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An Act in five
points
The Canada Health Act's stated
aim 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 barriers." It's an agreement
that governs the transfer of cash from the feds
to the provinces for healthcare. In order to get
the money, the provinces have to follow five golden
rules:
1. Public administration: a
public authority, accountable to the province,
must administer the system.
2. Comprehensiveness: All medically
necessary services offered either in hospital
or by a physician are covered.
3. Universality: All residents
of Canada have free access to healthcare.
4. Portability: Canadians can
get free medical coverage across the country.
5. Accessibility: All Canadians,
regardless of how much money they make or their
health status, get access to the healthcare system.
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Recent health reform proposals
in Quebec, Alberta and BC have called into question
the validity and legality of the Canada Health Act (CHA).
So just why is this document so sacred to some and the
object of disdain to so many others?
Policy experts are torn about whether
or not the reforms violate any of the Act's five principles
(see "An Act in five points" below).
To Dr Gordon Guyatt, a professor
at McMaster and a health policy pundit, it's crystal
clear that some of the provincial premiers have trampled
all over the law's intentions. "They undermine the spirit
of the Act, and also its practice," he says emphatically.
But researchers over at the Fraser
Institute have a different take, calling the CHA "the
single greatest barrier to the creation of a world-class
healthcare."
LEGAL
EYE
This whole issue was thrust onto the front burner after
the Supreme Court's ruling on the Dr Jacques Chaoulli
case. Pundits have since been scrambling to figure out
whether the decision and Quebec's subsequent response
represent a breach of the CHA.
Marie-Claude Prémont, associate-dean
of law at McGill and an expert in health law, thinks
folks are being a tad hysterical. "The Chaoulli decision
doesn't call into question the Canada Health Act," she
stresses, pointing out that the ruling had to do with
a Quebec law limiting private health insurance and not
the CHA.
As for Alberta and BC, according
to Ms Prémont it's still too soon to say. It
all depends on how they choose to proceed with their
reforms, she explains. Ralph Klein's proposal to allow
doctors to work in both the public and private systems,
for instance, could constitute a violation of the Act's
fifth tenet if it ended up reducing access to care.
She also points out that the CHA
doesn't actually prohibit private healthcare delivery.
Alberta already has private surgical facilities that
don't violate the law. And Gordon Campbell's penchant
for public-private-partnerships wouldn't necessarily
violate the Act, as long as patients weren't, say, charged
user fees.
WHAT
IS A VIOLATION?
User fees and extra-billing for insured services are
the two ways a province can run afoul of the Act. Insured
services are only those provided by a hospital or a
physician and are considered medically necessary —
a term many believe needs to be better defined.
This is one of the key problems
of the CHA, according to Dr Morris Bayer, a policy expert
and a professor at UBC. "Since the time it was written,
increasing amounts of care are being provided outside
of hospitals and increasing amounts could be provided
by healthcare professionals other than physicians,"
he says. Since only medically necessary services are
covered it creates huge anomalies, believes Dr Barer.
One example he gives is drugs that are considered medically
necessary when a patient is in a hospital bed but as
soon as they leave the drugs are no longer covered.
None of this is dealt with by the Act.
Another question is whether universal
healthcare is a human right. Many people pushing for
private care on the basis of timely access claim their
human rights are being violated, as Dr Chaoulli's patient
George Zeliotis did. Trouble is, both the CHA and the
Charter of Human Rights are very much open to interpretation.
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