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109-451: Advocates of balance billing argue that it increases the incomes of high-quality healthcare providers and measures their dissatisfaction with insurance company fees. Critics say that balance billing lets providers raise charges through stealth rather than transparent pricing, creates unnecessary administrative costs and patient confusion, and allows providers to simply pass along costs to patients, rather than helping them to secure good value. It

218-403: A middle power , Canada's strong support for multilateralism and internationalism has been closely related to its foreign relations policies of peacekeeping and aid for developing countries . Canada is part of multiple international organizations and forums . While a variety of theories have been postulated for the etymological origins of Canada , the name is now accepted as coming from

327-467: A parliamentary system within the context of a constitutional monarchy —the monarchy of Canada being the foundation of the executive, legislative , and judicial branches. The reigning monarch is also monarch of 14 other sovereign Commonwealth countries and Canada's 10 provinces . The monarch appoints a representative, the governor general , on the advice of the prime minister , to carry out most of their ceremonial royal duties. The monarchy

436-665: A consequence of European colonization, the Indigenous population declined by forty to eighty percent. The decline is attributed to several causes, including the transfer of European diseases , to which they had no natural immunity, conflicts over the fur trade, conflicts with the colonial authorities and settlers, and the loss of Indigenous lands to settlers and the subsequent collapse of several nations' self-sufficiency. Although not without conflict, European Canadians ' early interactions with First Nations and Inuit populations were relatively peaceful. First Nations and Métis peoples played

545-554: A constitutional amending formula and the Canadian Charter of Rights and Freedoms . The Charter guarantees basic rights and freedoms that usually cannot be overridden by any government; a notwithstanding clause allows Parliament and the provincial legislatures to override certain sections of the Charter for a period of five years. Canada's judiciary interprets laws and has the power to strike down acts of Parliament that violate

654-508: A critical part in the development of European colonies in Canada , particularly for their role in assisting European coureurs des bois and voyageurs in their explorations of the continent during the North American fur trade . These early European interactions with First Nations would change from friendship and peace treaties to the dispossession of Indigenous lands through treaties . From

763-506: A distinguishing element of Canada's political culture. Peace, order, and good government , alongside an Implied Bill of Rights , are founding principles of Canadian federalism . At the federal level, Canada has been dominated by two relatively centrist parties practising "brokerage politics": the centre-left leaning Liberal Party of Canada and the centre-right leaning Conservative Party of Canada (or its predecessors ). The historically predominant Liberals position themselves at

872-614: A hospital bed with extra amenities. Balance billing is prohibited in Taiwan , and extra fees have only been allowed recently and in rare defined circumstances. Today, patients in Taiwan are allowed to choose more expensive versions of some devices such as stents , implants or prosthetics , and to pay the difference in cost themselves. Canada Canada is a country in North America . Its ten provinces and three territories extend from

981-485: A method for resolving payment disputes between providers and insurers (either through a specific payment standard or a dispute resolution process). The states with a comprehensive approach are California, Connecticut, Florida, Illinois, Maryland, New York, Colorado, New Mexico, and Texas. A 2020 study found that reforms introduced by New York in 2014 successfully reduced out-of-network billing for emergency care by 88%. Similarly, after Texas enacted an anti-surprise billing law,

1090-613: A percentage of the center. Some large healthcare companies own many types of medical facilities, including ambulatory surgery centers. The largest ASC chains in terms of numbers of centers include Envision Healthcare , Tenet Healthcare / United Surgical Partners International , Surgical Care Affiliates , Hospital Corporation of America , Ambulatory Surgical Centers of America, and Surgery Partners and Physicians Endoscopy. Nearly 68 percent of ASC management companies reported having equity ownership in all freestanding entities they managed. ASCs are in all 50 states and can be found throughout

1199-568: A portion of the surprise bill, or for a repayment plan, and sometimes argue to their health insurer for the insurance company to pay a larger proportion of the bill. The 2019 Commonwealth Fund report found that federal action was needed to comprehensively protect consumers from balance billing, given that (1) only federal law can comprehensively address patients from one state being treated by providers from another state and (2) federal law currently blocks states from enacting protections against surprise billing from air ambulance services. Congress gave

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1308-674: A process of increasing autonomy from the United Kingdom. This increased sovereignty was highlighted by the Statute of Westminster, 1931 , and culminating in the Canada Act 1982 , which severed the vestiges of legal dependence on the Parliament of the United Kingdom . Canada is a parliamentary democracy and a constitutional monarchy in the Westminster tradition . The country's head of government

1417-765: A safety net, and argues that: Unfortunately, the claims of physicians who provide emergency care for commercially insured services are often paid by health plans at rates that are substantially below the usual and customary value of these services. In the recent past, most plans based the allowed benefit for these services on the 70th or 80th percentile of usual and customary charges, but the database most often used for this purpose underrepresented these charges. ... In response to successful challenges to such flawed databases, some plans have established out-of-network benefit rates that are still substantially below usual and customary payments. Health plans know that emergency medical care must be provided for their enrollees no matter how poorly

