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1957 – Advent of Medicare in Canada: Establishing Public Medical Care Access

Canadians are fortunate to have one of the best health care systems in the world. The creation of that system began in 1957, when the Hospital Insurance and Diagnostic Services Act was approved by Parliament. The Act provided free acute hospital care and laboratory and radiological diagnostic services to Canadians. It was followed by the Medical Care Act of 1966, which provided free access to physician services.

The concept of free medical coverage was implemented nationwide after several provinces had first done so. In 1947, Saskatchewan established public universal hospital insurance. Several provinces provided publicly funded hospital care in the following years. After the Hospital Insurance and Diagnostic Services Act was passed by Parliament in 1957, the Government of Canada started negotiating agreements with the provinces to share funding of acute hospital care and laboratory and radiological diagnostic services. By 1961, agreements were in place with all provinces and 99% of Canadians had free access to the health care services covered by the legislation.

In 1961, the federal government established the Royal Commission on Health Services, chaired by Justice Emmett Hall, to study and report on the health care needs of Canadians. The following year, the Government of Saskatchewan offered free access to physician services to all its citizens. In response, the province's doctors went on strike. Doctors in Saskatchewan eventually secured the right to practice outside the public program and to charge patients higher fees than those reimbursed by the province, a practice called extra-billing.

In 1964-65, the Royal Commission on Health Services released a two-volume report recommending a comprehensive and universal medicare system for all Canadians. The report advocated that medicare cover physician care and prescription drugs.

By 1966, the majority of Canadians were insured for physician services through various private or public insurance plans. That year, the Government of Canada passed the Medical Care Act. However, according to the Canadian constitution health care is a provincial area of jurisdiction so the Government of Canada entered into negotiations with each province individually. By 1972, each province had established its own system of free access to physician services and the federal government shared in the funding.

In 1979, Emmett Hall was again asked to study the operation and financing of health care in Canada. His commission's 1980 report recommended the abolition of extra-billing and user fees. It suggested that a collaborative means of setting provincial payment rates for doctors be put in place.

Then in 1984 the Government of Canada passed the Canada Health Act, which included the main recommendations of the Hall Report and established penalties for provinces that did not comply. By 1987, all provinces had banned extra-billing and the Government of Canada reimbursed them for the penalties previously levied. The Canada Health Act established a publicly administered health care system that is comprehensive, universal and accessible. That is, all medically necessary procedures are provided free of charge, they are available to all Canadians, and access to care is not based on health status or ability to pay. Moreover, coverage is portable between provinces and territories.

Today, Canadians continue to enjoy the benefits of medicare. However, the system is under strain due to rising costs, a higher volume of services and a population with a higher proportion of older persons. In 1999, public sector health expenditures were over $63 billion. On April 4, 2001 the Government of Canada launched a Commission on the Future of Health Care in Canada, asking it to report its recommendations to the Prime Minister by November 2002.

Links

Canada Health Act
Source: Health Canada
http://www.hc-sc.gc.ca/hcs-sss/medi-assur/overview-apercu/index_e.html

Commission on the Future of Health Care in Canada
Source: Health Canada
http://www.hc-sc.gc.ca/english/care/romanow/index1.html

Overview of the Canada Health Act
Source: Library of Parliament, Parliamentary Research Branch
http://www.parl.gc.ca/information/library/PRBpubs/944-e.htm

Financing health care in Canada
Source: Department of Finance. "Chapter 7: Fiscal Management in Uncertain Times," Budget 2001 - Budget Plan.
http://www.fin.gc.ca/budget01/bp/bpch7e.htm

Health care statistics
Canadian Institute for Health Information
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e

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