Notes on The History of Health Care in Canada (Chapter 1)

Evolution of Health Care in Canada: An Overview

  • 1867: The British North America Act established the Dominion of Canada, initially comprising Ontario, Quebec, New Brunswick, and Nova Scotia.
  • Each province had its own:
    • Representation in government
    • Law-making body
    • Lieutenant Governor
  • This laid the groundwork for a federal system with provincial responsibilities in health care.

Division of Responsibilities for Health (1 of 2)

  • In the British North America Act, health matters received little explicit attention.
  • Federal government responsibilities included:
    • Establishment and maintenance of marine hospitals
    • Care of Indigenous populations
    • Management of quarantine
  • Provincial responsibilities included:
    • Establishing and managing hospitals, asylums, charities, and charitable institutions
    • All other health-care-related responsibilities by default

Division of Responsibilities for Health (2 of 2)

  • In 1919: Creation of the Department of Health.
  • In 1944: Rename to Department of National Health and Welfare; expanded federal responsibilities included:
    • Food and drug control
    • Development of public health programs
    • Health care for members of the civil service
    • Operation of the Laboratory of Hygiene
  • In 1993: The department was renamed Health Canada.

The Origins of Medical Care in Canada

  • Early care was available only to the wealthy; others received help via religious/charitable organizations or family support.
  • European settlers brought doctors, mainly from England and France.
  • The first medical school was established in Montreal in 1825.

The Development of Hospitals in Canada

  • Canada’s first hospital: Hôtel-Dieu de Québec (1639) in Québec City.
  • Early hospitals were charitable institutions.
  • In the early 1900s: tuberculosis sanitariums and mental health institutions were established.

The Role of Volunteer Organizations

  • Before formal health systems, Canadians relied on volunteer groups:
    • The Order of St. John (later St. John Ambulance)
    • Canadian Red Cross Society
    • Victorian Order of Nurses (VON)
    • Children’s Aid Society

Indigenous People: Terms and Context

  • Terminology:
    • Aboriginal vs. Indigenous both refer to original inhabitants of a land.
    • First Nations and Indian refer to the same groups in Canada.
  • Indian and Aboriginal terms are no longer acceptable outside of references to federal or provincial/territorial legislation.

The History of Healing Practices of Indigenous Canadians (1 of 2)

  • Indigenous health and healing ceremonies date back centuries.
  • Knowledge transmitted orally and through hands-on practice.
  • Healers were known by names such as the “Medicine Man” and the “Shaman.”
  • Today, traditional medicines have been incorporated into contemporary Western medicine.

The History of Healing Practices of Indigenous Canadians (2 of 2)

  • Traditional rituals and spiritual ceremonies include:
    • Sweat lodge
    • Healing circle
    • Smudging ceremonies
    • Medicine wheel

Contact With Outsiders

  • Contacts began in the 1700s with Russian, French, Spanish, and British.
  • Traders introduced diseases that caused thousands of deaths.
  • Assimilation policies restricted Indigenous practices and way of life.
  • Residential schools had devastating effects on physical and mental health.
  • There is a contemporary movement to honor traditional health practices.

The Concept of Public Health is Introduced

  • Upper and Lower Canada established a board of health in 1832 and 1833, respectively.
  • Provinces began creating public health units in the early 1900s.
  • Public health units were responsible for:
    • Pasteurizing milk
    • Testing cows for tuberculosis
    • Managing TB sanatoriums
    • Controlling the spread of STIs
    • Focus on maternal and child health care at the start of the 20th century

The Role of Nursing

  • Pre-Confederation: Hôtel-Dieu Hospital (Québec) launched the first structured nursing training.
  • 1873: First school of nursing established at Mack’s General and Marine Hospital in St. Catharines, Ontario.
  • 1881: Toronto General Hospital established a nursing school.
  • Subsequently, most major Canadian hospitals offered nursing education programs.

The Introduction of Health Insurance

  • 1919: A publicly funded health care system formed as part of a Liberal election campaign but was not implemented.
  • 1935: Conservative government pledged to address social issues such as minimum wage, unemployment, and public health insurance.
  • 1940: Provincial and federal governments amended the British North America Act to introduce a national unemployment insurance program.
  • 1944: The federal government introduced the “baby bonus.”

Post-World War II: The Political Landscape

  • Canadians sought security and equity through publicly funded health care.
  • Medical advances improved treatment, care, and diagnostics.
  • There was a shift toward hospital-based care.
  • 1948: The federal government established grants to fund health care development in partnership with provinces.
  • 1952: Grants augmented by a national old-age security program.
  • 1954: Federal support began for adults who were disabled and unable to work.

Progress Toward Prepaid Hospital Care

  • 1957: Hospital Insurance and Diagnostic Services Act introduced; provided federal dollars to provinces/territories willing to implement comprehensive hospital insurance.
  • Population distribution affected some provinces’ ability to implement comprehensive services.
  • Equalization payments enabled richer provinces to support poorer ones to provide care for all.
  • The Act: provided residents with full care in an acute care hospital and included care in outpatient clinics.