1526-560: A self-contained unit within a hospital (also known as a hospital outpatient department), in a freestanding self-contained unit (also known as an ambulatory surgery center), or in a physician's office-based unit. Between the late 20th century and early 21st century, outpatient surgery has grown in popularity in many countries. In the United States, 65% of surgeries at hospitals in 2012 were conducted on an outpatient basis, compared with 54% in 1992. Studies have shown that outpatient surgery

1635-841: A separate colony in 1769. To avert conflict in Quebec , the British Parliament passed the Quebec Act 1774, expanding Quebec's territory to the Great Lakes and Ohio Valley . More importantly, the Quebec Act afforded Quebec special autonomy and rights of self-administration at a time when the Thirteen Colonies were increasingly agitating against British rule. It re-established the French language, Catholic faith, and French civil law there, staving off

1744-747: A small number of circumstances, and Prince Edward Island and New Brunswick do not restrict it at all. In 2003, the BC government enacted the Medicare Protection Amendment Act, which banned extra billing for medical services and diagnostic procedures deemed medically necessary and covered by the provincial Medicare system; however, many of the provisions were not enforced. In 2018, the government announced its intention to implement operational requirements more stringently and to impose financial penalties for extra billing for medically necessary diagnostic procedures. However, enforcement of medical procedures

1853-454: A specific provider or providers providing the treatment (such as an anesthesiologist or radiologist ) does not participate in the network of the patient's health plan. In both circumstances, "the patient is not in a position to choose the provider or to determine that provider's insurance network status." A 2019 Commonwealth Fund report identified 28 U.S. states as having at least some consumer protections relating to balance billing." This

1962-468: A surprise medical bill. A 2020 Peterson- KFF Health System Tracker found that, "for people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017." However, surprise billing also occurs in planned-care (non-emergency) settings: for example, when a patient receives care at an in-network hospital or ambulatory surgery center , only to subsequently learn that

2071-431: A temperate climate, with a mild and rainy winter. On the east and west coasts, average high temperatures are generally in the low 20s °C (70s °F), while between the coasts, the average summer high temperature ranges from 25 to 30 °C (77 to 86 °F), with temperatures in some interior locations occasionally exceeding 40 °C (104 °F). Much of Northern Canada is covered by ice and permafrost . The future of

2180-711: Is as safe as or safer than inpatient surgery. For instance, complication rates and post-surgical hospitalization or readmission rates are comparable, and pain and infection rates are lower after outpatient surgery than inpatient surgery. Nevertheless, articles in the newsmedia (such as some discussing the 2014 death of Joan Rivers after an outpatient procedure) have questioned the safety of outpatient surgery performed at ambulatory surgery centers. Ambulatory surgery centers , also known as outpatient surgery centers , same day surgery centers , or surgicenters , are health care facilities where surgical procedures not requiring an overnight hospital stay are performed. Such surgery

2289-504: Is commonly less complicated than that requiring hospitalization . Avoiding hospitalization can result in cost savings to the party responsible for paying for the patient's health care . These centers specialize in providing surgery, including certain pain management and diagnostic (e.g., eye muscle surgery services) in an outpatient setting. Overall, the services provided can be generally called procedures . These can be considered procedures that are more intensive than those done in

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2398-554: Is divided into 15 terrestrial and five marine ecozones . These ecozones encompass over 80,000 classified species of Canadian wildlife , with an equal number yet to be formally recognized or discovered. Although Canada has a low percentage of endemic species compared to other countries , due to human activities, invasive species , and environmental issues in the country , there are currently more than 800 species at risk of being lost . About 65 percent of Canada's resident species are considered "Secure". Over half of Canada's landscape

2507-1019: Is intact and relatively free of human development. The boreal forest of Canada is considered to be the largest intact forest on Earth, with approximately 3,000,000 km (1,200,000 sq mi) undisturbed by roads, cities or industry. Since the end of the last glacial period , Canada has consisted of eight distinct forest regions . Approximately 12.1 percent of the nation's landmass and freshwater are conservation areas , including 11.4 percent designated as protected areas . Approximately 13.8 percent of its territorial waters are conserved, including 8.9 percent designated as protected areas. Canada's first National Park , Banff National Park established in 1885 spans 6,641 square kilometres (2,564 sq mi). Canada's oldest provincial park, Algonquin Provincial Park , established in 1893, covers an area of 7,653.45 square kilometres (2,955.01 sq mi). Lake Superior National Marine Conservation Area

2616-534: Is one of the world's most ethnically diverse and multicultural nations, the product of large-scale immigration . Canada's long and complex relationship with the United States has had a significant impact on its history , economy , and culture . A developed country , Canada has a high nominal per capita income globally and its advanced economy ranks among the largest in the world by nominal GDP , relying chiefly upon its abundant natural resources and well-developed international trade networks . Recognized as

2725-634: Is solely a federal responsibility and is uniform throughout Canada. Law enforcement, including criminal courts, is officially a provincial responsibility, conducted by provincial and municipal police forces. In most rural and some urban areas, policing responsibilities are contracted to the federal Royal Canadian Mounted Police . Canadian Aboriginal law provides certain constitutionally recognized rights to land and traditional practices for Indigenous groups in Canada. Various treaties and case laws were established to mediate relations between Europeans and many Indigenous peoples. The role of Aboriginal law and

