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Canadians take considerable pride in their country's health care system. It is seemingly one of Canada's most famous and discussed characteristics. However, health care as we know it has developed over a long history, one not free from threats and obstacles. Understanding the system in which we operate is enhanced by learning its history, throughout which the Canadian government maintains that "the basics remain the same: universal coverage for medically necessary health care services provided on the basis of need, rather than ability to pay."
Contents:
The following timeline outlines some of the more significant events in the history of health care in Canada. These, in addition to other developments, are explored in detail below.
According to the Constitution Act, 1867, the provinces and territories were responsible for the bulk of healthcare-related matters, including establishing, maintaining, and managing hospitals, asylums, charities and charitable institutions, while the federal government was responsible for marine hospitals and quarantine. The Department of Agriculture handled federal responsibilities from 1897 until the introduction of the first Department of Health in 1919.
Until the end of the Second World War, health care in Canada was generally privately funded and delivered. However, some minor changes in healthcare operations perhaps foreshadowed the events in the late 1940s that transformed Canada's health care system. Interestingly, a special federal health care program was established in the First World War to help ill or wounded veterans, which could be seen as the beginning of medicare. Other changes included establishing municipal hospital plans in the 1920s, the Royal Commission on Health Insurance in British Columbia in 1921, and the introduction of some provincial health insurance legislation (though no operating program) throughout the 1930s.
Decades of economic and social hardship caused by the Depression and WWII triggered a post-war shift, which set the stage for the beginning of public health care in Canada.
The end of the Second World War saw the expansion of the Canadian welfare state, allowing broad consensus for a new economic and social model that would make the introduction of public health care more feasible.
In 1947, Saskatchewan introduced the first province-wide, universal hospital insurance plan, signalling Canada's foray into medicare. Over the next ten years, national grant programs were established to work towards public health.
By 1957, the federal government passed a Hospital Insurance and Diagnostic Services Act, which offered to reimburse or share one-half of provincial and territorial costs for specified services, meaning the federal government would cover 50% of these costs. This act provided publicly administered, universal coverage for a set of services under uniform terms and conditions. All provinces and territories had agreed to provide publicly funded inpatient hospital and diagnostic services within the following four years.
In 1964, a federal Royal Commission on Health Services chaired by Emmet M. Hall recommended developing a national health care program. Two years later, the Pearson minority government introduced the Medical Care Act, 1966, granting cost-sharing or reimbursement to provinces and territories for medical services provided by doctors outside of hospitals. Before this, doctors determine the costs for their services, and people occasionally went bankrupt trying to pay. Also introduced was the Canada Assistance Plan, which provided cost-sharing for social services, including services not covered under hospital plans for those in need.
Throughout this time, health care transformed into a system recognizable to Canadians today; however, this did not occur without challenges and threats. There was notable opposition by doctors, insurance companies, and big businesses, as their freedom to charge unreasonable prices was steadily decreasing. The national hospital insurance plan, introduced by Paul Martin Sr. in 1957, was challenged by the aforementioned groups. The Canadian Medical Association also went on record opposing all publicly funded health care in 1961. Notably, in 1962, the Saskatchewan government, introduced a universal provincial medical insurance plan to provide physician services to all its residents, causing the province's doctors to walk out and strike for 23 days.
The expansion of Canada's welfare state made the introduction and transformation of the health care system possible, though as political and economic conditions changed in the 1970s, so did the medicare operation.