Chapter 01

The History of Health Care
in Canada
Chapter 1
Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
Learning Outcomes
1.1 Summarize the early evolution of health care
in Canada.
1.2 Discuss the introduction of health insurance.
1.3 Describe significant events and legislation
shaping health care from 1960 until the
introduction of the Canada Health Act (CHA).
1.4 Describe the criteria and conditions of the
Canada Health Act.
1.5 Explain the events that have occurred since
the implementation of the Canada Health Act,
including commissioned reports and accords.
.
Ask Yourself
Does the Canada Health Act still meet the needs of
Canadians?
Is health care universal?
Is health care accessible to all?
Is health care provided to all Canadians on
uniform terms?
Is health care delivered in a timely fashion to all?

.
Evolution of Health Care: An Overview
In 1867, the British North America Act

established the Dominion of Canada, which
consisted of Ontario, Quebec, New Brunswick,
and Nova Scotia.
Each province had its own
Representation in government
Law-making body
Lieutenant Governor

.
Division of Responsibilities for Health
Health matters received little attention in the

British North America Act.
The federal government was responsible for the
Establishment and maintenance of marine hospitals

Care of Aboriginal populations
Management of quarantine
The provinces were responsible for
Establishing and managing hospitals, asylums,

charities, and charitable institutions
All other health-care-related responsibilities by default
.
Division of Responsibilities for Health
In 1919, the Department of Health was created.

In 1944, it was renamed the Department of
National Health and Welfare, and federal
responsibilities expanded to include
Food and drug control

The development of public health programs
Health care for members of the civil service
Operation of the Laboratory of Hygiene
The department was renamed Health Canada in

the late 1990s.
.
The Origins of Medical Care in Canada
Doctors first arrived with the European settlers

(mostly from England and France).
The first medical school was established in
Montreal in 1825.
Only the wealthy could afford care; those who
could not afford care received it through religious
and charitable organizations or from family and
friends.

.
Aboriginal Medicine and the Shaman
Sometimes referred to as shamans or medicine

men, Aboriginal healers
Were believed to have a strong connection to the

spirit world and Mother Earth
Possessed an understanding of healing and the use
of herbal medicines
Knew how to use local plants, herbs, roots, and
fungi to remedy common sicknesses that are still
prevalent today
Many traditional medicines have been

incorporated into contemporary Western
medicinal practices.
.
The Concept of Public Heath is Introduced
Upper and Lower Canada (now Ontario and Quebec) each

established a board of health, in 1832 and 1833,
respectively.
The remaining provinces followed suit in the early 1900s.
These boards of health
Enforced quarantine and sanitation laws

Imposed restrictions on immigration (to prevent the spread of
disease)
Stopped the sale of spoiled food
Maternal and child health care became a focus of public

health initiatives at the beginning of the twentieth century.
.
The Role of Volunteer Organizations
In the eighteenth and early nineteenth

centuries, Canadians health care needs were
met by volunteer organizations, such as
The Order of St. John (later known as St. John
Ambulance)
The Canadian Red Cross Society
Victorian Order of Nurses (VON)
Childrens Aid Society

.
10
The Role of Nursing
In the early 1600s, the Htel-Dieu Hospital in

Quebec launched the first structured training for
North American nurses.
In 1873, the first school of nursing was
established at Macks General and Marine
Hospital in St. Catharines, Ontario.
In 1881, Toronto General Hospital established a
nursing school.
Soon, nearly every major hospital in Canada
offered a school of nursing.
.
11
The Development of Hospitals in Canada
Canadas first hospital, the Htel-Dieu de

Quebec, was established in Quebec City in
1639.
Many early hospitals were charitable institutions.
In the early 1900s, tuberculosis sanitariums and
institutions to care for mentally ill people were
established.

