The health-care system inherent in our way of life in Canada, and which today we may take for granted, did not always exist. In fact it is less than 30 years since all the provinces and territories in Canada enacted what we refer to as medicare. And this large, intricate, and dynamic system evolved as a result of the vision and hard work of many individuals, public organizations, and governments; all working interdependently.

The simple but profound saying “Wayfarer, keep looking back” states well how we should look at our health-care system in order to understand where it is today. As you read the chronology below, highlight what, in your opinion, are the most significant moments in the evolution of Canada’s health-care system.

1867 Canada becomes a country, independent of Great Britain. The Constitution Act of that year (formerly known as the British North American Act), which sets out the duties and responsibilities of the federal and provincial governments, defines health care as a family or local concern, and makes the provinces responsible for its maintenance.

1947 Saskatchewan is the first province to introduce a public health insurance plan to cover hospital services; however, all medical costs outside hospitals are still privately paid.

1957 The Hospital Insurance and Diagnostic Services Act is introduced by the federal government. This act is the result of public pressure, going as far back as the Great Depression (1939), for government assistance in covering health-care costs that are incurred as a result of disasters or unusually ruinous social conditions. It offered federal money to the provinces to share in the costs of producing a Canada-wide health-care plan that would cover the costs of in-hospital service. The cost-sharing was roughly on a 50-50 basis, with the federal government and provinces paying the same amount. The federal government set criteria that the provinces had to meet to get the money in the form of federal grants. The criteria were that the service must be: universally available, portable, and administered publicly.

1961 By the beginning of the 1960s all provinces and territories had signed agreements establishing public insurance plans that provided universal coverage for at least in-patient hospital care and that therefore qualified for the federal assistance plan.

1962 Medical services insurance is born in Saskatchewan. The government of T.C. (Tommy) Douglas (who by the way was the grandfather of actor Kiefer Sutherland) requires doctors to now collect their fees solely from the government plan. Medical services in Saskatchewan are now paid for by the government and no longer are covered by private plans.

1964 The Royal Commission on Health Services led by former Saskatchewan chief justice Emmett Hall delivers its historic report. Hall confirms the need for the three criteria established in 1957 but also suggests that a national plan be extended to cover health care beyond hospitals and that such a plan be in place for all Canadians.

1966 The Medical Care Act is passed by the federal government. It extends health-care coverage to include doctors’ services outside hospitals.

1972 All provinces universally participate in what we now call medicare. The provinces and territories contribute approximately the same amount to the plan as does the federal government.

1977 The federal-provincial financial arrangements established in The Hospital Insurance and Diagnostic Services Act and the Medical Care Act are replaced by a new federal plan called The Federal Provincial Fiscal Arrangements and Established Programs Financing Act (EPF). This new method of cost-sharing set up by the federal government is called block funding.

1980 Chief Justice Hall, who headed the 1964 Royal Commission on Health, issues another report titled Canada’s National-Provincial Health Program for the 1980s. It cautions that extra billing by doctors and user fees by hospitals are endangering the principle of universality by denying reasonable access to health care for all Canadians. It suggests that charges by doctors and hospitals will lead to a two-tiered health system with standards of care depending on how much one could pay.

1984 The Canada Health Act brings together and revises all previous federal legislation regarding health care. It re-establishes the criteria by which the provinces qualify for federal grants. Now there are five criteria rather than three: they are: comprehensiveness, public administration, universality, portability, and accessibility. The Act, based on the concerns expressed in the Hall report, provides a dollar-for-dollar penalty deducted from grants given to the provincial governments if the individual province allows extra billing.

1995 The federal government announces yet another new federal formula for funding the provinces, the Canada Health and Social Transfer (CHST). This block fund covers all annual support for health, education, and social services to the provinces.

Follow-up Discussion
1. In your opinion, what was significant about the Canada Health Act? Name and define at least two new developments it introduced.
2. The two reports by Emmett Hall were very influential in the development of medicare in Canada. Suggest what the long-term significance and implications were of the reports.
3. Suggest how the saying “Wayfarer, keep looking back” applies to any discussion of health care in Canada.

Comprehensive News in Review Study Modules

Using both the print and non-print material from various issues of News in Review, teachers and students can create comprehensive, thematic modules that are excellent for research purposes, independent assignments, and small group study. We recommend the stories indicated below for the universal issues they represent and for the archival and historic material they contain.

“The Manitoba Nurses’ Strike,” February 1991
“Governments Cut Back,” September 1993
“Medicare: The Cost of Caring,” November 1993
“Health Care Cuts: Operating With Less,” February 1996
“Northern Medicine: Too Little, Too Far,” February 1998
“Overworked and Underpaid: Nurses Strike Back,” September 1999