POLI-221:

Government of Canada
Week 11, Part 2
Parting at the Crossroads (Maioni, 1997)
• Explaining why Canada created a universal health care system in the
post-war era while the US adopted a more targeted approach focused
on Medicare (for older people) and Medicaid (for poor people)?
• Maioni (1997: 412) argues “that the federal structure and
parliamentary institutions of the Canadian political system encouraged
the formation of a social democratic third party and enhanced its
efficacy in promoting health policy reform. The institutional constraints
of the American political system, in contrast, impeded the emergence
and consolidation of this type of policy ‘entrepreneur’ and forced the
proponents of health reform to restrain their strategies in order to
appeal to a wider coalition within the Democratic Party.”
Historical Timeline
• 1947: in Saskatchewan, the Co-operative Commonwealth Federation (CCF)
government of Tommy Douglas creates the first provincial hospital insurance
program.
• 1957: adoption of federal Hospital Insurance and Diagnostic Services Act, a
cost sharing program reimbursing half of provincial hospital and diagnostic
costs.
• 1962: “
Saskatchewan introduced a universal, provincial medical insurance plan to pro
vide doctors' services to all its residents
”.
• 1966: “
The federal government passed the Medical Care Act in 1966, which offered to
reimburse, or cost share, one-half of provincial and territorial costs for medica
l services provided by a doctor outside hospitals.
1984 Canada Health Act: Five Principles
• “Public administration: plans must be administered and operated on a non-profit basis
by a public authority;
• Comprehensiveness: plans must cover all insured health services provided by hospitals,
physicians, or dentists (for surgical dental procedures that require a hospital setting);
• Universality: all insured residents must be entitled to the insured health services on
uniform terms and conditions;
• Portability: insured residents moving from one province or territory to another, or
temporarily absent from their home province or territory or Canada, must continue to
be covered for insured health services (within certain conditions);
• Accessibility: not to impede or preclude, either directly or indirectly, whether by user
charges or otherwise, reasonable access to insured health services.” (Martin et al., 2018)
Health Care Governance (Martin et al. 2018)
Next Week’s Readings
• According to Geoffrey Hale (1998), what are the main factors that led to
unemployment insurance reform (and the advent of Employment Insurance) in the
early-mid 1990s?
• For Gerard Boychuk (2015), did the dismantlement of the Canada Assistance Plan
have a strong impact on the subsequent development of social assistance (welfare)
programs in the Canadian provinces? Do you find his analysis convincing?
• Charles Plante’s 2019 article on provincial poverty reduction strategies in Canada
is titled “Policy or window dressing?” How does he answer this question, and do
you find his answer compelling?