.
12
The Introduction of Health Insurance
In 1919, a publicly funded health care system

formed part of a Liberal election campaign but was
not successfully implemented.
In 1935, the Conservative government pledged to
address social issues such as minimum wage,
unemployment, and public health insurance.
In 1940, the provincial and federal governments
amended the British North America Act and
introduced a national unemployment insurance
program.
In 1944, the federal government introduced the
baby bonus.
.
13
Post-World War II: The Political

Landscape
Canadians wanted the security and equity of a publicly

funded health care system.
Medical discoveries were advancing treatment, care, and
diagnostic capabilities.
There was a shift to hospital-based care.
In 1948, the federal government set up a number of grants
to fund the development of health care services in
partnership with the provinces.
In 1952, these grants were supplemented by a national
old age security program.
In 1954, the federal government began providing support
for adults who were disabled and unable to work.
.
14
Progress Toward Prepaid

Hospital Care
In 1957, the federal government introduced the Hospital

Insurance and Diagnostic Services Act, which provided
federal dollars to provinces and territories willing to
implement a comprehensive hospital insurance plan.
Some provinces and territories were not able to
implement comprehensive services because of
population distribution.
Through an equalization payment system, richer
provinces would share revenue with poorer provinces to
provide care for all.
The Hospital Insurance and Diagnostic Services Act
Provided residents with full care in an acute care hospital
Included care provided in outpatient clinics

.
15
Progress Toward Prepaid

Medical Care
Tommy Douglas, known as the father of

medicare, was the premier of Saskatchewan
from 1944 to 1961.
Douglas campaigned for an affordable
comprehensive hospital and medical insurance
plan.
The Saskatchewan Medical Care Insurance Act
was passed in 1961.
Most other provinces and territories adopted
similar plans over the next few years.
.
16
Significant Events Leading Up to

the Canada Health Act
The federal government remained committed to

a comprehensive health insurance program
Significant events leading up to the Canada
Health Act included:
The Hall Report

The Medical Care Act
The Established Programs and Financing (EPF) Act

.
17
The Hall Report (1960)
The federal government authorized the Royal

Commission on Health Services (also known as
the Hall Report) in 1960.
This commission, under Justice Emmett Hall:
Supported a national medicare program

Recommended that the number of physicians be
doubled by 1990 to meet the needs of a growing and
aging population
Halls recommendations became the foundation

of the Medical Care Act.
.
18
The Medical Care Act (1966)
The Medical Care Act was implemented on July

1, 1968.
To receive funds, provincial and territorial health
plans had to meet the criteria of
Universality
Portability
Comprehensive coverage
Public administration

.
19
The Established Programs

Financing Act (1977)
Introduced a new funding formula to allocate

money to health care and postsecondary
education
Replaced 50/50 cost-sharing formula 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
.
20
Events Following the Introduction

of the EPF Act
Health care spending increased dramatically and

hospitals cut spending on staff and services
Doctors began extra billing, contravening the principles of
the Medical Care Act
In 1980, Hall and Girard conducted a health care services
review and released their conclusions in a report called
Canadas Provincial Health Program for the 1980s
A Parliamentary Task Force on Federal-Provincial
Arrangements completed their review in 1981
The Hall Report and the report of the Parliamentary Task
Force prompted the Canada Health Act
.
21
The Canada Health Act
The Canada Health Act became law in 1984

The Act received royal assent in June 1985 and
is still in place today
The Act governs and guides, and perhaps limits,
our health care delivery system
The Acts primary goal is to provide equal,
prepaid, and accessible health care to eligible
Canadians
Eligible Canadians are those who are lawful
residents of a province or territory
.
22
Criteria and Conditions of the

Canada Health Act
Criteria
1. Public administration
2. Comprehensive coverage
3. Universality
4. Portability
5. Accessibility
Conditions
1. Information
2. Recognition

.
23
Interpreting the Canada Health Act
The Canada Health Act does not detail which

health services should be insured
Instead, the Act states that only those
procedures and services that are judged to be
medically necessary are covered by provincial
and territorial insurance
Physicians, through their governing body, and
government officials, usually from the Ministry or
Department of Health, select which services are
medically necessary
Lists of insured services are regularly reviewed
and revised by the provinces and territories
.
24
Interpreting the Canada Health Act
Under the Act, extra billing and user charges are

not allowed
The federal government will deduct the amount of
any extra billing or user funds collected by the
province or territory 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
.
25
After the Canada Health Act:

