The Annals of Thoracic Surgery, Vol 52, 390-396, Copyright © 1991 by The Society of Thoracic Surgeons
Medicare: the Canadian experience
HE Scully
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
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.
