Canada Health Insurance

Adopted in 1984, the Canada Health Act was created to provide for the financial support of provincial health care from federal sources.  It sets out standards which all of the provinces must follow in terms of their health care programs in order to receive federal funding.  The goal of the Act is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers”.  The Canada Health Act dictates to the provinces how they should run their provincial health care plans if they want the federal government to help pay for it; it is intended to ensure that all Canadian residents have access to health care on an equal basis, regardless of their level of income, or ability to pay.

The Guidelines of the Canada Health Act for Provincial Health Care

Although each province is responsible for handling its own insurance plans in providing coverage to all its residents, the federal government has set some guidelines to ensure that the services are equitable.  The Canada Health Act outlines the following rules for all provinces with regard to medical coverage to Canadians:

• Provincial health care plans must be publicly administered by a non-profit organization and are subject to auditing procedures.
• Provincial health care plans must be comprehensive, covering medically necessary services from doctors, dentists and hospitals.  However, only specific types of dental care fall under the coverage; beyond the basics, provinces can determine additional services to be medically necessary at their discretion.
• Every individual who qualifies for the provincial insurance coverage must be given access to equal coverage and equal services.
• Coverage must be extended to residents while they are in another province, and must continue for a minimum period of time after a resident’s relocation, which is usually three months.
• Insured residents must be given reasonable access to the services provided for, and all practitioners must be compensated properly and reasonably.  The Act does not define what is considered reasonable, but allows provinces to engage in their own negotiations to determine the definition of reasonable.
• The province must provide specific information to the federal Minister of Health and must recognize the federal government in documents, promotional materials, and any other similar materials relating to medical insurance in the province.
• Extra billing and user charges for covered medical services are prohibited, and penalties are laid out.

What the Canada Health Act Means to You

As a resident of one of the provinces of Canada, and provided you meet all of the criteria for coverage, you have access to the same coverage as all other Canadian residents.  The Canada Health Act ensures that the ability to pay has no impact on the level of health services you will receive; nor does your age, race, or any other factor.  The province is accountable to the federal government for ensuring that you receive adequate and reasonable health care.

The terms of the Act reduce the capacity of private insurance providers to cover provincially insured services; however, they can still cover services that do not fall under the scope of the provincial plan, and provide for people who do not meet the provincial criteria for coverage.

The Canada Health Act does not have any bearing on how provincial health care systems are organized and how care is delivered, but is rather particularly focused on the availability of health insurance to Canadian residents, and the details of the partial funding by the federal government.  Although the provinces’ compliance with the guidelines of the Act is voluntary, they have had a large impact on the equality and availability of health care across Canada.