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Toronto Notes 2019 The Canadian Health Care System Ethical, Legal, and Organizational Medicine ELOM3 History of the Canadian Health Care System
1867 British North America Act (now Constitution Act) establishes Canada as a confederacy
• “establishment, maintenance, and management of hospitals” under provincial jurisdiction
1965 Royal Commission on Health Services (Hall Commission) recommends federal leadership and financial support with provincial government operation
1984 Canada Health Act passed by federal government
• replaces Medical Care Act (1966) and Hospital Insurance and Diagnostic Services Act (1957)
• provides federal funds to provinces with universal hospital insurance
• maintains federal government contribution at 50% on average, with poorer provinces receiving
more funds
• medical insurance must be "comprehensive, portable, universal, and publicly administered" • bans extra-billing by new fifth criterion: accessibility
1996 Canada Health and Social Transfer Act passed by federal government
• federal government gives provinces a single grant for health care, social programs, and
post-secondary education; division of resources at provinces’ discretion 2001 Kirby and Romanow Commissions appointed
Kirby Commission (final report, October 2002)
• examines history of health care system in Canada, pressures and constraints of current health
care system, role of federal government, and health care systems in foreign jurisdictions
Romanow Commission (final report, November 2002)
• dialogue with Canadians on the future of Canada’s public health care system
2004 First Ministers’ Meeting on the Future of Health Care produces a 10 year plan
• priorities include reductions in waiting times, development of a national pharmacare plan, and
primary care reform
2005 Chaoulli v. Québec, Supreme Court of Canada decision
• rules that Québec’s banning of private insurance is unconstitutional under the Québec Charter
of Rights, given that patients do not have access to those services under the public system in a timely way
2011 First progress report by the Health Council reviews progress (2004 First Ministers’ 10 year plan)
• significant reductions in wait times for specific areas (such as cancer, joint replacement, and
sight restoration), but may have inadvertently caused increases in wait times of other services
• despite large investments into EMRs, Canada continues to have very low uptake, ranking last
in the Commonwealth Fund International Health Policy survey, with only 37% use among
primary care physicians
• little progress in creating a national strategy for equitable access to pharmaceuticals; however,
there has been some success in increasing pharmacists’ scope of practice, reducing generic drug
costs, and implementing drug information systems
• increases in funding to provinces at 6% per annum until the 2016-2017 fiscal year; from then
onwards, increases tied to nominal GDP at a minimum of 3% per annum
2012 Second progress report by the Health Council reviews progress towards 2004 First Ministers’ 10 year plan
• funding is sufficient; however, more innovation is needed including incentivizing through models of remuneration
• 46 recommendations made to address the lack of progress
2014 Expiry of current 10 Year Health Care Funding Agreement between federal and provincial governments
• Canadian Doctors for Refugee Care v. Canada, the Federal Court of Canada ruled that the federal government could not significantly reduce/eliminate healthcare services for refugee claimants as to do so would constitute “cruel and unusual treatment” contrary to the Charter of Rights and Freedoms
2015 Negotiations underway for a new Health Accord with a $3 billion investment over four years to homecare and mental health services by the elected Liberal government
2017 New 10 year Canada Health Accord reached with a $11.5 billion federal investment over 10 years to homecare and mental health services and a 3% annual rise in the Canada Health Transfer (down from 6% in the previous agreement) by the elected Liberal government