Canada's health care system is generally considered one of the world's best, placing in the top ten in most measures of quality. Despite this it does have several problems that are major political issues in Canada. Canada is seen as a country with a publicly-funded health care system, with the various levels of government paying about 70% of health care costs. Canada is unusual in that the government pays for almost 100% of hospital and physician care, but contributes very little in areas such as prescription drug costs and dental care.
History
The first organized health care in Canada was hospitals set up by Catholic religious orders in New France. Religiously run hospitals were the norm up to the early twentieth century. They were generally for the poor; wealthier citizens would be cared for in their homes by expensive doctors. In the late nineteenth century a movement began that called for the improved health care for the poor, focusing mainly on sanitation and hygiene. This period saw important advances including the provision of safe drinking water to most of the population, public baths and beaches, and municipal garbage services to remove waste from the city.
The early twentieth century saw the first widespread construction of government run hospitals, mainly asylums for the mentally ill and sanitariums for those suffering from tuberculosis. Calls for increased government involvement also became common, and the idea of a national health insurance system had considerable popularity. William Lyon Mackenzie King promised to introduce such a scheme, but while he created the Department of Health he failed to introduce a national program. During the Great Depression calls for a public health system were widespread. Doctors who had long feared such an idea reconsidered hoping a government system could provide some stability as the depression had badly affected the medical community. However, governments had little money to enact the idea. In 1935, the United Farmers of Alberta passed a bill creating a provincial insurance program, but they lost office later that year and the Social Credit Party scrapped the plan due to the financial situation in the province. The next year a health insurance bill passed in British Columbia, but its implementation was halted over objections from doctors.
It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after groups of communities joined to open union hospitals under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas' Co-opertaive Commonwealth Federation government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.
In 1949, BC created a program similar to Saskatchewan's. Alberta however created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population[1].
In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions, public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act.
By 1961, all ten provinces had agreed to start HIDS Act provinces. In Saskatchewan, the act meant that half of their current program would now be paid for by the federal government. Premier Woodrow Lloyd decided to use this freed money to extend the health coverage to also include physicians. Over the sharp disagreement of the Saskatchewan College of Physicians and Surgeons, Lloyd introduced the law in 1962.
The Saskatchewan program proved a success and the federal government of Lester B. Pearson, pressured by the New Democratic Party (NDP) who held the balance of power, introduced the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan. It also set up the Medicare system. In 1984, the Canada Health Act was passed, which prohibited user fees and extra billing by doctors.
Government involvement
The various levels of government pay for about 70% of Canadians' health care, although this number has decreased somewhat in recent years. The British North America Act did not give either the federal or provincial governments responsibility for health care, as it was then a minor concern. The Act did give the provinces responsibility for regulating hospitals, and the provinces claimed that their general responsibility for local and private matters encompassed health care. The federal government felt that the health of the population fell under the Peace, Order, and Good Government part of its responsibilities. This led to several decades of debate over jurisdiction that were not resolved until the 1930s. Eventually the JCPC decided that the administration and delivery of health care was a provincial concern, but that the federal government also had the responsibility of protecting the health and well-being of the population.
By far the largest government health program is Medicare, which is actually ten provincial programs, such as OHIP in Ontario, that are required to meet the general guidelines laid out in the federal Canada Health Act. Almost all government health spending goes through medicare, but there are several smaller programs. The federal government directly administers health to groups such as the military, and inmates of federal prisons. They also provide some care to the Royal Canadian Mounted Police and veterans, but these groups mostly use the public system. Prior to 1966, Veterans Affairs Canada had a large health care network, but this was merged into the general system with the creation of Medicare. The largest group the federal government is directly responsible for is First Nations. Native peoples are a federal responsibility and the federal government guarantees complete coverage of their health needs. For the most part First Nations people use the normal hospitals and the federal government then fully compensates the provincial government for the expense. The federal government also covers any user fees the province charges. The federal government maintains a network of clinics and health centres on Native Reserves. At the provincial level, there are also several much smaller health programs alongside Medicare. The largest of these is the health care costs paid by the worker's compensation system.
Despite being a provincial responsibility, the large health costs have long been partially funded by the federal government. The cost sharing agreement created by the HIDS Act and extended by the Medical Care Act was discontinued in 1977 and replaced by Established Programs Financing. This gave a bloc transfer to the provinces, giving them more flexibility but also reducing federal influence on the health system. In 1996, when faced with a large budget shortfall, the Liberal federal government merged the health transfers with the transfers for other social programs into the Canada Health and Social Transfer, and overall funding levels were cut. This placed considerable pressure on the provinces, and combined with population ageing and the generally high rate of inflation in health costs, has caused problems with the system.
Private sector
In Canada the private sector has always been the frontline in healthcare. Canadian doctors operate for profit businesses and are the primary gatekeepers to the whole healthcare system. The doctors also have no controls placed on them by the primary payer for services, the government and they are therefore in a position to easily recommend more visits and are guaranteed payment by the government.
About 30% of Canadians' health care is paid for through the private sector. This is mostly goes towards services not covered or only partially covered by Medicare such as prescription drugs, dentistry and optometry. Many Canadians have private health insurance, often through their employers, that cover these expenses. Increasingly, there are private clinics that offer some of the same services as the public system such as hip replacements and MRI scans. These are legal. Selling private health insurance that could cover these procedures, however, is not legal, making these services too expensive for most Canadians. However, in June 2005, the Supreme Court of Canada ruled these laws unconstitutional, potentially opening the door to much more private sector participation in the health system . The Quebec and federal governments asked the high court to suspend its ruling for 18 months. Less than two months after its initial ruling, the court agreed to suspend its decision for 12 months, retroactive to June 9, 2005 which means that, for the interim, there would be no change to the status quo. "Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin, as a result of delays in receiving tests and surgeries, patients have suffered and even died in some cases, justices Beverley McLachlin, Jack Major, Michel Bastarache and Marie Deschamps found for the majority. [2]
There are large private entities that can buy priority access to medical services in Canada, such as WCB in BC
Canadian health care in comparison
Despite the relatively high costs of providing health care in Canada's hinterland and the high wages necessary to compete with wages in the United States, Canada spends no more than the G7 average on health care as a percent of its GDP. Most health statistics in Canada are about average for the G7, and vastly better than the world average.
| Country | Life expectancy | Infant mortality rate | Per capita expenditure on health (USD) | Healthcare costs as a percent of GDP | % of government revenue spent on health | % of health costs paid by government | % of health costs paid by private sector |
|---|---|---|---|---|---|---|---|
| Australia | 80.0 | 5.6 | 1,741 | 9.2 | 16.8 | 67.9 | 32.1 |
| Canada | 79.3 | 5.6 | 2,163 | 9.5 | 16.2 | 70.8 | 29.2 |
| France | 79.3 | 5.7 | 2,109 | 9.6 | 13.7 | 76.0 | 24.0 |
| Germany | 78.2 | 5.2 | 2,412 | 10.8 | 16.6 | 74.9 | 25.1 |
| Japan | 81.4 | 4.1 | 2,627 | 8.0 | 16.4 | 77.9 | 22.1 |
| UK | 77.5 | 5.9 | 1,835 | 7.6 | 15.4 | 82.2 | 17.8 |
| USA | 77.0 | 6.4 | 4,887 | 13.9 | 17.6 | 44.4 | 55.6 |