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Medicare 101
The Origins of Medicare
For the first half of the twentieth century, Canadians paid physicians and hospitals directly for health-care services: physicians and hospitals essentially operated as private businesses. If you couldn’t afford to pay for a doctor or for a hospital bed, you went without care or relied on charity. As a result, many Canadians spent their life savings or sold their homes to get health-care services when they or a family member became seriously ill or were injured. This still happens in countries that don’t have a universal, publicly funded health-care system.
The Medical Care Act, 1966-68
In 1947, Saskatchewan Premier Tommy Douglas, who became known as the “father of Canadian medicare,” introduced a program of public insurance for hospital services in his province, and he followed this in 1962 with a program covering physician services.
In 1966, Lester Pearson’s federal Liberal government introduced the Medical Care Act, which was similar to Saskatchewan’s programs. Implemented in 1968, the act set out the five principles of what has come to be called “medicare”:
- comprehensiveness: all necessary physician and hospital services are covered
- universality: services are available to all insured citizens
- accessibility: citizens have access to all covered health-care services under uniform terms and conditions, regardless of ability to pay
- public administration: the government is the single payer for all covered services
- portability: citizens are covered across the country
The Canada Health Act, 1984
In 1984, responding to an abundance of direct charges by physicians to patients (called “extra billing”), the Trudeau Liberal government introduced the Canada Health Act (CHA). Passed unanimously by the federal parliament, the CHA allows the federal government to deduct one dollar from federal transfers to any province or territory for every dollar of direct patient charges in that jurisdiction. Thus the CHA ended user fees for insured physician and hospital services.
The federal minister of health has the final authority to interpret and enforce the act, including the five principles (referred to in the CHA as “criteria”) and two conditions, information and recognition, that the provincial and territorial governments must fulfill.
