Canada Health Act

This essay has a total of 4270 words and 23 pages.

Canada Health Act

The Undermining of the Canada Health Act
Samantha Descoteaux
University of Alberta
Nurs 395


In the past, Canada's government-funded, universally accessible, health care system has
been praised and admired both at home and abroad as one of the finest in the world. A
great source of pride and comfort for many Canadians is that it is based on five
fundamental principles. Principles that are a reflection of the values held by Canadian
citizens since the formation of Medicare in 1966. These principles were reinforced in the
Canada Health Act, (CHA), of 1984 and state that the Canadian system is universal,
accessible, portable, comprehensive and non-profit.

With increasing concerns of debts and deficits, Canada's publicly funded health care
system has recently become the target of fiscal attack. Efforts to reform and restructure
the system have produced few results. Currently, some governments throughout the country
are looking towards a more radical approach. An approach that would see not only the
reform and restructuring of the method of operation of the current system, but that would
change the system entirely. The proposed idea? In Alberta, it is to increase the role of
the private sector in the current system.

On December 29th, 1999, Nancy MacBeth leader of the Alberta liberal party was cited in the
Edmonton Journal as saying: " There's ‘ample evidence' that the Alberta government's
plan to expand the role of private health-care will contravene the Canada Health Act."
This is the strongest argument against privatization. It reflects the fears of many
Albertans and Canadians; the fear that a two-tier system similar to that of the United
States will develop. The fear that the system which was built upon values reflected in
five principles will be eroded and replaced and that they will be the ones left to suffer
the consequences. Privatization of health care would undermine the principles of the
Canada Health Act and as such would undermine the integrity of the health care system.

The evolution of Health Care
In 1966 one of Canada's most prided achievements to date was introduced to the Canadian
Health Care system. Medicare was a daring and innovative concept pioneered by Canadians
for Canadians. It revolutionized health care. Canadians overwhelmingly supported the new
system as it reflected their values and the import they placed on universality and equal
access to health.

Now, in the dawn of the millennium, the ideals of the same system are in jeopardy.
Albertans are at present feeling the effects of restructuring. Accessibility and quality
are being threatened due to cutbacks coupled with a lack of funding. There is a consensus
now between medical professionals, the public, and the government that the health care
system is deteriorating. It is failing to provide the quality of care promised in the CHA
and prided by so many Canadians.

Yet the strings on the public purse continue to tighten. Transfer payments from the
federal government continue to decrease as provincial debt loads increase. And, although
the minister of health and the premier assured them that the costs of health care were
doubling or even tripling, Albertans have witnessed a steady decline in government
spending on health care. The proportion of gross domestic product, (GDP), which Alberta
allocates to health care is ranked last among the ten provinces, (Taft, 1997). Albertans
now find themselves with a struggling health care system and a waiting list.

The proposed solution from current Alberta government would see the health care system
incorporate the private sector. The government Most of all the government is looking to
decrease cost, increase accessibility and efficiency. *****

Universality and Accessibility vs. Choice
Universality and accessibility go hand in hand. They are the principles that assure that
each Canadian regardless of financial situation, will have equal opportunity to access the
same level of care. The lack of a private market in the current system, some will argue,
limits the individual's freedom of choice. Supporters of privatization maintain that these
principles conflict with Canadians' right to choose; the patient's autonomy to choose to
pay privately, and the physician's choice to provide preferential treatments to those
payers ( Dirnfeld, 1996; Gordon, Mintz & Chen, 1998). Increasing choice in this manner
would lead only to such detrimental practices as "cream skimming", (Dirnfeld, 1996).
Insurance companies would want only to provide coverage for those who meet certain
"low-risk" physical criteria; physicians could care for those who could pay or for those
who diagnosis proved to be the most profitable. This would be leading Canadians to take
giant leaps backward in health care; moving towards the medical model of old that focused
on disease and cure rather than health promotion and disease prevention.

With privatization comes private insurance, which can then delegate the what, whom, where
and when health care services are accessed, in turn greatly limiting the individual's
choice (Armstrong & Fegan, 1998). Utilization of a private for-profit system will be
restricted to those who have adequate insurance coverage or the ability to pay out of
pocket. Accessing services could also become dependent on hours of operation and rights to
different facilities as dictated by private business owners and restrictions imposed by
insurance plans.

Accessibility will also be affected when for-profit hospitals determine where to be
established. Many Albertans live in rural areas too sparsely populated to encourage
free-market competition. As more populated areas are bombarded with a barrage of health
care competitors vying for their money, rural communities will be abandoned. Businesses
and employees will be lured away by the prospect of fatter pocket books as profit is
exchanged for people.

Decreasing Cost vs. Non-profit
One of the driving forces behind privatization is that it will cut and control increasing
health care costs. There is a belief that a private for-profit market will create
competition between health care providers. This would then reduce cost to the consumer as
the different companies compete to obtain business. There have been however, many
instances that have shown the effects of privatization to be just the opposite. For
example, in order to remain competitive, money will have to be invested in advertising and
marketing, a cost that is not present in the system as it stands, (Wilson, 1995).

