Lexis Nexis Medicare in Ontario - A Legal Reference Guide
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Détails des produits
The First Book of its Kind! An Important New Resource for Lawyers and Heath Care Professionals
As author Laurel Montrose notes in her introduction "Hockey may be our national sport, but there is little question that Medicare is our national passion and, increasingly, our national concern."
Medicare's legislative scheme is far-reaching and complex. This comprehensive new guide by health law specialist Laurel Montrose has been written to assist lawyers, health care professionals, health policy analysts and patients to better understand the legal structure of the system and how it works.
While the focus of this guide is the legislation of Ontario, Montrose also addresses the Canada Health Act and its operation and includes interprovincial comparators in order to assist the reader in placing Ontario's legislation in a national context. No similar resource exists for any of the Canadian provincial or territorial Medicare systems.
Your Handbook for Understanding Medicare in Ontario
Medicare in Ontario - A Legal Reference Guide reviews the framework of Medicare by subject and category in an organized and easy to follow manner. It examines the law and, where useful, policy considerations. The text includes sections that will assist readers in understanding and evaluating all aspects of Medicare, including what services are and are not covered by the Ontario Health Insurance Plan (OHIP), whether to charge or pay a "block fee", what is "queue jumping" and how OHIP coverage can be lost.
This guide also reviews and explains Ontario's laws governing audit of payments, including the new medical audit rules: when and how OHIP can refuse to pay or recover payments already made to physicians, practitioners and health facilities.
Answers Key Questions
- How are hospitals financed?
- When can a physician charge a patient?
- What information does a physician give to OHIP about a patient when sending a bill for payment?
- Do professional athletes get special access to medical services?
- Why do Ontario residents have to pay a physician when visiting Quebec, but not when visiting Alberta?
- What is the best way to complete the form to obtain OHIP coverage for out-of-country services?
A Definitive Guide For
- Legal professionals requiring in-depth and current knowledge of Medicare in Ontario
- Patients and health-care providers seeking practical suggestions to understanding and navigating the system
- Health care professionals, health care administrators and educators, policy analysts, RHPA colleges, physicians and other OHIP insured service providers in search of information concerning Ontario's Medicare laws and procedures
- Canadian federal, provincial and territorial governments looking to understand Ontario's heath care system and compare it to other Canadian systems
- Foreign governments and health organizations looking for innovative ideas
Table des matières
Chapter 1: An Aerial View of Medicare In Ontario
Chapter 2: Introduction to Insured Services
Chapter 3: Insured Physician Service (Fee-For-Service)
Chapter 4: The Schedule of Benefits - Physician Services
Chapter 5: Opt in, Opt out
Chapter 6: Other Medically Necessary Physicians' Services
Chapter 7: Primary Care Reform and Alternative Payment Models
Chapter 8: Listing, Delisting and Non-Listing
Chapter 9: Insured Practitioner Services
Chapter 10: Insured Services of Health Facilities
Chapter 11: Insured Hospital Services
Chapter 12: Exclusions
Chapter 13: "Out-of-Province" Services Rendered in Canada
Chapter 14: "Out-of-Country" Services
Chapter 15: Fees
Chapter 16: Payments
Chapter 17: Claims and Accounts
Chapter 18: Insured Persons
Chapter 19: Health Cards and Health Numbers
Chapter 20: Record-Keeping and Information Requirements
Chapter 21: Appeals
Chapter 22: Joint Committees
Chapter 23: The "New" Medical Audit Process for Physicians
Chapter 24: Payment, Audit and Recovery: Practitioners and Health Facilities
Chapter 25: Block Fees
Chapter 26: Queue Jumping
Chapter 27: Extra Billing and Other Prohibitions Against Charging
Chapter 28: Reporting Requirements, Offences and Enforcement
Chapter 29: Regulation-making Authority
Chapter 30: The Canada Health Act
Chapter 31: Current and Developing Canada Health Act Issues
Chapter 32: Enforcement of the Canada Health Act
Appendix 1: Timeline of Major Ontario Provincial Health Insurance Legislative Initiatives
Appendix 2: A Narrative History of Ontario's Health Insurance Act
Appendix 3: Internet Reference Locators
Appendix 4: Table of Cases
