[2] As set out in the Act, the main objective of healthcare policy in Canada is to facilitate reasonable, continued access to quality healthcare to all Canadians, regardless of income or geographic location by establishing criteria and conditions in respect of insured health services and extended health care services.
[3][2] The statute establishes the framework for federal financial contributions to the provincial and territorial healthcare insurance programs under the Canada Health Transfer.
[7] In addition, prior to the COVID-19 pandemic health spending growth was constrained due to federal and provincial/territorial governments running budget deficits.
In 2005, international data shows that approximately 70% of Canadian health expenditures were paid from public sources,[8] thereby placing Canada below the OECD average.
This information is used in drafting annual reports, presented to parliament, on how the province administered its health care services over the previous year.
For non-compliance with any of the five criteria listed above, section 15 allows the federal government to withhold all or a part of the transfer payment with "regard to the gravity of the default".
argue that the federal government has not actively attempted to enforce these conditions, with particular concerns about handling of portability (e.g., the reduction of coverage for residents while traveling abroad) and comprehensiveness (e.g., de-insuring of some medical procedures).
In accordance with section 20, if a province were to violate the prohibition on extra-billing or user charges, the corresponding amount of that collected would be deducted from the transfer payment.
One aspect of the Canada Health Act was provision for reimbursement of funds withheld for extra-billing and user charges if these were eliminated within three years.
In 1996, Alberta had their EPF payment reduced by a total of $3,585,000 over the course of a few years due to the use of private clinics that charged user fees.
As required by section 23 of the CHA, the Government of Canada publishes a yearly report describing the extent to which each province and territory has complied with the Act.
Specific clauses of section 91 of the constitution give the federal Parliament some powers over aspects of health care, for example "quarantine and the establishment and maintenance of marine hospitals".
[citation needed] The development of Canadian health insurance[19] has been well described by Malcolm Taylor, who participated in many of the negotiations in addition to studying it as an academic.
Funded privately until the mid-to-late 20th century, Taylor notes that many 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 failed due to provincial opposition to federal incursion into their jurisdiction.
These included the 1937 Rowell-Sirois Commission on Dominion-Provincial Relations, and the 1945 Green Book proposals of Prime Minister Mackenzie 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 World War II and the still active memories of the Great Depression.
Following the collapse of the conference proposals in 1946, in 1947, the social democratic premier of Saskatchewan, Tommy Douglas of the Co-operative Commonwealth Federation (CCF) established Canada's first publicly-funded hospital insurance plan.
The result was that the Progressive Conservative government of John Diefenbaker, who also happened to represent Saskatchewan, introduced and passed (with all-party approval) the Hospital Insurance and Diagnostic Services Act of 1957.
By the start date (July 1, 1958) five provinces—Newfoundland, Manitoba, Saskatchewan, Alberta, and British Columbia—had programs in place which could receive the federal funds.
By this time, Douglas had moved to national politics, as leader of the federal New Democratic Party (NDP), The provincial plan precipitated a strike by the province's physicians in 1962.
These two acts established a formula whereby the federal government paid approximately 50 per cent of approved expenditures for hospital and physician services.
Rather than an open-ended commitment, EPF established a per capita entitlement (not adjusted for age-sex or other demographic factors) which would be indexed to inflation.
[23] Nonetheless, many argue that there has been no explicit federal transfer for health care since 1977, since these programs are no longer tied to specific spending.
Because there was little desire to withhold the full contribution for minor violations of terms and conditions, provinces increasingly were permitting extra billing for insured services.
In response to the resulting political uproar, the federal government again turned to Justice Emmett Hall and asked him to report on the future of medicare.
On December 12, 1983, under the Liberal government of Pierre Trudeau, Bill C-6 was introduced in the House of Commons by federal Minister of Health Monique Bégin.
In June 1985, Epp wrote a letter to the provincial health ministers that clarified and interpreted the criteria points and other parts of the new act.
"[24] Pro-choice advocates have pointed out that the Canada Health Act fails to meet its criteria in providing access to abortion.
Abortion, as a medical service, does not meet the basic principles of the CHA: public administration, comprehensiveness, universality, portability, and accessibility.