Universal health insurance in Canada

Abstract

This paper describes the universal health insurance program in Canada and identifies the historical events and social values leading to its adoption. Universal hospital insurance was adopted in 1958, ten years before medical insurance, as a result hospital-based patterns of practice were solidified. Through cost sharing, the federal government influenced the provinces to enact relatively uniform universal plans. From 1951 to 1971 health care expenditures rose rapidly to 7.3% of the gross national product (GNP), but have since decreased and stabilized at about 6.9%. In contrast, health care in the United States represents 8.6% of GNP. Hospital use also increased rapidly in Canada to 1970 but appears to have stabilized and decreased slightly in this decade. Physician incomes rose rapidly before 1971, but since then the increases have slowed and relative incomes of physicians have fallen. Althouth the percent of GNP spent for health care has leveled, there are still substantial annual increases in expenditures that are paid for by government. Two federal initiatives, Bill C-37 and the Lalonde Report, have their roots in cost containment; Bill C-37 transfers greater taxing authority from the federal government to the provinces. To meet the goal of containing costs, provincial governments are moving in the direction of regionalization, decentralization, and greater coordination. In the short term, the provinces have limited hospital budgetary increases to percentages less than the rate of inflation. Cost constraints may be long overdue. Imposing fiscal limits encourages rational planning. It does not appear that the health of Canadians will be adversely affected or essential benefits curtailed by present budgetary restrictions or reorganization.

A Long‐term Geriatric Teaching Ward in an Acute‐care Hospital: A Three‐year Experience

“…To understand the workings of Ward 8W, one should be familiar with the broad outline of healthcare financing in Canada and its provinces 12 . Health care is predominantly under provincial jurisdiction, with funds coming from both federal and provincial tax revenues.…”

The Fate of National Health Insurance in Canada and the United States: A Multiple Streams Explanation

“…As such, most provinces began to actually pressure the federal government to adopt the national hospital insurance plan as a way to help financing (Vayda et al, 1979). Provinces were in the position of having to convince the national government to pass a national hospital plan.…”

“…National mood is a vague concept measured not only by surveys of the general public, but also by the perceptions of policymakers as garnered from contacts with interest groups, activists, and political elites (Kingdon, 1995, p. 156). In Canada the national mood seemed to be supportive of more government intervention in health care (Taylor, 1978; Vayda et al, 1979;Weller & Manga, 1983). Likewise, the physician strike in Saskatchewan affected the public's perception of the medical profession.…”

The Canadian Health Care System: Development, Reform, and Opportunities for Nurses

“…Universal health insurance was first proposed at the federal Liberal party convention in 1919. It took nearly 40 years for the first federal health legislation to appear and several more years for all of the provinces to develop universal insurance programs (Sutherland & Fulton, 1988b;Taylor, 1987a;Vayda, Evans, & Mindell, 1979).…”

“…It established the framework for Medicare by specifying four essential criteria with which provinces had to comply. The provincial plans had to be comprehensive (i.e., cover those services deemed medically necessary), universally available to 95% of the population (later amended to loo%), portable among the provinces, and publicly administered (Sutherland & Fulton, 1988a;Vayda et al, 1979). Reasonable compensation for physicians and a significant amount of federal control over what was deemed essential also were part of the Act.…”