 Everything you need to know about the Canada Health Act … but were afraid to ask
Passed into law in 1984, the Canada Health Act is the overarching legislation for Canada’s national medicare program. The act sets the criteria and conditions of insured health care services, and the national standards provinces and territories must meet in order to get federal funding from the Canada Health and Social Transfer (CHST).
In 1984, the Canada Health Act brought together the elements of two previous pieces of legislation – the Hospital Insurance and Diagnostic Services Act (1957) and the Medical Care Act (1968). Extra provisions were added to eliminate direct charges to patients in the forms of extra-billing and user fees. The act established consequences for provincial and territorial governments that allow direct charges to patients by reducing federal transfer payments on a dollar-for-dollar basis. In other words, the Canada Health Act relies on federal spending powers to establish a Canada-wide, publicly funded health care system that bases patients’ access to health care services on need, not on the ability to pay.
While the federal government establishes the national standards for health care services, the provinces and territories deliver the services. Provincial governments decide where hospitals will be located, how many physicians are needed, and how much money will be spent on health care services. In order to qualify for full federal funding under the CHST, provinces must meet nine requirements under the Canada Health Act, including five criteria, two specific provisions and two conditions.
The five criteria of the CHA guiding the provincial public health insurance plans are:
- Public Administration: The public health insurance plan must be managed in a public, not-for-profit fashion.
- Comprehensiveness: All residents must be covered for “medically necessary” health services.
- Universality: All residents must be covered by the public insurance plan on uniform terms and conditions.
- Portability: All residents must be covered by their public plan, wherever they are treated in Canada.
- Accessibility: All residents must have access to insured health care services on uniform terms and conditions without direct or indirect financial charges, or discrimination based on age, health status or financial circumstances.
The two specific provisions provide definitions of extra-billing and user fees, while the two conditions require provincial and territorial governments to provide information annually to the Minister of Health in order to monitor compliance with the Canada Health Act.
While the Canada Health Act clearly states that health care must be provided on uniform terms and conditions without financial barriers, this principle is increasingly under threat, thanks to the for-profit clinics that are offering access to publicly insured services for a price. For example, private businesses, like the Copeman Clinic in Vancouver, require patients to pay a fee to access physicians and specialists. Patients register and pay a $1,200 enrollment fee, as well as an annual services fee of $2,300. This type of clinic contravenes the Canada Health Act by requiring people to pay money before they can access publicly insured health care services.
Similarly, fully private clinics like the Cambie Surgery Centre, which is also located in Vancouver and operates under the direction of Dr. Brian Day, contravene the Canada Health Act by enticing doctors to either leave the public system entirely, or provide services in both the public and private sectors.
Private MRI clinics are also examples of Canada Health Act contraventions. These clinics, which have shown up across the country, allow people to pay out of pocket for an MRI. Individuals who can afford to pay a private fee may be able to get their test results faster and return to the public system for treatment ahead of those who can’t afford to pay. In Winnipeg, the Maples Surgical Centre offers MRIs for $695. According to news reports, technologists who left the public Health Sciences Centre are doing the scans. The result has been a backlog at the public centre caused by a staffing shortage. People are able to pay for faster diagnostic services at the expense of those waiting in the public queue, and in contravention of the Canada Health Act.
Provinces are also making moves toward a private, parallel health care system in violation of the Canada Health Act. Recently, politicians in British Columbia, Quebec and Alberta have all said they are looking at the use of private, for-profit facilities to deliver publicly funded health care services.
In Quebec, Jean Charest’s government – under the pretext of reducing wait times, proposes to fund for-profit clinics out of public money even though it will cost more than expanding and improving the non-profit, public sector. There’s already a shortage of doctors in Quebec and this plan will drain resources from the public system even more. Quebec is also proposing to allow the purchase of private insurance for higher quality medical treatments, which goes against the core principle of the Canada Health Act – equal access to care for rich and poor alike.
Profit is not the cure
During the federal election, Stephen Harper promised to enforce the Canada Health Act and protect public health care. He is now breaking his promise by supporting the Quebec plan to allow private health care insurance and private clinics.
Take action!
Hold Prime Minister Stephen Harper accountable to his promise. Demand that he enforce the letter and the spirit of the Canada Health Act, which ensures access to quality, timely, publicly funded health care. Public dollars should never pay for private health care.
Contact Prime Minister Harper today!
Email: pm@pm.gc.ca
Fax: 613-941-6900
Mail: Office of the Prime Minister
80 Wellington Street
Ottawa, ON K1A 0A2
If you have have a complaint about a medical service or have experienced a violation of the Canada Health Act, please share your story with us (jmalek@canadians.org) for our website.
You may also help protect medicare by filing a complaint with your provincial College of Physicians and Surgeons and the Canada Health Act Division of Health Canada (click here for more information).
To find out more about the Council of Canadians, and to become a member, visit our website at www.canadians.org, or call us toll free at 1-800-387-7177.
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