Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong><br />
In contrast, there has been more limited progress on the intergovernmental<br />
front since the first ministers’ 10-Year Plan to Strengthen <strong>Health</strong> Care (CICS,<br />
2004). Following that meeting, provincial and territorial governments used<br />
additional federal cash transfers to shorten waiting times in priority areas,<br />
reinvigorate primary care re<strong>for</strong>m and provide additional coverage <strong>for</strong> home<br />
care services that could be substituted <strong>for</strong> hospital care. While a number of<br />
provincial and territorial governments introduced some <strong>for</strong>m of catastrophic<br />
drug coverage <strong>for</strong> their own residents, they achieved very little in <strong>for</strong>ging a<br />
pan-Canadian approach to prescription drug coverage and management.<br />
6.1 Analysis of recent re<strong>for</strong>ms<br />
The modern era of Canadian health care re<strong>for</strong>m began in the late 1980s and<br />
early 1990s after the passage of the <strong>Canada</strong> <strong>Health</strong> Act (1984). This federal<br />
law locked in place a pattern of universal coverage that had originally been<br />
established through the Hospital Insurance and Diagnostic Services Act (1957)<br />
and the Medical Care Act (1966). By withdrawing transfer funding from those<br />
jurisdictions permitting user fees and extra billing on a dollar-<strong>for</strong>-dollar basis,<br />
and then returning most of the nearly C$250 million originally withdrawn after<br />
the offending provinces had eliminated user fees and extra billing, the federal<br />
government entrenched the principle of first dollar coverage.<br />
Since universal coverage remained limited to medically necessary hospital<br />
and physician services – with no sustained ef<strong>for</strong>t to expand this basket of<br />
universally covered services – this “narrow but deep” coverage has remained the<br />
policy status quo ever since in <strong>Canada</strong>. At the same time, the law discouraged<br />
governments from reducing universal coverage <strong>for</strong> health care despite major<br />
cuts in public spending in response to decades of deficit-spending and a slowing<br />
economy in the early to mid-1990s. Conversely, when the economy improved<br />
and governments benefited from a fiscal bonus because of reduced payments<br />
on the debt, they chose not to increase universal coverage even marginally<br />
despite the recommendations of a Royal Commission (Romanow, 2002) and<br />
a Senate Committee (Senate of <strong>Canada</strong> 2002). As a consequence, there have<br />
been no major changes to the universal basket of health services since medicare<br />
was introduced.<br />
In what follows, more recent and incremental health re<strong>for</strong>ms have been<br />
separated into two movements, one driven by the desire <strong>for</strong> greater coordination<br />
and integration through structural reorganization, and the second motivated by<br />
concerns about quality of care. In the first set of re<strong>for</strong>ms, governments across