2834-533: Is the prime minister , who holds office by virtue of their ability to command the confidence of the elected House of Commons and is appointed by the governor general , representing the monarch of Canada , the ceremonial head of state . The country is a Commonwealth realm and is officially bilingual (English and French) in the federal jurisdiction. It is very highly ranked in international measurements of government transparency, quality of life, economic competitiveness, innovation, education and human rights. It

2943-564: Is the second-largest country . By land area alone, Canada ranks fourth , due to having the world's largest area of fresh water lakes . Stretching from the Atlantic Ocean in the east, along the Arctic Ocean to the north, and to the Pacific Ocean in the west, the country encompasses 9,984,670 km (3,855,100 sq mi) of territory. Canada also has vast maritime terrain, with

3052-512: Is the source of sovereignty and authority in Canada. However, while the governor general or monarch may exercise their power without ministerial advice in rare crisis situations , the use of the executive powers (or royal prerogative ) is otherwise directed by the Cabinet , a committee of ministers of the Crown responsible to the elected House of Commons and chosen and headed by the prime minister,

3161-545: Is the world's largest freshwater protected area, spanning roughly 10,000 square kilometres (3,900 sq mi). Canada's largest national wildlife region is the Scott Islands Marine National Wildlife Area which spans 11,570.65 square kilometres (4,467.45 sq mi). Canada is described as a " full democracy ", with a tradition of liberalism , and an egalitarian , moderate political ideology. An emphasis on social justice has been

3270-703: Is thought to erode political consensus in favor of a one-tier system of healthcare, and to inhibit some people from getting the care they need, by making that care more expensive. Throughout the 1970s in Canada , the country saw an increase in balance billing, which in Canada is normally called extra billing. It was not permitted in Quebec or British Columbia , but had been encouraged in Ontario and Alberta , and tolerated in other provinces. The federal government estimated that by 1983, extra billing across Canada totaled $ 100 million. The government believed that extra billing enabled

3379-400: Is when an out-of-network provider bills an individual for services that were not covered by the insurance plan. This is often a surprise because an individual may be unaware that the services were out-of-network or did not actively choose to receive in an inpatient setting. The "growing risk to patients of incurring burdensome unexpected out-of-network bills" has received significant attention in

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3488-644: The Canada Elections Act limits this to four years with a "fixed" election date in October; general elections still must be called by the governor general and can be triggered by either the advice of the prime minister or a lost confidence vote in the House. The 105 members of the Senate, whose seats are apportioned on a regional basis, serve until age 75. Canadian federalism divides government responsibilities between

3597-672: The Dominion Lands Act to regulate settlement and established the North-West Mounted Police to assert authority over the territory. This period of westward expansion and nation building resulted in the displacement of many Indigenous peoples of the Canadian Prairies to " Indian reserves ", clearing the way for ethnic European block settlements . This caused the collapse of the Plains Bison in western Canada and

3706-470: The Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean , making it the world's second-largest country by total area , with the world's longest coastline . Its border with the United States is the world's longest international land border. The country is characterized by a wide range of both meteorologic and geological regions. With a population of just over 41   million people, it has widely varying population densities, with

3815-746: The Battle of the Scheldt in 1944. Canada provided asylum for the Dutch monarchy while that country was occupied and is credited by the Netherlands for major contributions to its liberation from Nazi Germany . The Canadian economy boomed during the war as its industries manufactured military materiel for Canada, Britain, China , and the Soviet Union . Despite another Conscription Crisis in Quebec in 1944, Canada finished

3924-602: The COVID-19 pandemic in Canada began on January 27, 2020, with widespread social and economic disruption. In 2021, the possible graves of hundreds of Indigenous people were discovered near the former sites of Canadian Indian residential schools . Administered by various Christian churches and funded by the Canadian government from 1828 to 1997, these boarding schools attempted to assimilate Indigenous children into Euro-Canadian culture . By total area (including its waters), Canada

4033-571: The Canada Act 1982 , the patriation of Canada's constitution from the United Kingdom, concurrent with the creation of the Canadian Charter of Rights and Freedoms . Canada had established complete sovereignty as an independent country under its own monarchy . In 1999, Nunavut became Canada's third territory after a series of negotiations with the federal government. At the same time, Quebec underwent profound social and economic changes through

4142-783: The Canadian Shield , the interior plains , the Great Lakes-St. Lawrence Lowlands , the Appalachian region , the Western Cordillera , Hudson Bay Lowlands , and the Arctic Archipelago . Boreal forests prevail throughout the country, ice is prominent in northern Arctic regions and through the Rocky Mountains , and the relatively flat Canadian Prairies in the southwest facilitate productive agriculture. The Great Lakes feed

4251-554: The Constitution of Canada fully under Canadian control, referred only to Canada . Later that year, the name of the national holiday was changed from Dominion Day to Canada Day . The first inhabitants of North America are generally hypothesized to have migrated from Siberia by way of the Bering land bridge and arrived at least 14,000 years ago. The Paleo-Indian archeological sites at Old Crow Flats and Bluefish Caves are two of

