The Canada Health Act (CHA). Does it need Reform?

The Canada Health Act (CHA) was formulated in 1985 and is the legislation for the universal public healthcare insurance system in Canada. It outlines the principles that this system should operate under and states, “It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (Government of Canada, 1985, para. Canadian health care policy). The responsibilities of the Canadian healthcare system are shared by the federal, provincial and territorial governments. Provincial and territorial governments control their own healthcare, in its administration and delivery, but they must follow the five principles (public administration, comprehensiveness, universality, accessibility and portability) as stipulated in the CHA, in order to receive their cash transfer from the federal government (Health Canada, 2017).

As healthcare costs rise to unsustainable levels, inequities in healthcare accessibility become more prevalent and delivery of healthcare services deteriorate, many are calling for reform of the CHA. Flood and Thomas (2016) write that some support privatization of our healthcare system as a solution, but caution that evidence does not support this. They advocate a reform which would continue our public system but shift the focus from care in hospitals to community settings and recommend a constant evaluation of which services deserve to be publicly funded depending on the changing needs of the population, for instance the need to include prescription medicine in the universal coverage. They state, “by continually evolving to ensure a fair and efficient health-care system” (Flood, & Thomas, 2016, p. 411). Lagarde and Palmer, (2011) conducted a systematic review on the impact of user fees on the quality of services available, increased use of services, health expenditure and health outcomes. The results were mixed but the conclusion supported the position that an introduction of user fees had a negative impact on utilization of health services, both preventative and curative. Further, they found no evidence of effect of user fee implementation on health outcomes or expenditure (Lagarde, & Palmer, 2011).

Sibbald and Stanbrook (2016) concur, writing that change is needed as the deteriorating state of our healthcare system must be corrected. They do not support privatization though. Sibbald and Stanbrook (2016) state that this would only increase inequities, by allowing individuals who can afford to pay for services to receive them, while those who cannot afford to pay would not. Further, they state that global studies link private clinics to higher costs and lower quality services. The five principles of the CHA must be upheld, to have equitable healthcare for all Canadians. This is an attainable goal if our government enacts new legislation and takes a firm stand with the provinces and territories to comply with the law. (Sibbald & Stanbrook, 2016). Our principles of equity and equality for all Canadian citizens must be maintained and protected.

Elizabeth

References

Flood, C. M. & Thomas, B. P. (2016). Modernizing the Canada Health Act. Ottawa Faculty of Law Working Paper No. 2017-08. Retrieved from https://ssrn.com/abstract=2907029

Government of Canada. (1985). Canada Health Act. R.S.C., 1985, c. C-6 An Act relating to cash contributions by Canada and relating to criteria and conditions in respect of insured health services and extended health care services. Retrieved from the Justice Laws website https://laws-lois.justice.gc.ca/eng/acts/c-6/FullText.html

Health Canada. (2017). Canada Health Act Annual Report 2016-2017. Retrieved from the Government of Canada website https://www.canada.ca/en/health-canada/services/publications/health-system-services/canada-health-act-annual-report-2016-2017.html#a4

Lagarde, M., & Palmer, N. (2011). The impact of user fees on access to health services in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews, 4(CD009094). DOI: 10.1002/14651858.CD009094. Retrieved from https://www.cochrane.org/CD009094/EPOC_the-impact-of-user-fees-on-access-to-health-services-in-low-and-middle-income-countries

Sibbald, B., & Stanbrook, M. B. (2016). Canada Health Act needs bite. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne, 188(16), 1133. doi:10.1503/cmaj.161128 Retrieved from http://www.cmaj.ca/content/188/16/1133