Time to Reform the Canada Health Act

Canada’s provincial health-care systems have long suffered from a policy-driven confluence of high spending and poor performance. While some provinces have attempted minor reforms, all have largely remained committed to the status quo of monopolistic health care dominated by government. This lack of provincial policy innovation is at least partly driven by the federal government’s involvement in provincial policy making through the Canada Health Act and substantial cash transfers tied to provincial compliance.

This federal constraint on provincial experimentation must be reformed to free up provinces to explore proven approaches to delivering universally accessible health care.

First, the CHA should be amended to remove ambiguity, minimizing uncertainty and the potential for politically motivated interpretations of the Act. The CHA should also be amended to allow provinces the ability to explore alternate policy approaches, while maintaining the foundational principles of universality and inter-provincial portability.

Second is the recognition that the CHA is a financial act. In the absence of a pool of cash connected to the strings of the CHA, provinces would de facto have much greater flexibility to pursue those policies they consider to be in the best interest of their residents. Thus, the Canada Health Transfer (CHT) should be either held constant in nominal terms, reduced, or eliminated entirely with federal taxes being concordantly reduced.

Reforming the CHA and reducing the provinces’ reliance on federal transfers would bring greater account­ability to the health-care system and free the provinces to innovate and experiment with policies commonly found in other countries with more successful universal health-care systems. The likely result would be more timely access to quality care regardless of a patients’ ability to pay.