Strengthening the Foundations: Modernizing the Canada Health Act (Discussion Paper No. 13, Royal Commission on the Future of Health Care in Canada, 2002, 46 pp.) (with C.M. Flood).


The Canada Health Act (CHA) has served Canadians extremely well since 1984. However, to continue to realize the values that lie behind the Act, some changes are needed. In this paper, we propose significant reforms to the CHA. The CHA should maintain the prohibitions on extra-billing and user charges. The CHA should be reformed to actively encourage innovation and evidence-based reform in the delivery of care. The criterion of non-profit public administration should be amended to “public governance and democratic accountability” to emphasize the importance of good governance and accountability of decision makers at all levels in Medicare. The federal government should monitor the growth of health care delivery by for-profit firms but acknowledge that the CHA does not presently preclude their participation, provided services are fully publicly funded. The CHA should require provinces to establish transparent and democratic processes to determine on an ongoing basis which services and goods should be publicly funded. The CHA should be amended to include a guarantee of timely access to meet Canadians’ concerns about waiting lists and times. A non-partisan and expert Medicare Commission should be jointly appointed by the federal and provincial governments to reward provinces that meet objective performance indicators or that undertake reform that the Commission has identified as worthwhile. A permanent dispute settlement machinery should be created to deal with disputes over the interpretation of the program criteria in the CHA. Separate legislation is required to provide for national standards for insuring prescription drugs and home care.