Progress Toward Prepaid Medical Care

  • Tommy Douglas (the father of Medicare) was Premier of Saskatchewan (1944–1961).
  • Douglas campaigned for an affordable, comprehensive hospital and medical insurance plan.
  • Saskatchewan Medical Care Insurance Act passed in 1961.
  • Most other provinces/territories adopted similar plans in the following years.

Significant Events Leading Up to the Canada Health Act

  • Federal commitment remained to a comprehensive health insurance program.
  • Key precursors included:
    • The Hall Report
    • The Medical Care Act
    • The Established Programs Financing (EPF) Act

The Hall Report (1960)

  • The Royal Commission on Health Services (Hall Commission) was authorized in 1960 under Justice Emmett Hall.
  • Key conclusions:
    • Supported a national Medicare program
    • Recommended doubling the number of physicians by 1990 to meet growing/aging needs
  • Hall’s recommendations formed the foundation for the Medical Care Act.

The Medical Care Act (1966)

  • Passed in Parliament on December 8, 1966.
  • Legislation provided federal support to provincial/territorial Medicare plans that met criteria of:
    • Universality
    • Portability
    • Comprehensive coverage
    • Public administration
  • Implemented on July 1, 1968.

The Established Programs Financing Act (1977)

  • Introduced a new funding formula for health care and postsecondary education.
  • Replaced the 50/50 cost-sharing with a block transfer of cash and tax points.
  • Reduced restrictions on how jurisdictions could spend money.
  • Provided more transfer money for an extended health care services program.

Events Following the Introduction of the EPF Act

  • Health care spending rose dramatically; hospitals cut spending on staff and services.
  • Doctors began extra billing, challenging the principles of the Medical Care Act.
  • In 1980, Hall and Girard conducted a health care services review (Canada’s National-Provincial Health Program for the 1980s) and released their conclusions.
  • A Parliamentary Task Force on Federal-Provincial Arrangements completed their review in 1981.
  • The Hall Report and the Task Force report prompted the Canada Health Act.

The Canada Health Act

  • The Canada Health Act became law in 1984; Royal assent granted in June 1985; remains in place today.
  • The Act governs and guides, and perhaps limits, health care delivery in Canada.
  • Primary goal: provide equal, prepaid, and accessible health care to eligible Canadians.
  • Eligible Canadians: lawful residents of a province or territory.

Criteria and Conditions of the Canada Health Act

  • Criteria:
    • Public administration
    • Comprehensive coverage
    • Universality
    • Portability
    • Accessibility
  • Conditions:
    • Information
    • Recognition

Interpreting the Canada Health Act (1 of 2)

  • The Act does not specify which health services should be insured.
  • It states that only medically necessary procedures/services are covered by provincial/territorial insurance.
  • Physicians, through their governing body, and government officials (usually from Health ministries) determine which services are medically necessary.
  • Lists of insured services are regularly reviewed and revised by provinces/territories.

Interpreting the Canada Health Act (2 of 2)

  • Under the Act:
    • Extra billing and user charges are not allowed.
    • The federal government will deduct the amount of any extra billing or user fees from the next transfer of funds.
  • Extended health care services considered medically necessary include:
    • Intermediate nursing home care
    • Adult residential care services
    • Home care services
    • Services provided in ambulatory care centres

The Canada Health Act: 1986 Context

  • In 1986, Ontario physicians participated in a 25-day strike in opposition to the Act.
  • The Canadian Medical Association accused the Act of violating the Constitution Act of 1982.
  • The federal government took steps to remove extra billing and user fees, but these practices were not entirely eliminated.
  • Hospitals faced budget pressures, leading to restructuring and service shortages.
  • Alternative health care strategies emerged and primary health care reform began.

The Kirby Report: The Health of Canadians – The Federal Role (2002)

  • Kirby Report (October 2002) argued Canada’s health care system was not sustainable.
  • Key recommendations:
    • Develop strategies to reduce wait times
    • Consider covering the cost of medications under certain circumstances
    • Invest $2 billion in information technology
    • Invest $2.5 billion in advanced medical equipment
    • Provide incentives to encourage health care professionals to return to Canada
    • Provide funds to recruit and train doctors and nurses

The Romanow Report: Building on Values – The Future of Health Care in Canada (2002)

  • Roy Romanow chaired the Commission on the Future of Health Care in Canada.
  • Argued that health care was sustainable with appropriate and immediate action.
  • Opposed privatization of health care.
  • Provided recommendations for reform and renewal of the Canada Health Act, including:
    • Health promotion campaigns
    • Limits on wait times
    • Primary health care reforms
  • Several recommendations were implemented.

The Truth and Reconciliation Commission of Canada: Calls to Action

  • Calls to Action address inequities for Indigenous peoples in Canada.
  • Specifically, Calls to Action numbers 18–24 address health matters and inequities in health care for Indigenous people.