Commissioned Reports and Accords
In 1986, Ontario physicians participated in a 25day strike in opposition to the Act

The same year, the Canadian Medical Association
accused the Canada Health 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 struggled to function within budgets,
leading to restructuring and service shortages
Alternative health care strategies emerged and
primary health care reform began
.
26
Social Union
First ministers gathered in 1997 to form a social

renewal program and press Ottawa for a funding
increase
All provinces and territories, except Quebec, signed
a federal agreement in 1999 giving them more
spending flexibility
The social union improved the provincial and
federal-territorial relationships
The social union agreed to maintain the five criteria
of the Canada Health Act
The federal government promised to increase health
care spending significantly
.
27
The Mazankowski Report: A Framework

for Reform (2001)
This report, released in August 2000, provided advice to the

premier on preserving and improving Alberta health
services.
Key Points:
Supported some aspects of private health care
Recommended delisting selected services
Recommended implementing electronic health records
Suggested that Albertans pay higher health premiums
Outcomes:
Alberta became the first province to implement electronic
health records in 2003
.
28
The Kirby Report: The Health of

Canadians The Federal Role (2002)
This report, released in October 2002, argued that Canadas

current health care system was not sustainable and
recommended that the government
Develop strategies to reduce wait times
Cover the cost of medications under certain circumstances
Invest $2 billion for 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, train, and retain doctors and
nurses

.
29
The Romanow Report: Building on

Values: The Future of Health Care
in Canada (2002)
Roy Romanow, as chair of 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
The Romanow Report provided 47 recommendations for
both health care reform and renewal of the Canada Health
Act
Several recommendations were implemented including
health promotion campaigns, limits on wait times, and
primary health care reforms
.
30
Accords
The following first ministers meetings highlight the latest

agreements between the federal government and the
provincial and territorial governments:
First Ministers Meeting, 2000
First Ministers Accord on Health Care Renewal, 2003
First Ministers Meeting on the Future of Health Care,
2004
Annual Conference of Ministers of Health, 2005
Kelowna Accord, 2006
The Mental Health Commission of Canada, 2007
The 2014 Health Accord
.
31

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The History of Health Care

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Evolution of Health Care: An Overview

In 1867, the British North America Act

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Division of Responsibilities for Health

Health matters received little attention in the

Establishment and maintenance of marine hospitals

The provinces were responsible for

Establishing and managing hospitals, asylums,

Division of Responsibilities for Health

In 1919, the Department of Health was created.

Food and drug control

The department was renamed Health Canada in

The Origins of Medical Care in Canada

Doctors first arrived with the European settlers

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Aboriginal Medicine and the Shaman

Sometimes referred to as shamans or medicine

Were believed to have a strong connection to the

Many traditional medicines have been

The Concept of Public Heath is Introduced

Upper and Lower Canada (now Ontario and Quebec) each

Enforced quarantine and sanitation laws

Maternal and child health care became a focus of public

The Role of Volunteer Organizations

In the eighteenth and early nineteenth

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

The Role of Nursing

In the early 1600s, the Htel-Dieu Hospital in

The Development of Hospitals in Canada

Canadas first hospital, the Htel-Dieu de

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

The Introduction of Health Insurance

In 1919, a publicly funded health care system

Post-World War II: The Political

Canadians wanted the security and equity of a publicly

Progress Toward Prepaid

In 1957, the federal government introduced the Hospital

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Progress Toward Prepaid

Tommy Douglas, known as the father of

Significant Events Leading Up to

The federal government remained committed to

The Hall Report

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

The Hall Report (1960)

The federal government authorized the Royal

Supported a national medicare program

Halls recommendations became the foundation

The Medical Care Act (1966)

The Medical Care Act was implemented on July

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

The Established Programs

Introduced a new funding formula to allocate

Events Following the Introduction

Health care spending increased dramatically and

The Canada Health Act

The Canada Health Act became law in 1984

Criteria and Conditions of the

Copyright 2016 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Interpreting the Canada Health Act

The Canada Health Act does not detail which