Making Medicare:  The History of Health Care in Canada, 1914-2007 Timeline Timeline History Key Players Geography Costs and Benefits History: 1914 - 1929 History: 1914 - 1929 Key Players: 1914 - 1929 Geography: 1914 - 1929 Costs and Benefits: 1914 - 1929 History: 1930 - 1939 History: 1930 - 1939 Key Players: 1930 - 1939 Geography: 1930 - 1939 Costs and Benefits: 1930 - 1939 History: 1939 - 1948 History: 1939 - 1948 Key Players: 1939 - 1948 Geography: 1939 - 1948 Costs and Benefits: 1939 - 1948 History: 1948 - 1958 History: 1948 - 1958 Key Players: 1948 - 1958 Geography: 1948 - 1958 Costs and Benefits: 1948 - 1958 History: 1958 - 1968 History: 1958 - 1968 Key Players: 1958 - 1968 Geography: 1958 - 1968 Costs and Benefits: 1958 - 1968 History: 1968 - 1978 History: 1968 - 1978 Key Players: 1968 - 1978 Geography: 1968 - 1978 Costs and Benefits: 1968 - 1978 History: 1978 - 1988 History: 1978 - 1988 Key Players: 1978 - 1988 Geography: 1978 - 1988 Costs and Benefits: 1978 - 1988 History: 1989 - 2007 History: 1989 - 2007 Key Players: 1989 - 2007 Geography: 1989 - 2007 Costs and Benefits: 1989 - 2007
 

Glossary

Accountability
All the provincial and federal health commissions and task forces undertaken during the 1990s recommended greater accountability for health care spending through the establishment of benchmarks that would measure improvements in the quality of care, ease of access to services and health outcomes of various procedures. Saskatchewan created a provincial Quality Council in 2002 and in 2003–2004, the federal government, eight provinces and three territories created the Health Council of Canada to provide annual reports on health spending and new practices.

Advisory Committee on Health Insurance
The Advisory Committee on Health Insurance, also known as the Heagerty Committee, was formed in 1942 to conduct an official inquiry into health services in Canada. Chaired by Dr. John J. Heagerty, it included senior government civil servants and statisticians who compiled and analyzed health care data. The committee concluded that any federal health insurance proposal had to include a comprehensive preventive public health program, universality, compulsory contributions and national standards, but that such a plan was currently unconstitutional and amending the constitution was impractical. Most of the committee’s recommendations were later implemented as part of medicare.

Alberta Blue Cross
Alberta Blue Cross was a prepaid medical care plan that provided 118,000 Albertans with hospital insurance prior to July 1, 1958, when the province joined the national plan.

Atlantic Charter
The Atlantic Charter was a declaration of eight common principles in international relations, drawn up by British Prime Minister Winston Churchill and U.S. President Franklin D. Roosevelt, on behalf of the British Empire and the United States, at their meeting aboard a warship in the Atlantic in August 1941. Among its stated aims was ridding the world of problems such as hunger, disease and war. Post–Second World War organizations, such as the United Nations and the North Atlantic Treaty Organization (NATO), incorporated these principles and others into their charters.

Avian Influenza
In 2005, American and British researchers sequenced the DNA of the 1918–1919 flu virus and discovered that it was an H1N1, or partially avian, virus. Frequent outbreaks of avian flu (H5N1) in domestic poultry in Southeast Asia and its appearance in migratory birds in Russia and Western Europe have aroused concern that the virus will mutate and infect humans, leading to a future pandemic. Current cases of avian flu have a 33 to 50 per cent mortality rate; the great flu pandemic of 1918–19 had a 2 to 5 per cent mortality rate.

Baby Boom
The baby boom was a short-term but significant increase in the birthrate that occurred after the Second World War. People born between 1946 and 1965 are generally considered “baby boomers.”

Binding Arbitration
During a labour dispute in which the two parties involved are unable to reach agreement, they may choose to submit to the decisions of an independent arbitrator to resolve the dispute. Under binding arbitration, both parties are legally required to abide by the terms of the new contract drawn up by the arbitrator.

