Medicare (Canada)

Prior to World War II, health care in Canada was privately funded and delivered, with the exception of services provided to the sick poor that were financed by local governments.

In a bid for unprecedented cooperation between the federal and provincial governments, these initiatives formed the foundations of a national program for social security, including provisions for health insurance.

However, the failure to come to a consensus on the required allocation of tax resources at the Dominion-Provincial Conference in August 1945 precluded adoption and delayed subsequent action.

[7] The first implementation of public health care at the federal level came about with the Hospital Insurance and Diagnostic Services Act (HIDS), which was passed by the Liberal majority government of Louis St. Laurent in 1957,[8] and was adopted by all provinces by 1961.

[13] The resolution of the dispute was assisted by mediation by a British Labour peer, Lord Taylor, who had been involved in the development of the National Health Service in Britain.

[16] In 1964, after intensive study and public consultations, the Hall Commission released the first volume of its report, calling for federal funding for a national medicare plan.

The new Minister of Health and Welfare, Allan MacEachen, pushed for the enactment of the proposals, introducing the Medical Care Act, 1966 into Parliament.

[24] As word of the split within the Liberals became public, the PC and Social Credit MPs began to put greater pressure on the government to stop the bill in the Commons.

The Canada Health Act requires coverage for all medically necessary care provided in hospitals or by physicians, which explicitly includes diagnostic, treatment and preventive services.

In some provinces, individual hospital boards have been eliminated and combined into quasi-private regional health authorities, subject to varying degrees of provincial control.

Historically, they have practised in small solo or group practices and billed the government Canadian Health Care system on a fee for service basis.

Unlike the practice in fully socialized countries, hospital-based physicians are not all hospital employees, and some directly bill the provincial insurance plans on a fee-for-service basis.

According to a 1958 study, Provincial governments have been responsible for providing necessary medical and hospital care "to indigent residents of municipally unorganized territory".

[33][34] Each province may provide its own prescription drug benefit plan, although the Canada Health Act requires only coverage for pharmaceuticals delivered to hospital inpatients.

As a result of this coalition, Canada's pharmacare act received royal assent on October 10, 2024, with the first phase creating a single payer system for contraceptives and diabetic medications, as well as the creation of a government agency to identify which drugs will be added next.

In some jurisdictions, public health units have been involved in providing targeted programs to address the need of the young, the elderly or those who are on welfare.

The Canadian Association of Public Health Dentistry tracks programs, and has been advocating for extending coverage to those currently unable to receive dental care.

As a result, someone that sees a physician outside Quebec, even in another part of Canada, must either pay the cost themselves and submit a request to the Régie de l'Assurance Maladie du Québec (RAMQ Medicare) for reimbursement (even then, expenses are often denied), or take out a third party insurance plan.

"[45] As analysts have noted, the root of the concern may be traced to successful cost control efforts in the mid-1990s, where public health expenditure per capita, in inflation-adjusted dollars, actually fell.

The authors surveyed both private and publicly funded outpatient health care offices and estimated the amount of wait time between general practitioner and specialists for elective treatments such as getting breast implants.

Under federal law, private clinics are not legally allowed to charge patients directly for services covered by the Canada Health Act', if they qualify for public insurance.

This gap has been filled in most provinces, but sometimes only after celebrated incidents in which patients died in unregulated clinics, including one physician who performed cosmetic surgery in an Ontario hotel room.

Here, provinces can choose to offer 'facility fees' to these clinics, but doing so has often been contentious, particularly if hospitals felt that these costs would be better devoted to allowing them to increase their operating room time.

Proponents of this approach point to[citation needed] the rise of neo-conservative economic policies in Canada and the associated reduction in welfare state expenditure (particularly in the provinces) from the 1980s onwards as the cause of degradation in the system.

In 2007, the first nurse practitioner-led office to relieve waiting times caused by a shortage of primary practitioners was opened in Sudbury, Ontario.

In June 2005, the Supreme Court of Canada overturned a Quebec law preventing people from buying private health insurance to pay for medical services available through the publicly funded system and this ruling does not apply outside the province.

[82] In fact according to a report by Keith Leslie of the Canadian Press in the Chronicle Journal, November 21, 2005, over 10,000 trained doctors are working in the United States, a country ranked 37th in the world.

[84][85] One consequence of the shortage in Canada is that a great many patients are left without family doctors, and trained specialists, making early intervention very difficult.

Same thing with labs and radiology clinics …The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies.

[83] Essentially, privatized healthcare is not a choice of interest for lower income Canadians, it is most likely to be unaffordable and unfair to those who suffer on a social standard.