4360-807: The Federated Ambulatory Surgery Association (FASA) and the American Association of Ambulatory Surgery Centers (AAASC) merged. William Prentice is the executive director of ASCA. He previously served as the director of the Washington office for the American Dental Association. Accreditation organizations for ASCs provide standards of medical care, record keeping, and auditing. Some of the goals of these organizations include continuous improvement of medical care in surgery centers and providing an external organization where

4469-499: The First Nations , Inuit , and Métis , the last being of mixed descent who originated in the mid-17th century when First Nations people married European settlers and subsequently developed their own identity. The Indigenous population at the time of the first European settlements is estimated to have been between 200,000 and two million, with a figure of 500,000 accepted by Canada's Royal Commission on Aboriginal Peoples . As

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4578-731: The Meech Lake Accord failed in 1990. This led to the formation of the Bloc Québécois in Quebec and the invigoration of the Reform Party of Canada in the West. A second referendum followed in 1995, in which sovereignty was rejected by a slimmer margin of 50.6 to 49.4 percent. In 1997, the Supreme Court ruled unilateral secession by a province would be unconstitutional, and the Clarity Act

4687-668: The Oka Crisis of 1990, the first of a number of violent confrontations between provincial governments and Indigenous groups. Canada joined the Gulf War in 1990 and was active in several peacekeeping missions in the 1990s, including operations in the Balkans during and after the Yugoslav Wars , and in Somalia , resulting in an incident that has been described as " the darkest era in the history of

4796-550: The Parliament of Canada and the commissioners represent the King in his federal Council , rather than the monarch directly. The powers flowing from the Constitution Act, 1867 , are divided between the federal government and the provincial governments to exercise exclusively and any changes to that arrangement require a constitutional amendment , while changes to the roles and powers of the territories may be performed unilaterally by

4905-539: The Quiet Revolution of the 1960s, giving birth to a secular nationalist movement. The radical Front de libération du Québec (FLQ) ignited the October Crisis with a series of bombings and kidnappings in 1970, and the sovereigntist Parti Québécois was elected in 1976, organizing an unsuccessful referendum on sovereignty-association in 1980. Attempts to accommodate Quebec nationalism constitutionally through

5014-662: The Saint Lawrence River as Canada . From the 16th to the early 18th century, Canada referred to the part of New France that lay along the Saint Lawrence River. Following the British conquest of New France , this area was known as the British Province of Quebec from 1763 to 1791. In 1791, the area became two British colonies called Upper Canada and Lower Canada . These two colonies were collectively named

5123-523: The St. Lawrence Iroquoian word kanata , meaning "village" or "settlement". In 1535, Indigenous inhabitants of the present-day Quebec City region used the word to direct French explorer Jacques Cartier to the village of Stadacona . Cartier later used the word Canada to refer not only to that particular village but to the entire area subject to Donnacona (the chief at Stadacona); by 1545, European books and maps had begun referring to this small region along

5232-758: The St. Lawrence River (in the southeast) where the lowlands host much of Canada's economic output. Canada has over 2,000,000 lakes—563 of which are larger than 100 km (39 sq mi)—containing much of the world's fresh water . There are also fresh-water glaciers in the Canadian Rockies , the Coast Mountains , and the Arctic Cordillera . Canada is geologically active , having many earthquakes and potentially active volcanoes . Average winter and summer high temperatures across Canada vary from region to region. Winters can be harsh in many parts of

5341-441: The head of government . To ensure the stability of government, the governor general will usually appoint as prime minister the individual who is the current leader of the political party that can obtain the confidence of a majority of members in the House. The Prime Minister's Office (PMO) is one of the most powerful institutions in government, initiating most legislation for parliamentary approval and selecting for appointment by

5450-471: The 21st century. Out-of-network care in the United States is very common and unavoidable in emergencies . A 2017 study published in Health Affairs concluded that in 2014, one in five inpatient emergency department causes will lead to surprise bills, and that 20% of emergency department admissions, 14% of outpatient visits to the emergency department, and 9% of elective inpatient admissions likely incurred

5559-513: The ASC for another procedure. As of 2011, physicians performed more than 23 million procedures per year in over 5,300 ASCs in the United States. In the 1980s and 1990s, many procedures that used to be performed exclusively in hospitals began taking place in ASCs as well. Many knee, shoulder, eye, spine and other surgeries are currently performed in ASCs. As of 2016, of procedures in ASCs funded by Medicare in

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5668-568: The Atlantic coast. In general, early settlements during the Age of Discovery appear to have been short-lived due to a combination of the harsh climate, problems with navigating trade routes and competing outputs in Scandinavia. In 1583, Sir Humphrey Gilbert , by the royal prerogative of Queen Elizabeth I , founded St John's, Newfoundland , as the first North American English seasonal camp . In 1600,

5777-465: The Atlantic coast. As a consequence of various armed conflicts , France ceded nearly all of its colonies in North America in 1763. In 1867, with the union of three British North American colonies through Confederation , Canada was formed as a federal dominion of four provinces. This began an accretion of provinces and territories resulting in the displacement of Indigenous populations , and

5886-606: The Canadas until their union as the British Province of Canada in 1841. Upon Confederation in 1867 , Canada was adopted as the legal name for the new country at the London Conference and the word dominion was conferred as the country's title. By the 1950s, the term Dominion of Canada was no longer used by the United Kingdom, which considered Canada a "realm of the Commonwealth". The Canada Act 1982 , which brought

