Myths in Canadian health care

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This article was published 21/07/2023 (870 days ago), so information in it may no longer be current.

Canada’s premiers recently met in Winnipeg and, as expected, asked Ottawa for more health-care funding and balked at having to justify how they were going to spend the money.

Health care is our jurisdiction, they shouted — just give us the money and don’t question what we are going to use it for.

This constant finger pointing between the provinces and Ottawa over health-care funding is not productive.

The result of this bickering is that Canadians are losing faith in their health-care system. In fact, 70 per cent of Canadians felt health care was worse post COVID-19, 45 per cent felt our health-care system is in crisis and 38 per cent did not trust any level of government to solve the problem, according to a 2022 Nanos poll for the Globe and Mail.

This is discouraging, especially considering how proud Canadians used to be of our universal health-care system. As a testament to this, Tommy Douglas, the father of Canadian medicare, won the title of “the greatest Canadian” in a 2004 CBC competition.

The first step to finding solutions to our health-care crisis is to dispel prevailing myths about the system. The second step is to hold the appropriate politicians and health-care leaders accountable to deliver quality health-care services.

Myth No. 1: There is a “Canadian health-care system.”

There is no such thing as a Canadian health-care system. Canada has 10 provincial and three territorial health-care systems, which have constitutional jurisdiction over hospital services and, in a practical sense, all health-care services. There are a few exceptions in which the federal government takes the lead (e.g., in the military and the RCMP). The issue of Indigenous health services is complicated and is an ever-moving-target between Ottawa and the provinces about who takes the lead.

Myth No. 2: Ottawa can force the provinces and territories to follow the principles of the Canada Health Act (CHA). The CHA spells out the terms and conditions that provinces have to follow to receive federal health-care transfer payments.

In fact, Ottawa can’t legally force provinces and territories to comply with the terms of the CHA, such as universal access to comprehensive care that is publicly administered and accessible across the nation. However, Ottawa can withdraw, or claw back, health-care transfer payments if provinces and territories don’t comply.

This means, in theory, that a province could decline CHA health-care transfer payments and go its own way — a perilous strategy as blame for the health-care crisis could no longer be deflected to Ottawa.

Myth No. 3: All Canadians have access to the same set of “medically necessary” health-care services.

The CHA does not define, under the “comprehensive” principle, what “medically necessary” services are. It is up to the provinces and territories to decide which services they consider necessary and this can vary by jurisdiction, leading to a patchwork quilt of publicly funded services across Canada.

Provinces can arbitrarily add, or remove, items from the list of “medically necessary” insured health services. Once a province de-lists a health service, patients can be charged for it without the province breaching the CHA.

Myth No. 4: Canadians have a right to health care.

There is no enshrined right to health care under the Canadian Constitution or the Canadian Charter of Rights. To varying degrees, other countries have enacted constitutional rights to health care in line with the “right to health” provisions in the United Nations Declaration of Human Rights.

However, it would be political suicide for provinces to not provide publicly funded health care. That said, Canadians are experiencing an erosion of health-care services, which started before COVID-19, leading to long waits in ERs as well as a backlog of diagnostic and elective procedures, such as joint replacement.

At the end of the day, the provinces and territories, not the federal government, have the ultimate responsibility, and accountability, to provide health-care services to their constituents.

It is time to hold our provincial politicians and health-care leaders accountable and tell them to stop bickering and deflecting accountability.

They own this problem and need to find working solutions — or the solutions may be found at the next ballot box.

Dr. Sandor Demeter is a Winnipeg physician and an associate professor in the department of community health sciences at the University of Manitoba.