Contents:
Healthcare System Historical Initiatives
Healthcare System:History Provincial and Federal Initiatives
Introduction to Healthcare System Historical Initiatives
Until the 1940s, the government was not very involved in health care. It mostly focused on efforts to improve public health, such as disease control and food and drug regulation. In addition, local governments provided charitable hospitals and medical care for indigent people. Canadians paid for health care either directly out of their pockets or through private insurance.
The first real initiatives for developing public health insurance on a wide scale originated in the provinces. In 1947 the Saskatchewan government, led by the Co-operative Commonwealth Federation, a social democratic party, inaugurated the first hospital insurance plan in North America. The plan used public funds to cover the costs of hospital services. The success of this plan and similar plans in other provinces convinced the federal government to pass the Hospital Insurance and Diagnostic Services Act in 1957. This legislation allowed the federal government to share in the cost of provincial hospital insurance plans. By 1961 every province in Canada had set up a hospital insurance plan.
In 1962 the Saskatchewan government introduced a further innovation: a medical insurance program that used public funds to reimburse doctors for the services they provided to patients outside of hospitals. This again proved to be a successful model. In the Medical Care Insurance Act of 1966, the federal government agreed to share provincial health costs for medical care outside of hospitals. By 1971 every province had a medical insurance plan in operation, and Canada's health insurance system was fully in place.
In 1984 the federal government combined the 1957 and 1966 laws into the Canada Health Act. This legislation reinforced the underlying principles of the previous health insurance programs, including public administration, comprehensive benefits, universality, and portability. In addition the new law emphasized a fifth principle, equal access, which was designed to prohibit practices such as extra-billing that presented potential financial hardship for some patients.
Federal financial support for health care has varied over time. Prior to 1977 the federal government paid an agreed-upon percentage of provincial medical costs. In 1977 the Established Programs Financing Act replaced this system with a single payment for health care, known as a federal block transfer payment; this new payment was based on provincial population. At various times in the 1980s and early 1990s the federal government froze or reduced those payments as part of a movement to contain health-care costs and reduce federal spending in general. Beginning in 1996 federal funding for provincial health systems was combined into a super-grant, the Canada Health and Social Transfer (CHST). The CHST combined federal contributions to health care, higher education, social assistance, and other social services into one lump sum. In the CHST, the federal government provided fewer funds for health care. However, in the 1999 budget the federal government renewed its commitment to health funding and injected new money into the health-care sector.
As federal health-care contributions declined in the 1980s and 1990s, provincial governments came under pressure to control health-care costs. Many provinces attempted to make health-care services more efficient by combining or closing hospitals. Some, like Québec, attempted to shift the emphasis of health-care delivery to preventative and community care. Most provinces also implemented controls on physicians, such as salary caps for specialists. Governments have also attempted to control demand by extending the waiting lists for certain surgical procedures or discontinuing coverage of some services that are not medically necessary.” (1)