Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
In 1984, the federal government replaced the Hospital Insurance and
Diagnostic Services Act and the Medical Care Act with the Canada Health Act,
a law that required the federal government to deduct (dollar-for-dollar) from a
provincial government’s share of Established Programs Financing (EPF) the
value of all extra billing and user fees permitted in that province (Taylor, 1987).
The origins of the Canada Health Act can be traced to the federal government’s
concern that, despite the stipulation in the Medical Care Act that provincial
plans must allow user fees to “impede or preclude” any “reasonable access to
insured services”, some provincial governments had increasingly permitted the
imposition of patient user fees by hospitals and physicians by the late 1970s (see
section 3.3.3). In addition to incorporating the four original funding criteria –
public administration, comprehensiveness, universality and portability – from
its earlier laws, the federal government added a fifth criterion – accessibility –
to reinforce the view that access should not be impeded by user fees. At the
same time, the federal government made it clear that provincial governments
that eliminated all user fees within three years of the introduction of the new
law would have their deductions reimbursed at the end of that period. By 1988,
extra billing and user fees had been virtually eliminated for all insured services
under the Canada Health Act (Bégin, 1988).
Table 2.2
Five funding criteria of the Canada Health Act (1984)
Criteria Each provincial health care insurance plan must:
Public Administration
Section 8
Comprehensiveness
Section 9
Universality
Section 10
Portability
Section 11
Accessibility
Section 12
Source: Health Canada (2011).
Be administered and operated on a non-profit-making basis by a public authority
Cover all insured health services provided by hospitals, physicians or dentists (surgical
dental services that require a hospital setting) and, where the law of a province permits,
similar or additional services rendered by other health care practitioners
Ensure entitlement to all insured health services on uniform terms and conditions
Not impose a minimum period of residence, or waiting period, in excess of three months for
new residents; pay for insured health services for its own residents if temporarily visiting
another province (or country in the case of non-elective services) with reimbursement paid
at the home rate of province or territory; and cover the waiting period for those residents
moving to another province after which the new province of residence assumes
responsibility for health care coverage (see section 2.9.6 for application outside of Canada)
Not impede or preclude, either directly or indirectly, whether by charges made to insured
persons or otherwise, reasonable access to insured health services
While the five criteria of the Canada Health Act (summarized in Table 2.2)
started out as funding conditions, over time they have come to represent
the principles and values that underpin Canadian medicare. After extensive
national consultations in 2001 and 2002, the Commission on the Future of