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The Canada Health Act

The Canada Health Act (CHA) is a statute that provides the framework for federally funded, provincial/territorial health insurance programs. Established in 1984, the CHA requires all essential medical services–such as hospital or physician visits–to be paid for by a provincial or territorial health insurance plan. It also sets out the criteria that provincial and territorial insurance programs must meet in order to receive the full financial contribution from the federal government for which they are eligible.

History

Because healthcare in Canada falls under provincial jurisdiction, federal interventions in the field of health were, prior to the mid-twentieth century, slow to come. Healthcare was primarily privately funded until 1947, when Saskatchewan started funding in-hospital services. Shortly thereafter British Columbia and Alberta developed similar plans. In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act as a cost-sharing measure to split funding for certain hospital care and diagnostic services between the federal government and the provinces. This new cost-sharing program included specific criteria—those certain publicly-funded services would be provided in all funded jurisdictions. By 1961, all provinces and territories were funding certain forms of hospital care and diagnostic services under the new program.

In 1962, Saskatchewan led the way again, as the first province to extend province-wide universal health insurance plan, to include doctors’ services. Once again, the federal government intervened to offer a cost-sharing program, this time through the 1966 Medical Care Act, to reimburse provinces half of the cost of medical services provided by a doctor outside of a hospital. Within six years, all provinces had agreed to join this cost-share program.

In 1977, the funding model for hospital care, diagnostic services, and doctors’ visits shifted from a model where the federal government was matching provincial funding to a block grant program, where the federal government would provide a lump sum. This new arrangement under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act restricted the funding available to the provinces somewhat, but it also removed some of the restrictions, allowing the provinces more flexibility about how they spent federal funds.

The Canada Health Act

In 1984, the Canada Health Act was passed 1984, replacing and consolidating the pre-existing federal hospital and medical insurance acts. The new Act was intended to ensure that people across the country have relatively similar access to essential health care services by setting up  the minimum standard of care required for provinces to qualify for federal funding.  While each province is different in terms of the services they cover, they must provide services that are “medically necessary”, and follow the Act’s five principles (listed below) in order to receive federal health funding. If the provinces do not adhere to the Act’s principles, they can be fined, or their federal health transfers may be restricted.

The CHA’s principles are:

  • Public administration — a provincial or territorial insurance plan must be administered by a non-profit, public authority that is overseen by the provincial/territorial government
  • Comprehensiveness — provinces/territories must ensure that all of the required services outlined in the CHA are insured by the provincial/territorial health plan
  • Universality — all insured persons must be entitled to insured health services under uniform terms and conditions
  • Portability — individuals moving from one province/territory to another must continue to be covered by health insurance by the “home” jurisdiction for up to three months.
  • Accessibility — healthcare services and institutions must be easily accessible to all, regardless of age, gender, race, religion, or ability.

Key Developments since the CHA

The Canadian healthcare system has continued to evolve since the 1984 passage of the CHA. In the 1990s, the funding mechanisms changed once again, as funding for healthcare was consolidated with funding for post-secondary education, social services, and social assistance programs into the Canada Health and Social Transfer. This shift meant that the provinces had more flexibility as to how to spend federal funding transfers, but that as healthcare costs rose, that other areas of social support might be affected (or vice versa). Later, in 2003, the provinces and federal government signed the Accord on Health Care Renewal to provide structural support to provinces to ensure access, quality and long-term sustainability of the Canadian healthcare system. The Accord split the Canada Health and Social Transfer in two (the Canada Health Transfer and the Canada Social Transfer), rededicating specific funds for health.

In 2004, the first ministers announced further healthcare reforms with  A 10-Year Plan to Strengthen Health Care. Which provided new funding, tied to key areas of concern, namely wait times management, Aboriginal health, primary health care, a national pharmaceutical strategy, health care services in the North, medical equipment, public health, and additional reporting on the progress made towards these reforms.

Critiques of the Act

The scope of medicare in Canada remains a relevant issue for most Canadians. While access to services such as doctors, surgery, and emergency treatment are widely available, there is debate around whether the government should incorporate more health services, such as dental care, and mental healthcare, which are not widely considered “medically necessary” in Canada.  

Further, overbilling is an increasing problem, Longer wait times in one province compel citizens with the means to cross provincial borders and access overbilled medical services. For instance, waiting times for an MRI in Ottawa can be if six weeks, while the same procedure is available more quickly in Quebec, a steep price tag attached. Or, in Saskatchewan, patients can “pay to skip waiting lists for MRIs“.  Not only does this traverse the ‘universal’ aspect of the Act, but it also infringes on one of the major tents of the law: accessibility.

Another criticism of the Act is its inability to adequately provide access to abortion services. Pro-choice activists in Canada have been vocal about the fact that while abortion is treated as a medical service in Canada rather than a strictly reproductive issue, the accessibility, portability, and especially universality of the service is seriously compromised. Joyce Arthur, an abortion-rights activist has argued that abortion services in Canada “fail at least 4 out 5” basic principles of the Canada Health Act.

Finally, the Health Act’s definition of “medically necessary” is currently left to the discretion of provincial legislators, and critics argue that this creates gaps in national health coverage as some Canadians are legislated out of accessing necessary healthcare. The CHA’s clear lack of definitions for terms such as “medically necessary” and “medically required” gives provinces and territories freedom to restrict access to important medical services.

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Contributors: Venus Amador Giraldo, Joshua Eisenmenger, Minahil Fatima, Max Lague, Stephanie Lica, Hillary Russell, Greg Woods, Nina Zamora