5995-729: The Canadian military ". Canada sent troops to Afghanistan in 2001 , resulting in the largest amount of Canadian deaths for any single military mission since the Korean War in the early 1950s. In 2011, Canadian forces participated in the NATO-led intervention into the Libyan Civil War and also became involved in battling the Islamic State insurgency in Iraq in the mid-2010s. The country celebrated its sesquicentennial in 2017, three years before

6104-423: The Crown the governor general, lieutenant governors , senators, federal court judges, and heads of Crown corporations and government agencies. The leader of the party with the second-most seats usually becomes the leader of the Official Opposition and is part of an adversarial parliamentary system intended to keep the government in check. The Parliament of Canada passes all federal statute laws. It comprises

6213-439: The First Nations to education, government and legal rights. Because Britain still maintained control of Canada's foreign affairs under the British North America Act, 1867, its declaration of war in 1914 automatically brought Canada into the First World War . Volunteers sent to the Western Front later became part of the Canadian Corps , which played a substantial role in the Battle of Vimy Ridge and other major engagements of

6322-400: The French established their first seasonal trading post at Tadoussac along the Saint Lawrence. French explorer Samuel de Champlain arrived in 1603 and established the first permanent year-round European settlements at Port Royal (in 1605) and Quebec City (in 1608). Among the colonists of New France, Canadiens extensively settled the Saint Lawrence River valley and Acadians settled

6431-411: The Métis' grievances ignited the Red River Rebellion and the creation of the province of Manitoba in July 1870. British Columbia and Vancouver Island (which had been united in 1866) joined the confederation in 1871 on the promise of a transcontinental railway extending to Victoria in the province within 10 years, while Prince Edward Island joined in 1873. In 1898, during the Klondike Gold Rush in

6540-414: The Northwest Territories, Parliament created the Yukon Territory. Alberta and Saskatchewan became provinces in 1905. Between 1871 and 1896, almost one quarter of the Canadian population emigrated south to the US. To open the West and encourage European immigration, the Government of Canada sponsored the construction of three transcontinental railways (including the Canadian Pacific Railway ), passed

6649-532: The Parliament of Canada. Ambulatory surgery center Outpatient surgery , also known as ambulatory surgery , day surgery , day case surgery , or same-day surgery , is surgery that does not require an overnight hospital stay. The term “ outpatient ” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs. Outpatient surgery may occur in an inpatient facility, in

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6758-563: The Texas Department of Insurance reported receiving up to 95% fewer surprise billing complaints. In states with a law preventing or restricting surprise billing, commercially insured consumers who receive a surprise bill "may be able to obtain assistance from their state Department of Insurance, though state law protections may not cover all surprise billing situations, and may not cover people with insurance through their job." Consumers who live in states that lack surprise billing protections sometimes negotiate with health care providers to write off

6867-425: The United Kingdom. The delay underscored Canada's independence. The first Canadian Army units arrived in Britain in December 1939. In all, over a million Canadians served in the armed forces during the Second World War . Canadian troops played important roles in many key battles of the war, including the failed 1942 Dieppe Raid , the Allied invasion of Italy , the Normandy landings , the Battle of Normandy , and

6976-452: The United States is typically provided by a managed care plan with a preferred or exclusive "network" of providers; balance billing does not occur with providers in-network, as the insurer negotiates an agreed rate ahead of the service. However, out-of-network medical billing has become common for privately insured patients even when they receive care in an in-network hospital, creating a substantial financial burden. Surprise balance billing

7085-509: The United States , the three most common were cataract surgery with intraocular lens insert (18.7% of all procedures), upper gastrointestinal endoscopy with biopsy (8.2%), and colonoscopy with biopsy (6.8%). The first center in the USA was established in Phoenix, Arizona in 1970 by two physicians who wanted to provide timely, convenient and comfortable surgical services to patients in their community, avoiding more impersonal venues like regular hospitals. Five surgeons performed cases at

7194-400: The United States in 1846 ended the Oregon boundary dispute , extending the border westward along the 49th parallel . This paved the way for British colonies on Vancouver Island (1849) and in British Columbia (1858) . The Anglo-Russian Treaty of Saint Petersburg (1825) established the border along the Pacific coast, but, even after the US Alaska Purchase of 1867, disputes continued about

7303-411: The abortive Rebellions of 1837 . The Durham Report subsequently recommended responsible government and the assimilation of French Canadians into English culture. The Act of Union 1840 merged the Canadas into a united Province of Canada and responsible government was established for all provinces of British North America east of Lake Superior by 1855. The signing of the Oregon Treaty by Britain and

7412-450: The average doctor's office but not so intensive as to require a hospital stay. An ambulatory surgery center and a specialty hospital often provide similar facilities and support similar types of procedures. The specialty hospital may provide the same procedures or slightly more complex ones and the specialty hospital will often allow an overnight stay. ASCs do not routinely provide emergency services to patients who have not been admitted to

