all employees.

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Structural characteristics of the

Plan1. Risk screening2. Financial Structure: A

Private Insurance Model3. Tax-Like Deduction Powers

given to Private Insurance4. Social amity defused

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• Good risks to the Private Insurer (Workers; 4.3 millions insured)

• Bad Risks to the Public Sector (Seniors and Welfare Recipients; 3.2 millions insured)

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1.1. Risk ScreeningRisk Screening

The financial structure is based on a Private Insurance model

• Annual Premium• Deductible• Co-insurance

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2. 2. Plan Financing: A Private ModelPlan Financing: A Private Model

• Payroll Deductions

• Private Insurers are granted the Benefit of Group Plans exclusively

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3.3. Tax-Like Deduction Powers Tax-Like Deduction Powers given to Private Insurancegiven to Private Insurance

• No possible cross-subsidization between public and private segments of the General Plan

• Identical Premiums within groups

Basic Plan for Public portion Private Group Plans may be enhanced

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4. 4. Social Amity DefusedSocial Amity Defused

The general Plan presented as a new model for Healthcare

solidarity

On the contrary, it inhibits the fostering of a truly universal Plan and solidarity amongst all segments of the population

Currently, proponents of this Plan promote it as a model for Hospital and Medical care.

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