Block Funding
Block funding is a federal financing policy used to pay for health services by giving a province a fixed sum of money based on its population and delivering it through tax-point transfers as well as cash. Block funding allowed the federal government to control the rising cost of medicare while maintaining national standards.

Canadian Army Medical Corps
The Canadian Army Medical Corps (later, the Royal Canadian Army Medical Corps) was founded on July 2, 1904 to provide the Canadian army with a permanent staff of physicians and surgeons who would deliver medical care to the military. In 1974, it was amalgamated with the equivalent medical service bodies of the other branches of the armed forces to form the Medical Service Branch of the Canadian Forces.

Canadian Charter of Rights and Freedoms
The Canadian Charter of Rights and Freedoms came into force on April 17, 1982 as part of Canada’s newly patriated constitution. Currently all federal and provincial legislation must be compatible with the Charter to be legal, unless the notwithstanding clause (section 33) is invoked to exempt legislation from the Charter’s provisions.

Canadian Doctors for Medicare
Formed in 2005, Canadian Doctors for Medicare is a volunteer group that provides a national perspective on current health system issues. With branches throughout the country, its members publicly criticize provincial efforts to privatize health services, remind citizens of the flaws in the American and European systems and inform them of ongoing improvements and innovations in medicare services.

Canadian Medical Association
The Canadian Medical Association (CMA) was founded in Québec City in October 1867. It was created by 164 physicians who saw the need for a national medical organization in their new country. Currently, the CMA lobbies various levels of government on behalf of over 65,000 members and their patients to maintain high-quality health care.

Canadian Nurses Association
In 1908, delegates from 16 organized nursing bodies met in Ottawa and formed the Canadian National Association of Trained Nurses (CNATN). In 1924, the organization changed its name to the Canadian Nurses Association (CNA). Currently, the CNA is a federation of 11 provincial and territorial registered nurses associations and colleges, which assists the professional development of its members and lobbies on their behalf and on behalf of their patients for high-quality health care.

Canadian Social Hygiene Council
The Canadian National Council for Combating Venereal Disease was created in 1919 to provide public education on sexually transmitted diseases. It was renamed the Canadian Social Hygiene Council in 1922, and branches were established throughout Canada as the non-governmental organization began to expand its interests to include contemporary health concerns such as health insurance. In 1935, the Canadian Social Hygiene Council became the Health League of Canada.

Capitation
Capitation is a fee paid for a service performed for each person. In Canada, it often referred to an agreement whereby a doctor under contract received a fixed fee per person for treating a certain number of people, often employees of a company.

Catastrophic Drug Plan
New or experimental drugs needed to treat specific problems are often not covered under provincial drug formularies or plans, with the result that patients, their families and their extended health insurance plans pay large sums for them. Since this can result in financial hardship, the Romanow Report on health recommended a federal and provincially funded catastrophic drug plan to pay for these expensive, life-saving drugs.

C.D. Howe Institute
The C.D. Howe Institute, founded in 1958, is a national, non-partisan, non-profit organization that conducts research on social and economic policy to improve the standard of living of Canadians. It is named after Clarence Decatur Howe, a long-serving Liberal Member of Parliament and Cabinet minister, who led Canada’s war effort as Minister of Munitions and Supply, and its post-war redevelopment as Minister of Reconstruction and, later, Trade and Commerce.

Check-off
A “check-off” was an automatic deduction that employers made from wages (especially those of Nova Scotia coal miners and other resource workers) in order to provide for health care and other services.

The Cold War
The “Cold War” describes the hostile relations between an American-led bloc that included Great Britain, Canada and its allies, and a SovietUnion-dominated bloc and its allies. The Cold War began in 1947 with the revelation that the Soviet Union had been spying on the United States, Great Britain, Canada and other Second World War allies, and ended with the loss of Soviet influence in Eastern Europe, which was symbolized by the fall of the Berlin Wall in 1989.

Conditional Grants
During the 1930s, conditional grants were suggested as a way for the federal government to ensure a national level of health care without violating the provinces’ constitutional control over health care as defined by the British North America Act.

