Canada Health Act

The Canada Health Act (CHA) (French: Loi canadienne sur la santé) (the Act) is a piece of Government of Canada legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer. These criteria require universal coverage of all insured services (for all 'insured persons'). The Canada Health Act (CHA) (French: Loi canadienne sur la santé) (the Act) is a piece of Government of Canada legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer. These criteria require universal coverage of all insured services (for all 'insured persons'). 'Insured health services' include hospital services, physician services, and surgical-dental services provided to insured persons, if they are not otherwise covered, for example by provincial workers' compensation programmes. The Act deals only with how the system is financed. The act also deals with professional people like students. Because of the constitutional division of powers among levels of government in Canadian federalism, adherence to CHA conditions is voluntary. However, the fiscal levers have helped to ensure a relatively consistent level of coverage across the country. Although there are disputes as to the details, the Act remains highly popular. In popular discussion, the Act is often conflated with the health care system in general. However, the Act is silent about how care should be organized and delivered, as long as its criteria are met. The Act states that 'the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.' Another cause for debate is the scope of what should be included as 'insured services'. For historical reasons, the CHA's definition of insured services is largely restricted to care delivered in hospitals or by physicians. As care has moved from hospitals to home and community, it increasingly has been moving beyond the terms of the Act. International data shows that approximately 70% of Canadian health expenditures are paid from public sources, placing Canada below the OECD average. However, health insurance covers surgery and services, including psychotherapy, in clinics and doctors' offices as well as dental surgery at dental offices and laboratory tests. Canada is a federal country in which power is distributed between the national government and the ten provinces. The division of power was spelled out in the British North America Act 1867 (renamed the Constitution Act, 1867 in 1982). Section 92(7) lists as one of the 'exclusive powers of provincial legislatures' 'The Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province, other than Marine Hospitals.' Over time, the mismatch between fiscal resources and fiscal capacity became increasingly problematic. If Canadians were to have similar levels of service, it would be necessary for the national government to somehow equalize the ability to pay for it. Yet attempts by the national government to implement programs directly encountered resistance from the provinces. This resulted in several legal battles. In a few cases, where there was agreement that the federal government should take the lead, adverse court decisions were handled by amending the constitution (e.g., in 1940, in response to a court decision that federal unemployment insurance was unconstitutional, the Constitution Act, 1867 was amended to give the national Parliament jurisdiction over unemployment insurance). The Constitution Act does give potential powers over elements of health care to the federal government through various clauses (e.g., quarantine), but the role of the federal government has been highly debated. As summarized by a Senate Committee led by Michael Kirby, the federal government has a number of roles to play, including assisting the provinces in paying for health services. Although this has not been tested in court, the federal government has assumed that it is entitled to use its spending powers to set national standards. However, the extent to which 'strings' can be (and are) attached to federal transfers has remained contentious, and most federal governments have been unwilling to antagonize the provinces. The development of Canadian health insurance has been well described by Malcolm Taylor, who participated in many of the negotiations in addition to studying it as an academic. Health care is delivered privately but largely administered and funded publicly by provinces, consistent with their jurisdictional authority. Funded privately until the mid-to-late 20th century, Taylor notes that many Canadians 'daily faced the potentially catastrophic physical and financial consequence of unpredictable illness, accident, and disability,' and providers, unwilling to deny needed care, had growing bad debts. A number of efforts to establish social insurance systems failed due to provincial opposition to federal incursion into their jurisdiction. These included the 1937 Rowell-Sirois Commission on Dominion-Provincial Relations, and the 1945 Green Book proposals of Prime Minister Mackenzie King as part of the post-World War II reconstruction. At the same time, Canada resembled other developed economies in its receptivity to a more expansive government role in improving social welfare, particularly given the widespread sacrifices during World War II and the still active memories of the Great Depression.