Canada’s health care policy was designed to give all residents equal right and access to health care professionals. Although health care is available to all Canadian citizens, it publicly funded, not free. The provinces have separate health care plans but they all share common characteristics which were decided in the Canada Health Act. The Canada Health Act of 1984 was an amalgamation of two previous acts with an addition to give all Canadians access to health services; however, recently Canada’s health care policy has been challenged.
It has been argued that there is confusion in the meaning of accessibility (Wilson & Rosenberg, 2004) and that Canada’s health care policy does not address the need for competent patient care (Liberman, 2010) or the inequalities in the Social Determinants of Health (Bryant et al, 2011). In 1867 Canada became a self governing colony, determining the federal and provincial jurisdictions with the British North America Act (Potter & Perry, 2006). At this time provinces were responsible for providing the funds for health, education and social services.
However, they did not have the funding to support the health care needs of the public. Therefore, as the country grew and more people began to immigrate to Canada, “provinces enacted public health acts to establish local boards of health to hire medical health officers and sanitary inspectors” (Potter & Perry). Although throughout the 1890’s and early 1900’s different charitable organizations were created such as the Children’s Aid Society and the Red Cross, it was still very difficult for individuals to pay physicians. Because of this, the use of taxation to pay for physicians was introduced through the Municipality Act in 1916.
Throughout the Great Depression, the financial struggles made it impossible for many people to pay their medical bills, which is why Premier Tommy Douglas of Saskatchewan introduced paying for health care services by insurance plans through the Hospital Insurance and Diagnostic Services Act of 1957. Once all provinces agreed to cover inpatient hospital care, the Federal Medical Care Act of 1966, providing outpatient medical care, was to follow (Potter & Perry). The Canada Health Act of 1984 was a combination of the Hospital Insurance and Diagnostic Services Act of 1957 and the Federal Medical Care Act of 1966 with the addition of accessibility (Potter & Perry, 2006).
According to the Canada Health Act, “all provinces and territories in Canada must uphold five principles in order to receive federal funding for health care (universality, comprehensiveness, portability, public administration, and accessibility)” (Wilson & Rosenberg, 2004). With universality as one of the principles, all permanent residents of a province are entitled to coverage regardless of their age, gender, race, income or health status.
Comprehensiveness is a principle to guarantee that insurance plans cover all necessary health services in hospitals and by physicians, dentists and other medical professionals. Portability makes certain that residents have medical coverage in other provinces and out of the country. Those who move to another province have health care coverage by their province of origin for no more than three months and when out of the country, pay for services based on the cost of the service in Canada.
Public administration insures that a public authority who reports to the provincial government will administer and operate the plan on a non profit basis. Finally accessibility certifies that all permanent residents of a province have reasonable access to necessary health services regardless of age, gender, etc (Potter & Perry). By providing access to publicly funded health care services, the Canada Health Act protects residents from obstacles that prevent them from achieving and maintaining good health.
It has been 27 years since the Canada Health Act was accepted and although “Canadians are very supportive and proud of the principles of the Canada Health Act, Canadians have also perceived deterioration in the quality of the system during the past decade” (Murray et al, 2009). Wilson and Rosenberg explain that Canada’s health care system went through many changes when the “federal government reduced its financial support to the provinces and the provincial governments responded by restructuring health care delivery, sometimes in open defiance of the Canada Health Act” (2004).
Since these changes have been made, many Canadians feel as though health care is now less accessible than it was before. For example “for Canadians in their everyday lives, there is a growing perception that health care delivery is becoming less accessible as waiting times to see a physician or receive hospital services grow longer, services disappear altogether, or become privatized in their communities” (Wilson & Rosenberg). For some residents, they do not seek health care when they need it because do not want to deal with these long waiting times, others cannot afford the travel cost or the cost of the service itself.
Many Canadian residents are not confident that they would not receive the health care they need if they were to have a medical crisis (Wilson & Rosenberg). There is a question that must be answered, is the principle of accessibility from the Canada Health Act being defied? The answer to this question is unclear because the Canada Health Act does not give an exact definition in the meaning of “reasonable access” (Wilson & Rosenberg). Medical services are available and most of the costs are covered under insurance, however these health services are not always easy to travel to and are not always available when they are needed.
Liberman expresses the concerns of registered nurses in Saskatchewan and how they would like to change Canada’s health care policy (2010). In 1984, RN’s helped advocated for the universality, comprehensiveness, portability, public administration and accessibility, now they are advocating for patient first care and “improving health care performance and leadership” (Liberman). Many people are becoming impatient with health care which is why there is a need for change.
To improve the experience of the patient and family, care must be convenient and timely, communicative, informative and respectful. Both registered nurses and public agree that health care must respond faster and more efficiently to the growth and changes happening in the world. Liberman states that “we need health care that builds on the principles of the Canada Health Act, incorporates the voice of our patients, and is consistent with primary health care”. The Social Determinants of Health for many people are affected by low-income or poverty.
“Lower-income Canadians are more likely to experience difficulty seeing a medical specialist as needed or to wait 5 days or more to see a physician” (Bryant et al, 2011), however, many studies have been done that give proof that many diseases do not end in mortality based on delays in diagnosis. Many are worsened by “the conditions of life and work (the Social Determinants of Health) to which individuals are exposed are of greater importance as influences both on overall population health and on health disparities within populations” (Bryant et al).
Two of the five principles of the Canada Health Act, universality and accessibility, insure that no one is discriminated and therefore does not receive health services based on low-income. Now it is argued that there needs to be a shift in focus from making services available to people with lower-income to changing the environment they live in and their Social Determinants of Health (Bryant et al). Canada’s health care system has gone through many changes since it was founded in 1867.
Canadians are proud of their health care system because it is available for everyone, some services are federally funded and other services are paid for through their insurance plans. Canada’s Health Act of 1984, ended many inequalities in health care so it no longer depends on race, gender, age, religion, or income, everyone has the same access to health care. Many people believe that as the year’s progress, health care is becoming less and less accessible. Others believe that the modifications that need to be made are with the focus of care.
Although there are many obstacles for Canada’s health policy to overcome, it will take time before health care will adapt and any major adjustments will be made. ? References Bryant, T. , et al. (2011). Canada: a land of missed opportunity for addressing the social determinants of health. Health Policy, 101 (1): 44-58. Liberman, S. (2010). The Canada Health Act, patient first and primary health care: a call to advocacy. SRNA NewsBullitin, 12(1): 10-11. Murray, R. B, et al. (2009).
Sociocultural influences on the person and family. In Health Promotion Strategies through the Lifespan (pp. 14). Toronto, Ontario: Pearson Education Canada. Potter, P. A. , & Perry, A. G. (2006). The Canadian health care delivery system. In J Ross-Kerr & M Wood (Eds). Canadian Fundamentals of Nursing (pp. 18-33). Toronto, Ontario: Elsevier Canada. Wilson, K. & Rosenberg, M. W. (2004). Accessibility and the Canadian health care system: squaring perceptions and realities. Health Policy 67 (2): 137-148.