HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
Chapter 2: Health Care and Health Reforms: Trends and Issues
¾ Canadians have access to a wide range of physician and hospital services any direct out-of-pocket costs.
¾ This system of universal, accessible, comprehensive and portable medical and hospital care insurance, publicly
administered on non-profit bases is called medicare.
programs, and it is a source of great national pride. Yet, at the same time, it is a source of perpetual public concern.
¾ As taxpayers, however, we worry about the cost of medicare and whether it is financially sustainable.
¾ We also worry about whether it is draining public resources away from other areas of public policy, such as post-
secondary education, social services, national defence and security, etc.
¾ Numerous cost containment and various cost transfer measures have been implemented as possible solutions to the
crisis. Paradoxically, in many cases, these cost containment and cost transfer measures are seen as part of the
problem, rather than part of the solution.
¾ Cost transfer initiatives are of two main types. The first involves directly transferring costs from the public sector to
the private sector. This can be referred to as marketization.
¾ The second, indirect cost transfer strategy, involves having family, friends, and community organizations providing
uncompensated care to individuals in need. This is often referred to as downloading.
¾ The other main dimension of the perpetual crisis in health care involves concerns about whether medicare has the
capacity to satisfy the existing and emerging health care need of Canadians in a timely and effective fashion.
¾ The changing pattern of illness is related to several factors, including the aging of the population (the so-called
demographic transition), changing lifestyles, climate change, and the changing types and patterns of illness
associated with these developments.
¾ The other main dimension of the health care crisis is the lack of transparency and accountability of health care policy-
makers, system managers, and service providers. In recent years, there have been several reforms introduced that
are intended to increase transparency and accountability in health care.
Medicare: Origins and Contradictions
¾ By the 1940s, failure of the market to ensure adequate access to necessary medical and hospital care, combined with
limitations of various locally developed collectivist solutions, had generated renewed interest in a system of public
¾ This was given added impetus because wartime military and industrial recruitment efforts revealed that an alarmingly
high proportion of recruits were too sickly for military or industrial service.
¾ As a result, and faced with other evidence of the poor health of the Canadian population, health insurance was firmly
established as a key component in government 0lans for the reconstruction of Canadian society following the Second
¾ Thus, in 1945, the federal government put forward a plan for itself and provincial governments to share the costs of a
universal medical care and hospital services insurance program.
¾ It is believed that improving access to medical and hospital services by removing financial barriers would result in
improved population health status.
¾ Thus, by the end of the Second World War, there was a political consensus that health care could not be left entirely
to the market. Beyond that, however, there was little agreement.
¾ The medical profession for example, favoured a hospital and medical care insurance system that was based on
voluntary participation in physician-sponsored or for-profit insurance plans where government was limited to means-
testing patients and covering the costs of care for those who could not pay for it themselves.
¾ The private insurance industry was in favour of a similar arrangement. Business organizations in general, as well as
several provincial governments, also favoured such an arrangement because of concerns about creeping socialism.
¾ Despite these differing views, in 1945, the federal government introduced draft legislation for a universal,
comprehensive, publicly financed and administered hospital and doctor services plan.