The Canada Health Act: Let's Modernize

The Canada Health Act, which was enacted in 1984 (Flood & Thomas, 2016) was intended to provide universal health care to Canadians under five principles: public administration, comprehensiveness, universality, portability, and accessibility (Skyvington, 2019). What I’ve come to discover as I learn more about this act, is that these five principles are written into law with a significant amount of room for interpretation. As Flood & Thomas (2016) described, medical treatments and coverage is all based on whether said treatment qualifies as “medically necessary” or “medically required”. The problem with this? There is no definition for “medically necessary” or “medically required”. So, who determines what is covered by the Canada Health Act? The government decides. They have created billing fees and schedules based on their determination of whether the treatment adheres to an antiquated list of procedures/treatments that have very little adaptation to the changing landscape of healthcare today (Flood & Thomas, 2016).  

Life expectancy has increased by almost 20 years and has contributed to 70% of the healthcare costs in this country today (Skyvington, 2019, pg 43). Skyvington speaks heavily on how one of the principles, accessibility, is supposed to be at the forefront of The Act, but instead falls under an ambiguous heading with room for interpretation that varies from province-to-province, doctor to doctor (2019).  

Let’s for one minute take a second to process this. We are living in a country that boasts of universal access to health care. At the same time, we are faced with an aging population, increased use of the health care system, which causes increased wait times for access to care, and limited access to many treatment options that are not deemed “medically necessary” (ophthalmology, naturopathic medicine, dental, many prescriptions) (Flood & Thomas, 2016). Skyvington has gone as far as to say “the system promotes mediocrity and punishes innovation. So long as everyone [must] wait in line and suffer needlessly, then as far as our elected officials are concerned, everything is fine.”  

For me, I have noticed a consistent underpinning in the rhetoric of Canadian healthcare: political involvement. It doesn’t seem as though there is much medical input to determine what is covered under the act, to draw attention to what is required in 2024 for basic healthcare, and to help with any amendments/changes that need to be made to bring it into the current time. The country shouldn’t be making medical decisions based only on the input of politicians and funding. Perhaps, positive change can be enacted when they look at the “whole picture” rather than just the funding.  

It is important for the definition of “medically necessary” to be made specific and intentional. I believe this needs to be done with the assistance of practicing healthcare practitioners. Involving practicing MDs will ensure that there is a proper representation of what procedures, treatments, drugs are needed to ensure increased accessibility. Providing this outlook to policy makers would in turn (ideally) help provide a better understanding on what is needed for our system today, and (again, ideally) drive a reform that will change the way healthcare is offered in. Canada today.  

I don’t know if this speaks to a tiered system, but it might. Skyvington said  

“the reality is, we simply cannot afford ‘free’ healthcare anymore ... those ... who pay taxes provide the funds for the 70% of things medicare actually  covers, while the other 30% ... is taken care of by private insurance ... and yet .. there still isn’t enough to fund patient demand.” (2019, pg. pg 43) 

Collaboration. Collaboration needs to be at the forefront of any reform. Collaboration to develop a specific, intentional framework for necessary treatments that can help drive the changes needed for the funding of accessible healthcare. 

RESOURCES 

Canada health act (CHA). Effective Public Healthcare Panacea Project. (2019, October 17). https://www.ephpp.ca/canada-health-act/

Flood, C. M., & Thomas, B. (2016). Modernizing the Canada health act. Dalhousie Law Journal, 39(2). 

Skyvington, S., & Day, B. (2019). This may hurt a bit: Reinventing Canada’s health-care system. Dundurn.