Medical Care Act

Medical Care Act
Short title	Medical Care Act
Legislature	Parliament of Canada
Long title	An Act to authorize the payment of contributions by Canada toward the cost of insured medical services
Citation	S.C. 1966-67, c. 64
Enacted by	27th Canadian Parliament
Royal assent	December 21, 1966
Commenced	July 1, 1968
Status	Amended

Medical Care Act. The Medical Care Act was a landmark piece of federal legislation in Canada that established a nationwide, universal public insurance program for physician services. Enacted by the Parliament of Canada under Prime Minister Lester B. Pearson, it built upon the foundational Hospital Insurance and Diagnostic Services Act to create a comprehensive medicare system. The act came into force on July 1, 1968, following negotiations with the provinces, and fundamentally reshaped the delivery and financing of healthcare across the country.

Overview

The act created a cost-sharing framework whereby the federal government would provide approximately fifty percent of the funding to provincial and territorial plans that met four key criteria: public administration, comprehensiveness, universality, and portability. This model was heavily influenced by the recommendations of the Royal Commission on Health Services, commonly known as the Hall Commission, which reported in 1964. The legislation marked the culmination of decades of advocacy by social reform movements and political figures like Tommy Douglas, the Premier of Saskatchewan who had introduced the first provincial public insurance plan for doctors' services. The program's implementation was overseen by the federal Department of National Health and Welfare.

Historical background

The push for national health insurance gained significant momentum after World War II, paralleling developments in the United Kingdom under the National Health Service. In Canada, the 1945 Green Book proposals under Prime Minister William Lyon Mackenzie King included health insurance but faced provincial opposition. The breakthrough came with the 1957 Hospital Insurance and Diagnostic Services Act, which provided federal support for hospital care. The success of Saskatchewan's pioneering medical care plan in 1962, despite the bitter Saskatchewan Doctors' Strike, demonstrated the viability of a public model. The subsequent Hall Commission, chaired by Justice Emmett Hall, formally endorsed a national program, creating the political imperative for the Liberal government of Lester B. Pearson to act.

Key provisions

The act's central mechanism was a federal contribution to each province, calculated as half of the per capita cost of insured medical services, provided the provincial plan adhered to the four principles. Public administration required the plan be run by a public authority accountable to the provincial government. Comprehensiveness mandated coverage for all medically necessary services provided by physicians. Universality guaranteed coverage to all eligible residents of the province. Portability ensured coverage was maintained when residents moved or traveled temporarily within Canada or abroad. The act specifically covered services rendered by medical practitioners, defined under provincial law, and excluded areas like cosmetic surgery and services covered under other legislation like the Workers' Compensation Board.

Implementation and impact

Implementation proceeded province by province after the 1968 start date, with all provinces and territories participating by 1972. The act led to a dramatic increase in the utilization of physician services and helped reduce financial barriers to care for millions of Canadians. It also significantly increased federal spending on health and altered the fiscal relationship between Ottawa and the provinces. The system faced immediate pressures from rising costs and physician fees, leading to ongoing negotiations between the federal government, provinces, and organizations like the Canadian Medical Association. The act solidified the federal role in healthcare and established the template for the broader Canada Health Act of 1984.

Amendments and related legislation

The original cost-sharing formula was amended by the 1977 Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, which replaced it with block funding and tax point transfers, giving provinces more flexibility. The principles of the Medical Care Act were entrenched and expanded in the 1984 Canada Health Act, which added the criterion of accessibility and introduced financial penalties for provinces allowing extra-billing or user fees. Other related federal health legislation includes the Canada Health Transfer and the Public Health Agency of Canada Act. The act also influenced subsequent social policy debates, including those surrounding pharmacare and long-term care.

Criticisms and controversies

Critics, including some provincial governments and segments of the medical profession, argued the act infringed on provincial jurisdiction under the Constitution Act, 1867 and created an unsustainable fiscal burden. Concerns about long wait times, rationing of services, and a lack of innovation were raised by organizations like the Fraser Institute. The shift to block funding in 1977 was itself controversial, seen by some as a federal withdrawal from the original funding commitment. Debates over privatization, exemplified by the 2005 Chaoulli v Quebec (AG) decision from the Supreme Court of Canada, and intergovernmental disputes over the Canada Health Transfer continue to shape the legacy of the system the act created.

Category:1966 in Canadian law Category:Healthcare in Canada Category:Canadian federal legislation