ABSTRACT

A federal, ten provincial and two territorial governments govern Canadians. According to the provisions of the Canadian constitution (1867), the provinces have jurisdiction for the organization and delivery of health care along with other public services including education and social welfare. There are, however, several populations for whom the federal government retains primary responsibility for delivery of health services. These include members of the armed forces, the R.C.M.P., offshore federal employees, prisoners in federal facilities, and Aboriginal persons who are registered under the Indian Act of Canada. In order to ensure equality of health services to all Canadians, the federal government shares the cost of health care with the provinces. In 1996, the Canada Health and Social Transfer Act, which is the most recent legislation in this area, arranged for the transfer of a “block of funds,” consisting of cash payments and “tax points” from the federal government to the provinces. This was to be applied towards hospital and medical insurance, post secondary education and welfare programs. The allocation of resources between these programs was left to the discretion of the provincial governments. However, the Canada Health Act (1984) stipulates the conditions with which provinces must comply to receive cash transfers each year. These conditions include: (a) public administration-the provincial health care insurance plan must be “administered and operated on a non profit basis by a public authority appointed or designated by the government of the province.” This provision does not say who actually delivers the health care services; (b) comprehensiveness-the provincial health care insurance plan must “ insure all insured health services provided by hospitals, medical practitioners or dentists, and where the law of the province so permits, similar or additional services rendered by other health care practitioners”; (c) universality-to satisfy this criterion the provincial insurance plan must “entitle one hundred percent of the insured

persons of the province to the insured health services provided for by the plan on uniform terms and conditions”; (d) portability-this criterion requires that Canadians be covered when traveling within and outside of Canada, at the rate of their home province. Also it stipulates that the provincial plan “must not impose any minimum period of residence in the province, or waiting period in excess of three months before residents of the province are eligible or entitled to insured health services”; and (e) accessibility-this provision requires that the provincial plan “must provide for insured services on uniform terms and conditions and on the basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons.” Also the province must “provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists” and pay hospitals for the “cost of insured health services.” The CHA also sets out penalties if a province allows extra billing by health care providers or sets user fees.