Established in 1984, the Canada Health Act sets five key principles for publicly insured health care, which provinces and territories must adhere to in order to receive federal funding: public administration, comprehensiveness, universality, portability, and accessibility.
What Canadians may not often realize, however, is despite advocating for such “comprehensiveness,” the act is rather limited in the scope of services it includes.
This is attributable to the status of the Canadian health care system at the time the act was passed.
In the Canada Health Act, comprehensiveness ensures that provincial health insurance covers all medically necessary hospital services, physician services, and surgical-dental services provided in a hospital setting. In other words, services that are not provided by physicians or hospitals are not insured under the Canada Health Act.
Given that the health care system during the time of legislation was primarily concerned with a young population that mainly required acute care from physicians and hospitals, home- and long-term care are two examples of services not included in the act.
However, according to Statistics Canada, 2016 was the first year in Canadian history where the number of people aged 65 and older exceeded those aged 15 and under. As life expectancy increases and Baby Boomers continue to age, it is doubtful Canada will be able to effectively accommodate the growing health-care needs of seniors.
Wait times for long-term care beds are high and continue to rise. In Ontario alone, approximately 26,500 individuals were wait-listed for beds in 2015. Furthermore, the number of Canadians aged 75 and above, who have the highest demand for long-term care, is expected to increase significantly in the upcoming years.
Public funding is still focused on hospital-based approaches to treating disabilities and chronic conditions, instead of home-care methods, which are much more cost-effective.
With wait times often extending over months already, the increase in demand for home-care by the aging population is imminent. The fact that nearly half a million Canadians aged 15 and above did not receive home-care for chronic health conditions in 2012 emphasizes that the younger demographic has a significant unmet need for this type of care as well.
Prescription drugs provided outside hospital settings are also not covered by the Canada Health Act and require out-of-pocket spending. In 2017, approximately 700,000 Canadians had no prescription drug coverage, while an estimated 3.6 million had inadequate coverage to afford necessary medications.
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Factors such as rapid progress of drug development and introduction of new home drug therapies for chronic conditions are anticipated to spike out-of-hospital prescription drug expenses in the near future as well.
The exclusion of prescription drugs from the Canada Health Act was due to a lack of focus on prescription medication as a means of care in the 1960s. Today, Canada is the only developed country in the world with a universal health care system that does not include prescription drugs as a publicly insured service. This acts as a barrier of access for those who do not have private health insurance or are ineligible for government drug benefit programs.
Various other notable services are not insured by the Canadian Health Act as well. For instance, despite the large burden of mental illness in Canada today, the act does not cover psychiatric hospitals and various mental health-related services, resulting in a lack of acceptable mental health services. Exclusion of out-of-hospital dental services by the act has led to 6 million Canadians being unable to attain dental services per year due to high costs.
The history of Canadian health policy shows that lack of federal funding has not been an issue in medicare. Rather, the issue arises from the fact that Canada’s entire health-care system is based on an act more than three decades old.
Reform to the Canada Health Act is warranted to satisfy the needs of the nation’s current, and future, population in various aspects.
Given that each province and territory maintains its own unique health-care systems, support and compliance for reform may of course present notable challenges for the federal government in setting renewed criteria for health insurance programs. However, reform is needed more than ever for Canadians to have access to the medically necessary services they need.
Jin Soo Roh is an undergraduate student at the University of British Columbia studying population and public health.
https://www.thestar.com/opinion/contributors/2019/01/09/what-many-canadians-dont-know-about-the-canada-health-act.html
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