Health care is not a place for the free-market competition. As a consumer one is driven to
shop around for the best product for the best price. It is simply not feasible for an
individual to wait for a medical service to go on sale or to exchange the same if not 100%
satisfied. Nor is it consistent with the principles of the CHA that explicitly state that
the provision of medically necessary services shall not be for profit and shall be
publicly funded, (Armstrong & Armstrong, 1996). It explicitly contradicts a value on which
Canadians founded their beliefs of what constitutes Health Care in Canada.

Simply the operation of a private system will likely lead to increased costs. Less
bureaucracy in a public system eliminates the extra expenses often attributed to the
higher overhead and increased operating rates, (Armstrong & Fegan, 1998). These costs are
incurred from the paperwork and administration necessary to regulate a private system. In
Canada's single-payer system it is not necessary to make an itemized list of the equipment
used per individual patient in order to draw up a bill for services. In a single-payer
system it is also not necessary to keep records of each individual's insurance plan and
their payment and treatment options. In fact, in the past, when Canada has moved to
de-insure medical services, (i.e.: eye exams, prescriptions), it has actually indicated
increased cost for the consumer, (Armstrong & Armstrong, 1996).

In all, increasing privatization will likely do little to reduce operating costs of the
health care system; rather it will simply shift the burden of cost. With increasing
privatization, the responsibility for payment will no longer fall on the public purse but
will instead become the responsibility of the individual, (Armstrong & Armstrong, 1996).

Efficiency and Quality
The increasing competitiveness that comes along with for-profit markets, many believe,
will reduce waste and increase efficiency. Because the private market is more concerned
with controlling costs in order to increase profit many believe that there would be more
efficient waste management and less abuse or misuse of health care resources. However,
there is little solid evidence that the current system is abused or subject to overuse,
(Armstrong & Fegan, 1998; Wilson, 1995). In fact, if the private sector allows money to
govern health care administration the possibility exists that business will diagnose and
treat simply for the sake of profit.

Both those who support and those who oppose private health care recognize that the quality
of care is suffering. Supporters of privatization believe that it is the "tyranny of a
single-payer, which has led to rationing through the use of queues, to decreasing
accessibility and to diminishing quality", (Dirnfeld, 1996, p.409). They believe that a
private option in health care would decrease waiting lists for public facilities. This, in
turn, would improve access for those using the public system. Evidence shows that an
introduction of the private sector would not reduce waiting lists, rather it would alter
the way waiting list are structured and prioritized. Instead of greatest necessity being
moved to the top of the list, those who could pay would jump the list and receive the care
they required.

Implications for nursing practice
Nursing is a profession based on ethical principles. One of these principles states that
nurses must be accountable for their actions and the care they provide. If there is an
influx of the private for- profit sector into the health care system accountability is
threatened as hospitals decrease standards in order to increase profit. Nurses are also
ethically responsible for assuring that clients are provided with safe, competent, quality
care (CAN, 1997). As previously stated, a decrease in quality is inevitable as money
becomes the driving force behind health care provision. The ethics of fairness and
equitable distribution dictate that health care should be based on need rather than
ability to pay. This belief is reinforced by the AARN who, in their position statement on
privatization, affirms its loyalty to the maintenance of the principles of the CHA

Nursing also prides itself as a profession that takes a holistic approach to providing
care for the individual. As the medical model and profit align to affirm their position of
authority in health care it is the client who would suffer. There would be an urge to
focus on a quota of parts to be fixed in a specified time frame rather than to focus on
the individual and their specific needs.(Armstrong & Armstrong, 1996). Neglecting the
principles of the CHA in order to incorporate privatization will have detrimental effects
on the integrity of nursing practice.

All of this is by no means meant to indicate that the current Canadian Health Care system
is ideal. Nor does it stand to say that radical restructuring is not necessary in the
evolution of Canada's Health Care system. Rather that the restructuring necessary for the
system to thrive needs to be undertaken as a holistic approach, not simply focused on
cutting costs for the public sector. Cutbacks and downsizing are not the means by which to
rejuvenate an ailing health care system. Nor is the introduction of investor-owned
hospitals that strive to maximize profits, not to decrease costs. Reform and restructuring
need to start at the bottom; fundamental changes need to be made in the way we view health
and health care. The focus needs to continue to move away from the medical model of the
past to one that promotes health and prevents illness, accommodating the needs of a
changing population, while maintaining the fundamental principles of the Canada Health

Alberta Association of Registered Nurses. (1995). Position Statement on Privatization. Edmonton: Author.
Armstrong, P., & Armstrong, H. (1996). Wasting Away: The Undermining of Canadian Health
Care. Toronto: Oxford University Press.

Armstrong & Fegan. (1998). Universal Health Care. New York: New York Press.
Canadian Nurses Association. (1997). Code of ethics for registered nurses. Ottawa: Author.
Dirnfeld, V. (1996). The benefits of privatization. Canadian Medical Association,155 (4), 407-410.
Gordon, M., Mintz, J., & Chen, D. (1998). Funding Canada's health care system: A tax based
alternative to privatization. Canadian Medical Association, 159 (5), 493-496.

National Advisory Council on Aging. (1997). The NACA position on the privatization of health care. Ottawa: Author.
Taft, K. (1997). Shredding the Public Interest: Ralph Klein and 25 Years of One-Party
Government. Edmonton: The University of Alberta Press and Parkland Institute.

Wilson, D. (1995). Myths and facts about paying privately for health care. AARN,51(10), 9-10.
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