Canadian Health Act
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Canadian Health Act
The Canadian Health Act, which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government, does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. This does not constitute a ban on privately funded care; indeed, about 30% of Canadian health expenditures come from private sources, both insurance and out-of-pocket payments. The Canada Health Act does not address delivery. Private clinics are therefore permitted, albeit subject to provincial/territorial regulations, but they cannot charge above the agreed-upon fee schedule unless they are treating non-insured persons (which may include those eligible under automobile insurance or workers compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding.
Before the CHA the development of Canadian health insurance has been well described by Malcolm Taylor, who participated in many of the negotiations in addition to studying it as an academic. Unlike the UK, Canada never implemented a National Health Service; health care was and largely remains privately delivered. For many decades, it was also privately financed through a variety of programs. In consequence, as Taylor wrote, most Canadians “daily faced the potentially catastrophic physical and financial consequence of unpredictable illness, accident, and disability,” and providers, unwilling to deny needed care, had growing bad debts. A number of efforts to establish social insurance systems in Canada had been unable to overcome provincial opposition to federal incursion into their jurisdiction. These included the 1937 Roull serius commission on Dominion-Provincial Relations, and the 1945 Green Book proposals of Prime Minister Mike King as part of the post-World War II reconstruction. At the same time, Canada resembled other developed economies in its receptivity to a more expansive government role in improving social welfare, particularly given the widespread sacrifices during WWII and the still active memories of the Great Depression.