7521-432: The bill. The percentage is higher for specialists rather than generalists and doctors in urban rather than rural areas. Balance billing is prohibited in Germany . Fee schedules are negotiated between sickness funds and physicians, and physicians are not permitted to charge more than the set amount. Balance billing is prohibited in Japan , and extra fees are only allowed in a small number of circumstances, such as having

7630-399: The bottom of the list. Although complications are very rare, ASCs are required by Medicare and the accreditation organizations to have a backup plan for transfer of patients to a hospital if the need arises. The national nonprofit organizations that represents the interests of ASCs and their patients is Ambulatory Surgery Center Association (ASC Association), which was formed in 2008 when

7739-442: The center on the first day it opened, and four of those procedures required general anesthesia. ASCs rarely have a single owner. Physicians partners who perform surgeries in the center will often own at least some part of the facility. Ownership percentages vary considerably, but most ASCs involve physician owners. Occasionally, an ASC is entirely physician-owned. However, it is most common for development/management companies to own

7848-760: The centre of the political scale. Five parties had representatives elected to the Parliament in the 2021 election —the Liberals, who formed a minority government; the Conservatives, who became the Official Opposition ; the New Democratic Party (occupying the left ); the Bloc Québécois ; and the Green Party . Far-right and far-left politics have never been a prominent force in Canadian society. Canada has

7957-548: The constitution. The Supreme Court of Canada is the highest court, final arbiter, and has been led since 2017 by Richard Wagner , the Chief Justice of Canada . The governor general appoints the court's nine members on the advice of the prime minister and minister of justice . The federal Cabinet also appoints justices to superior courts in the provincial and territorial jurisdictions. Common law prevails everywhere except Quebec, where civil law predominates. Criminal law

8066-499: The country and consists of written text and unwritten conventions. The Constitution Act, 1867 (known as the British North America Act, 1867 prior to 1982), affirmed governance based on parliamentary precedent and divided powers between the federal and provincial governments. The Statute of Westminster, 1931 , granted full autonomy, and the Constitution Act, 1982 , ended all legislative ties to Britain, as well as adding

8175-421: The country, particularly in the interior and Prairie provinces, which experience a continental climate , where daily average temperatures are near −15  °C (5  °F ), but can drop below −40 °C (−40 °F) with severe wind chills . In non-coastal regions, snow can cover the ground for almost six months of the year, while in parts of the north snow can persist year-round. Coastal British Columbia has

8284-631: The creation of a two-tiered Canadian healthcare system , in which people who could not afford extra charges would receive lesser care. In 1984, the government passed the Canada Health Act , which promised universal and comprehensive health coverage for all Canadians, and which contained provisions to discourage user fees and extra billing by imposing financial penalties on and reducing transfer payments to provinces that permitted them. In 2002, five provinces prohibit all extra-billing, while Alberta , British Columbia (BC), and Newfoundland allow it in

8393-577: The early 1930s saw an economic downturn, leading to hardship across the country. In response to the downturn, the Co-operative Commonwealth Federation (CCF) in Saskatchewan introduced many elements of a welfare state (as pioneered by Tommy Douglas ) in the 1940s and 1950s. On the advice of Prime Minister William Lyon Mackenzie King , war with Germany was declared effective September 10, 1939, by King George VI , seven days after

8502-624: The emergence of a new Canadian identity , marked by the adoption of the maple leaf flag in 1965, the implementation of official bilingualism (English and French) in 1969, and the institution of official multiculturalism in 1971. Socially democratic programs were also instituted, such as Medicare , the Canada Pension Plan , and Canada Student Loans ; though, provincial governments, particularly Quebec and Alberta, opposed many of these as incursions into their jurisdictions. Finally, another series of constitutional conferences resulted in

8611-663: The exact demarcation of the Alaska–Yukon and Alaska–BC border. Following three constitutional conferences, the British North America Act, 1867 officially proclaimed Canadian Confederation on July 1, 1867, initially with four provinces: Ontario , Quebec, Nova Scotia, and New Brunswick. Canada assumed control of Rupert's Land and the North-Western Territory to form the Northwest Territories , where

8720-416: The federal government and the 10 provinces. Provincial legislatures are unicameral and operate in parliamentary fashion similar to the House of Commons. Canada's three territories also have legislatures, but these are not sovereign, have fewer constitutional responsibilities than the provinces, and differ structurally from their provincial counterparts. The Constitution of Canada is the supreme law of

8829-584: The financial feasibility of the nation's emergency care system. The " No Surprises Act " was signed into law as a part of the Consolidated Appropriations Act of 2021 on December 27, 2020. In France , physicians who want to charge more than the government-negotiated set fees are considered to be in a separate "payment sector," which essentially means they are treated as self-employed . They can charge higher fees and receive reduced benefits . In 1987, about 27% of French physicians chose to balance

8938-473: The growth of an independence movement in contrast to the Thirteen Colonies. The Proclamation and the Quebec Act in turn angered many residents of the Thirteen Colonies, further fuelling anti-British sentiment in the years prior to the American Revolution . After the successful American War of Independence, the 1783 Treaty of Paris recognized the independence of the newly formed United States and set

