Canada Health Act of 1984
The Canada Health Act of 1984 is a pivotal piece of legislation that solidifies the framework for the country's public health care system, which has its origins in Saskatchewan's model established in 1947. Aimed at ensuring equitable access to health services for all Canadians, the Act prohibits extra-billing and user charges, which were prevalent in previous health care frameworks. It was unanimously supported by Parliament and received royal assent on April 1, 1984. The Act outlines five key principles that provincial and territorial health systems must adhere to: public administration, comprehensiveness, universality, portability, and accessibility.
Under this legislation, health care services are largely managed at the provincial level, leading to some variations in service offerings across the country. It mandates that services be portable among provinces for limited durations and requires provinces to report on their health care operations. While the Act covers essential health services, it excludes non-essential procedures and amenities, placing the federal government in charge of specific populations like military personnel and prisoners. Despite its foundational strength, the Act faces ongoing challenges such as funding reductions and debates over privatization, reflecting the dynamic nature of health care in Canada.
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Canada Health Act of 1984
Legislation to improve the national health care system
Date Received royal assent on April 1, 1984
The Canada Health Act established national standards for health care delivery, spelling out criteria and conditions that the nation’s provinces and territories were required to satisfy in order to receive federal funds.
The Canada Health Act continued a system of public health care that had its roots in a system established in Saskatchewan in 1947. Canada’s national system is public, funded primarily by taxation and administered by provincial and territorial governments, but most of the nation’s health services are provided by private medical practitioners and facilities. Unlike the preceding Health Care Acts of 1957 and 1966, the act of 1984 contained provisions intended to eliminate direct billing to patients in the form of extra-billing and user charges.
The act received unanimous support from the House of Commons and the Senate, and it was given royal assent on April 1, 1984, thereby becoming law. The purpose of the legislation was to assure that insured and extended health care services are readily available to all Canadians regardless of their socioeconomic status. In addition to the provisions regarding extra-billing and user charges, the act established five criteria for provincial and territorial systems: public administration, comprehensiveness, universality, portability, and accessibility. For example, it required that health care services of one’s home province be portable to other provinces and territories for a period of up to three months. It also instituted two conditions regarding insured and extended health care services: Provinces and territories must file reports with the federal government on the operation of their health care services, and they must acknowledge that federal cash transfers are responsible for the maintenance of their systems. Violation of the extra-billing and user-charges provisions of the act would result in dollar-for-dollar deductions from a province’s federal funding. The act also stipulated discretionary penalties for failure to adhere to the five criteria and two conditions, although no such penalty has ever been applied.
Impact
Under the act, provinces and territories have jurisdiction over most services offered to their populations and take responsibility for approving hospital budgets, negotiating fee scales, and determining classification of staff. Health care services vary somewhat among the provinces and territories, as some jurisdictions may offer additional services, such as optometric and dental care, to certain target populations. Children and disadvantaged groups, for example, may be given benefits beyond those given the general population. The act does not cover non-essentials like cosmetic surgery, hospital amenities, and private nursing services. The federal government assumes direct responsibility for some populations, including prisoners and military personnel. Reductions in federal transfers, brain drain, privatization, and waiting times for services are pressing concerns for Canadians and have led to heated debates over reforming the act.
Bibliography
Downie, Jocelyn, Timothy Caulfield, and Colleen M. Flood, eds. Canadian Health Law and Policy. 2d ed. Markham, Ont.: Butterworths, 2002.
Fulton, Jane. Canada’s Health Care System: Bordering on the Possible. New York: Faulkner and Gray, 1993.
National Council of Welfare. Health, Health Care, and Medicare. Ottawa: Author, 1990.