Canada - World Health Organization Regional Office for Europe

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and then returning most of the nearly C$250 million originally withdrawn after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