9047-456: The introduction of European cattle farms and wheat fields dominating the land. The Indigenous peoples saw widespread famine and disease due to the loss of the bison and their traditional hunting lands. The federal government did provide emergency relief, on condition of the Indigenous peoples moving to the reserves. During this time, Canada introduced the Indian Act extending its control over

9156-489: The issue serious attention in 2018-2019 with both the House and Senate passing substantive bills out of committee in the summer of 2019. An American College of Emergency Physicians policy statement on balance billing noted that the Emergency Medical Treatment and Active Labor Act of 1986 requires patients presenting at an emergency department to be treated regardless of insurance coverage or ability to pay as

9265-515: The late 18th century, European Canadians forced Indigenous peoples to assimilate into a western Canadian society. Settler colonialism reached a climax in the late 19th and early 20th centuries. A period of redress began with the formation of a reconciliation commission by the Government of Canada in 2008. This included acknowledgment of cultural genocide , settlement agreements , and betterment of racial discrimination issues, such as addressing

9374-715: The later wars of the period constituted the North American theatre of the Seven Years' War . Mainland Nova Scotia came under British rule with the 1713 Treaty of Utrecht and Canada and most of New France came under British rule in 1763 after the Seven Years' War. The Royal Proclamation of 1763 established First Nation treaty rights, created the Province of Quebec out of New France, and annexed Cape Breton Island to Nova Scotia. St John's Island (now Prince Edward Island ) became

9483-761: The main front in the War of 1812 between the United States and the United Kingdom . Peace came in 1815; no boundaries were changed. Immigration resumed at a higher level, with over 960,000 arrivals from Britain between 1815 and 1850. New arrivals included refugees escaping the Great Irish Famine as well as Gaelic -speaking Scots displaced by the Highland Clearances . Infectious diseases killed between 25 and 33 percent of Europeans who immigrated to Canada before 1891. The desire for responsible government resulted in

9592-404: The majority residing in urban areas and large areas of the country being sparsely populated. Canada's capital is Ottawa and its three largest metropolitan areas are Toronto , Montreal , and Vancouver . Indigenous peoples have continuously inhabited what is now Canada for thousands of years. Beginning in the 16th century, British and French expeditions explored and later settled along

9701-672: The monarch, the House of Commons, and the Senate . While Canada inherited the British concept of parliamentary supremacy , this was later, with the enactment of the Constitution Act, 1982, all but completely superseded by the American notion of the supremacy of the law . Each of the 338 members of Parliament in the House of Commons is elected by simple plurality in an electoral district or riding. The Constitution Act, 1982 , requires that no more than five years pass between elections, although

9810-620: The name of Henry VII of England . In 1534, French explorer Jacques Cartier explored the Gulf of Saint Lawrence where, on July 24, he planted a 10-metre (33 ft) cross bearing the words, "long live the King of France", and took possession of the territory New France in the name of King Francis I . The early 16th century saw European mariners with navigational techniques pioneered by the Basque and Portuguese establish seasonal whaling and fishing outposts along

9919-430: The oldest sites of human habitation in Canada. The characteristics of Indigenous societies included permanent settlements, agriculture, complex societal hierarchies, and trading networks. Some of these cultures had collapsed by the time European explorers arrived in the late 15th and early 16th centuries and have only been discovered through archeological investigations. Indigenous peoples in present-day Canada include

10028-552: The permafrost is uncertain because the Arctic has been warming at three times the global average as a result of climate change in Canada . Canada's annual average temperature over land has risen by 1.7 °C (3.1 °F), with changes ranging from 1.1 to 2.3 °C (2.0 to 4.1 °F) in various regions, since 1948. The rate of warming has been higher across the North and in the Prairies. In

10137-421: The plans pay for these services. The lack of a system to ensure fair benefit payments has allowed payers to underpay the fair value of emergency services, creating an imperative to preserve balance billing. Balance billing ensures the ability to provide patient care services where no enforced laws or regulations require health plans to pay appropriate benefits for emergency care claims at rates sufficient to maintain

10246-548: The plight of missing and murdered Indigenous women . It is believed that the first documented European to explore the east coast of Canada was Norse explorer Leif Erikson . In approximately 1000 AD, the Norse built a small short-lived encampment that was occupied sporadically for perhaps 20 years at L'Anse aux Meadows on the northern tip of Newfoundland . No further European exploration occurred until 1497, when seafarer John Cabot explored and claimed Canada's Atlantic coast in

10355-704: The present-day Maritimes , while fur traders and Catholic missionaries explored the Great Lakes , Hudson Bay , and the Mississippi watershed to Louisiana . The Beaver Wars broke out in the mid-17th century over control of the North American fur trade. The English established additional settlements in Newfoundland in 1610 along with settlements in the Thirteen Colonies to the south. A series of four wars erupted in colonial North America between 1689 and 1763;

10464-488: The provinces collect more revenue than the federal government, equalization payments are made by the federal government to ensure reasonably uniform standards of services and taxation are kept between the richer and poorer provinces. The major difference between a Canadian province and a territory is that provinces receive their sovereignty from the Crown and power and authority from the Constitution Act, 1867 , whereas territorial governments have powers delegated to them by

