Canada Health Act
The Canada Health Act (CHA) is a piece of
Canadian federal
legislation, adopted
in
1984, which specifies the conditions and cri-
teria with which the provincial and territorial
health insurance programs must conform in
order to receive federal transfer payments
under the Canada Health Transfer. These cri-
teria require universal coverage (for all "in-
sured persons") for all "medically necessary"
hospital and physician services, without co-
payments.
The CHA deals only with how the system
is financed. Because of the constitutional di-
vision of powers among levels of government,
adherence to CHA conditions is voluntary.
However, the fiscal levers have helped to en-
sure a relatively consistent level of coverage
across the country. Although there are dis-
putes as to the details, the CHA remains
highly popular.
In popular discussion, the CHA is often
conflated with the health care system in gen-
eral. However, the CHA is silent about how
care should be organized and delivered, as
long as its criteria are met.
Another cause for debate is the scope of
what should be included as "insured ser-
vices". For historical reasons, the CHA’s
definition of insured services is largely re-
stricted to care delivered in hospitals or by
physicians. As care has moved from hospitals
to home and community, it increasingly has
been moving beyond the terms of the CHA.
International data shows that approximately
70% of Canadian health expenditures are
paid from public sources,[1] placing Canada
below the OECD average.[2]
The key battles around the CHA, however,
concerned the question of charges to insured
persons for insured services. These were
termed ’extra billing’ when they referred to
physician care, and ’user charges’ when they
referred to hospitals. The policy debate was a
long-standing one. Health care differs from
many consumer goods to the extent that it is
allocated on the basis of need. If someone
who needs care is not to be denied it on the
basis of ability to pay, providers often find
themselves providin