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Ann Thorac Surg 1991;52:390-396
© 1991 The Society of Thoracic Surgeons

Articles

Medicare: The Canadian experience

Hugh E. Scully, MD*

Division of Cardiovascular Surgery, The Toronto Hospital, Toronto, Ontario, Canada

* Address reprint requests to Dr Scully, Division of Cardiovascular Surgery, The Toronto Hospital, 200 Elizabeth St, EN13-226, Toronto ON, Canada M5G 2C4.

In the 1940s Canada and the United States had similar lack of structure and reimbursement for diagnostic, hospital, and physician services. In Canada over the next 40 years there evolved a complex system mandated and partially funded by the federal government, but administered and delivered through 10 provincial and 2 territorial jurisdictions. Each must negotiate with federal government on cost sharing and deal with hospital budgets and physician compensation at the provincial or territorial level. The Medical Care Act of 1966 enshrined in law the five principles of public administration, universality, comprehensiveness, portability, and accessibility, converting all medical services in Canada from a privilege to a right. Any patient participation in hospital or physician charges came under increasing political attack. In 1984 the Canada Health Act specified financial penalties in federal transfer payments to provinces that permitted any direct patient charges. While Canada has "contained" health expenditures at 8.7% of gross national product, universal access to quality care is increasingly subject to rationing. The relationship between the profession and governments hard pressed to fund escalating costs in a deteriorating economy has been one of increasingly bitter confrontations. There have been four acrimonious doctors' strikes. More optimistically, there is now an emerging recognition of society's need to have physicians actively participating with other providers and governments to create a balance between access to quality health services and both public and private funding.






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Copyright © 1991 by The Society of Thoracic Surgeons.