10573-455: The public can get information on many aspects of ASCs. These accreditation organizations require members to receive periodic audits. These audits will come every one to three years, depending on the accreditation organization and the circumstances of the surgery center. In an audit, a team of auditors visits the facility and examines the ASC's medical records, written policies, and compliance with industry standards. Effective in 1996, California

10682-807: The rights they support were reaffirmed by section 35 of the Constitution Act, 1982 . These rights may include provision of services, such as healthcare through the Indian Health Transfer Policy , and exemption from taxation. Canada is a federation composed of 10 federated states , called provinces, and three federal territories . These may be grouped into four main regions : Western Canada , Central Canada , Atlantic Canada , and Northern Canada ( Eastern Canada refers to Central Canada and Atlantic Canada together). Provinces and territories have responsibility for social programs such as healthcare , education , and social programs , as well as administration of justice (but not criminal law). Although

10791-740: The southeast. Canada is also home to the world's northernmost settlement, Canadian Forces Station Alert , on the northern tip of Ellesmere Island —latitude 82.5°N—which lies 817 kilometres (508 mi) from the North Pole. In latitude, Canada's most northerly point of land is Cape Columbia in Nunavut at 83°6′41″N, with its southern extreme at Middle Island in Lake Erie at 41°40′53″N. In longitude, Canada's land extends from Cape Spear , Newfoundland, at 52°37'W, to Mount St. Elias , Yukon Territory, at 141°W. Canada can be divided into seven physiographic regions:

10900-485: The southern regions of Canada, air pollution from both Canada and the United States—caused by metal smelting, burning coal to power utilities, and vehicle emissions—has resulted in acid rain , which has severely impacted waterways, forest growth, and agricultural productivity. Canada is one of the largest greenhouse gas emitters globally , with emissions increased by 16.5 percent between 1990 and 2022. Canada

11009-498: The terms of peace, ceding British North American territories south of the Great Lakes and east of the Mississippi River to the new country. The American war of independence also caused a large out-migration of Loyalists , the settlers who had fought against American independence. Many moved to Canada, particularly Atlantic Canada, where their arrival changed the demographic distribution of the existing territories. New Brunswick

11118-532: The war with a large army and strong economy. The financial crisis of the Great Depression led the Dominion of Newfoundland to relinquish responsible government in 1934 and become a Crown colony ruled by a British governor. After two referendums , Newfoundlanders voted to join Canada in 1949 as a province. Canada's post-war economic growth, combined with the policies of successive Liberal governments, led to

11227-534: The war. The Conscription Crisis of 1917 erupted when the Unionist Cabinet's proposal to augment the military's dwindling number of active members with conscription was met with vehement objections from French-speaking Quebecers. In 1919, Canada joined the League of Nations independently of Britain, and the Statute of Westminster, 1931 , affirmed Canada's independence. The Great Depression in Canada during

11336-459: The world's longest coastline of 243,042 kilometres (151,019 mi). In addition to sharing the world's largest land border with the United States —spanning 8,891 km (5,525 mi) —Canada shares a land border with Greenland (and hence the Kingdom of Denmark ) to the northeast, on Hans Island , and a maritime boundary with France 's overseas collectivity of Saint Pierre and Miquelon to

11445-448: The world. In the US, most ASCs are licensed, certified by Medicare and accredited by one of the major health care accrediting organizations. California is the leading US state in the number of Medicare Certified ASCs, followed by Florida, and then Texas. California has 694 ASCs. It is followed by Florida with 387 ASCs and then Texas with 347 ASCs. With only 1 Medicare Certified ASC, Vermont is at

11554-627: Was an increase from 2017–2018, when a total of 25 states had at least some protections against surprise billing. Only nine states had comprehensive consumer protections relating to balance billing at the end of 2018. That number rose to 13 states in 2019. Researchers consider a state to offer "comprehensive protections" against surprise bills if the state's law limits a consumer's "financial exposure to normal in-network cost sharing"; bars providers from balance billing; applies to both emergency department and non-emergency care in an in-network hospital; applies to both HMO and PPO enrollees; and creates

11663-602: Was delayed until after March 31, 2020, and diagnostic procedures until April 1, 2020, because of a court injunction in the case that would ultimately become Cambie Surgeries Corporation v. British Columbia . On September 10, 2020, the Supreme Court of British Columbia dismissed the Cambrie plaintiffs' claims. The plaintiffs filed a notice of appeal and in July 2022, the BC Court of Appeal upheld Justice Steeves' decision. Health insurance in

11772-676: Was in turn split from Nova Scotia as part of a reorganization of Loyalist settlements in the Maritimes, which led to the incorporation of Saint John, New Brunswick , as Canada's first city. To accommodate the influx of English-speaking Loyalists in Central Canada, the Constitutional Act of 1791 divided the province of Canada into French-speaking Lower Canada (later Quebec ) and English-speaking Upper Canada (later Ontario ), granting each its own elected legislative assembly. The Canadas were

11881-430: Was passed by Parliament, outlining the terms of a negotiated departure from Confederation. In addition to the issues of Quebec sovereignty, a number of crises shook Canadian society in the late 1980s and early 1990s. These included the explosion of Air India Flight 182 in 1985, the largest mass murder in Canadian history; the École Polytechnique massacre in 1989, a university shooting targeting female students; and

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