Modernizing the Canada Health Act

The Canada Health Act (CHA) mandate 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." (Government of Canada, 2023) Fundamentally, a determination must be made on what aspects of health care are essential to the physical and mental well-being of Canadian residents. This is where the challenge comes in. How is it possible to make all aspects associated with protecting, promoting, and restoring the physical and mental well-being of Canadians accessible? This blog post goes on to suggest changes to be considered to strengthen the role of various levels of government in the mandate of the CHA.

The sheer size of the nation automatically imposes restrictions when it comes to universally accessible healthcare. While the cost of the service, whether that is a diagnostic test, a procedure or a consultant appointment is covered under the Ontario Health Insurance Plan or other provincial plans, the cost for residents to travel or take time off work to attend is not. Thus, disadvantaging those residents in remote areas, creating a divide.

In 1984, the CHA was adopted and determined medically necessary hospital and physician services were included in coverage while excluding other service provisions such as dental, pharmacy and many outpatients’ mental health services. (Flood & Thomas, Modernizing the Canada Health Act, 2016). After almost 30 years since the CHA was introduced, there appears to have been an erosion of the mandate and a passive tendency to focus on the provision of services hired to "restore" the physical and mental well-being of Canadians jeopardizing the original mandate to protect and promote to the point of making the Canadian Health Act obsolete. This is evidenced by the introduction of user fees and premiums in certain provinces. The financial tie between the Federal and Provincial governments as the basis for the CHA perpetuates the issues outlined above given it has not been strictly enforced leading to concern at a system level around accountability. To reform the system in attempt to better serve Canadians, one must be prepared to significantly examine the status of the system at present.

If one wants to maintain the mandate, there must be enhanced relationships between the Federal and Provincial governments along with increased accountability from a provincial aspect. I would suggest starting with the creation of a new statute between the levels of government sharing costs. (Flood & Choudhry, Strengthening the Foundations: Modernizing the Canada Health Act, 2002). The Federal government will transfer funds to the provincial government if they demonstrate compliance with a defined set of standards thus increasing accountability and adhering to the essence of the original act. This new potential cost sharing agreement would build the foundation for a reformed system with the ability to expand and grow to include important services imperative to maintaining the wellbeing of Canadians and ensuring access to services. While it may seem somewhat counterintuitive to increase services where over spending and gaps in accountability is a concern, by strengthening the relationships between the levels of government one lays the foundation to spread the program and with the increased coverage of essentials such as prescription medications, the regulatory bodies would also be able to make gains on driving the cost of medications down as a larger partner. (Flood & Choudhry, Strengthening the Foundations: Modernizing the Canada Health Act, 2002)

When I reflect on the criteria laid out in the act - Universality, Portability, Public administration, Accessibility, and Comprehensiveness, I would reframe public administration to reflect better governance and accountability. Not simply that it must be publicly administered but that the oversight and adherence to standards / criteria is upheld as the key fundamental principle allowing the reformation of key areas of coverage to become integrated while continuing to maintain the spirit of Tommy Douglas' original Medicare.

Works Cited

Flood, C. M., & Choudhry, S. (2002). Strengthening the Foundations: Modernizing the Canada Health Act. Toronto: Commission on the Future of Healthcare in Canada.

Flood, C. M., & Thomas, B. (2016). Modernizing the Canada Health Act. Dalhousie Law Journal, 39(2), 397-411.

Government of Canada. (2023, January 29). Government of Canada. Retrieved from Canada Health Act: https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html