Colleen M. Flood is dean of the Faculty of Law at Queen’s University.
As we celebrate the 40th anniversary of the Canada Health Act (CHA), it’s important to acknowledge its pivotal role in shaping Canada’s health care landscape. Enacted in 1984, the CHA stands as a testament to our commitment to a system where necessary care is available on the basis of need and not the ability to pay. However, as we commemorate this milestone, it’s equally important to recognize the yawning gaps that persist in achieving the act’s promise of “reasonable access” to health care for all.
The CHA has undeniably succeeded in its goal to limit opportunities for patients to be billed for medically necessary hospital and physician care. Its success in this regard is tied to the mandatory requirement in the act for the federal government to withhold funds, on a dollar-for-dollar basis, from provinces permitting such billing. This mechanism, rooted in the act’s provisions, has effectively (if sometimes slowly) steered most provinces toward compliance, thereby growing equitable access to health care services across the country.
Despite the act’s achievements, challenges persist, primarily revolving around access and wait times. As we know, unless we have been living under a rock, there is a crisis in access to primary care, with more than 6.5 million Canadians lacking access to a regular primary care physician, while others endure protracted wait times for essential treatments, including emergency care. These stark realities underscore the pressing need to redefine and animate the notion of “reasonable access,” which was promised but has not been delivered by the CHA.
But to modernize the CHA, it is vital not to prescribe rigid standards that will soon be outmoded by changing needs, technologies or expectations. In other words, you don’t want to modernize the CHA only to find it not fit-for-purpose in a few short years. Moreover, it is important to recognize the challenges of having a system that can meet the very different needs of Canadians from coast to coast.
So the path forward in amending the CHA is not to dictate, but to empower provinces to transparently determine what reasonable access means for their residents. This approach respects provincial jurisdiction while ensuring responsiveness to local health care needs and resources, and advancements in medical technology.
The federal government should require each province, in exchange for a federal contribution, to set down a public process for determining benchmarks for reasonable access, including metrics for timely access to primary care, elective procedures and emergency rooms. These benchmarks should be subject to periodic review and adjustment based on emerging evidence and best practices in health care delivery. This mechanism could support provincial voters to hold provinces accountable for ensuring reasonable access to health care, and in this way, the CHA could spur the growth, improvement and adaptation needed over time for our health care system.
A crucial aspect of modernization involves enhancing transparency and accountability in health care delivery. Introducing a centralized platform within the CHA for doctors and patients to register concerns about wait times and access issues would provide invaluable insights into the challenges faced nationwide. This collective data repository would facilitate informed decision-making, drive continuous improvement, and foster public trust in the health care system.
Critics advocating for throwing out the CHA, and/or advocating for privatization, opine without evidence that privatization will cure all the ills of our health system. But even if greater privatization were permitted, there remains the very difficult job of ensuring reasonable and equitable access for services and persons not covered privately. That doesn’t magically happen. Instead of dismantling the CHA, we should renew our commitment to its core principles of universality and equity – values deeply ingrained in Canadians – while adapting to the evolving health care landscape.
As the Canada Health Act blows out 40 candles, it’s time for more than just a nostalgic trip down memory lane or a sombre audit of its failures. Let’s give this act a makeover – not because it’s to blame for every health care problem, but because it deserves credit where it’s due, and a revamp where it’s needed. Let’s inject some vigour into it, making access not just a buzzword but a lived reality for every Canadian.
So happy birthday, CHA. Here’s to a transformation that ensures a better, brighter future for our public health care system. After all, this act is not only the key to our individual well-being, but our collective economic and social futures, as well.