Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
Diagnostic Services Act in parliament in 1957. This law set out the common
conditions that provincial governments would have to satisfy in order to
receive shared-cost financing through federal transfers. One year later in 1958,
the provinces of Saskatchewan, British Columbia, Alberta, Manitoba and
Newfoundland agreed to work within the federal framework. By 1959, Ontario,
Nova Scotia, New Brunswick and Prince Edward Island also joined. Quebec
did not agree until 1961, shortly after the election of a government dedicated to
modernizing the provincial welfare state (Taylor, 1987) (Table 2.1).
With the introduction of federal cost-sharing for universal hospitalization,
the Saskatchewan Government was financially able to proceed with universal
coverage for physician services. However, the introduction of the prepaid,
publicly administered medical care insurance plan triggered a bitter, provincewide,
doctors’ strike in 1962 that lasted for 23 days. The strike officially ended
with a compromise known as the Saskatoon Agreement in which the nature
and mechanism of payment emphasized the contractual autonomy of physicians
from the provincial government, and fee-for-service as the dominant method of
payment (Badgley & Wolfe, 1967; Marchildon & Schrijvers, 2011).
In 1964, the Royal Commission on Health Services, commonly known
as the Hall Commission, delivered its report to the Prime Minister. This
federal commission had been established in the wake of the polarized debate
in Saskatchewan about the merits of single-payer, universal medical care
insurance compared with the state providing targeted subsidies for the purchase
of private insurance as championed by Alberta and organized medicine.
Ultimately, the Hall Commission leaned in favour of the Saskatchewan model,
and recommended that the federal government encourage other provinces
to implement universal medical care insurance through conditional grants
(Canada, 1964). In 1966, the federal government passed the Medical Care Act
with federal cost-sharing transfers to begin flowing in 1968 to those provinces
that conformed to the four conditions of universality, public administration,
comprehensiveness and portability. By 1972, all the provinces and territories had
implemented universal coverage for medical care to complement their existing
universal coverage for hospital care. This federal–provincial system of narrow
but deep coverage would become known as medicare (Marchildon, 2009).
The 1970s marked a period of rapid expansion of public coverage and
subsidies for health services well beyond hospital and medical care by the
provinces and territories. These included prescription drug plans as well as