Contributory Plan
A contributory plan is an insurance plan where an individual contributes a specific amount to a common fund in return for a set number of services and benefits. For example, an individual who purchases a health insurance policy has a contributory plan.

Cooperative Federalism
Prime Minister Lester Pearson used the approach of cooperative federalism — a concept of federalism in which federal and provincial governments interact cooperatively to solve common problems — to negotiate agreements with provincial governments on shared-cost programs. Allowing Quebec to opt out of the Canada Pension Plan and still receive federal funding for its equivalent Quebec Pension Plan is an example of cooperative federalism.

Cost Overruns
Cost overruns occur when the costs of producing goods or delivering services exceed the costs allocated by the budget to produce those goods or deliver those services. Cost overruns in health care generally occur when the costs of new technologies or drug treatments are added to existing costs for salaries, wages, administration, and ancillary services.

Curative Services
Curative services are services intended to cure disease and heal injuries. For example, dressing a wound repeatedly until it is fully healed would be a curative service.

Deficit
A deficit is the amount by which government budgetary spending exceeds revenues in any given year.

Dental Care
Both the Heagerty and Hall reports identified dental care as a key component of overall health care services. But both also recognized that a shortage of dentists meant that the fluoridation of municipal water supplies and increasing use of dental hygienists offered partial solutions to the problem. Although dental schools increased the number of graduates, the rising costs of hospitalization and medical services made provinces wary of expanding their medicare programs to include dental care. As a result, Canadians generally either pay their own dental bills or receive pro-rated reimbursement through employee benefit packages.

Department of National Health and Welfare
The Department of National Health and Welfare, a federal department created by legislation in June 1944, was responsible for administering federal programs such as family allowances, as well as for providing expert policy advice on health issues.

Department of Veterans Affairs
The Department of Veterans Affairs was established in 1944 to administer the pensions and benefits owed to veterans by the federal government, as well as rehabilitation and re-establishment programs for returning service men and women.

Determinants of Health
The determinants of health are education, employment, housing, good nutrition, a healthy environment, equitable access to health care services, family and community links, and the absence of poverty, social isolation, family violence and environmental pollution. In the 1980s, the determinants of health were identified as key factors in enabling individuals and families to become and remain healthy.

Direct Relief
During the Great Depression, direct relief meant payments made by local government agencies directly to destitute individuals and families to provide them with a bare minimum of food, clothing and shelter.

Electronic Health Records
Electronic health records are a patient’s medical records that are stored and retrieved electronically through an information network, rather than being written down, filed and physically retrieved.

Eleemosynary Institutions
Eleemosynary institutions are charitable organizations established to dispense free assistance to the poor and needy. For example, an Hotel-Dieu would be an example of an eleemosynary institution.

Equalization Payments
Equalization payments are unconditional payments made by the federal government that allow all provinces, regardless of their ability to raise revenue, to provide roughly comparable levels of services at roughly comparable levels of taxation. Eligibility to receive equalization funding is determined by a formula, first introduced in 1957, that measures each province’s revenue-raising capacity against a given standard.

Extended Care
Extended care facilities, such as convalescent and nursing homes, provide long-term in-patient care for convalescent or elderly patients. The need to move such patients from acute care hospitals to more appropriate facilities was recognized in the 1960s. Indeed, the 1977 changes to federal funding were intended to provide provinces with funds to expand their extended care facilities and thus limit rising hospital costs. This issue has continued to be a policy challenge.

Extra-Billing
The terms “extra-billing,” “balance billing” or “direct charges” describe the additional service charges made by doctors who expected to be paid according to provincial medical association fee schedules, rather than the rates of provincial health care plans.

Fee-for-Service Payment
The system of fee-for-service payment was preferred by the medical profession because it allowed doctors to bill patients or their insurers based on services performed, rather than accept patients under capitation and risk losing money because their treatments were more expensive than the capitation fee for looking after them. Doctors throughout Canada also argued that fee-for-service payment from either government or private medical insurance plans was a fundamental aspect of professional practice.

Fiscal Federalism
Fiscal federalism is a system of transfer payments or grants through which the federal government shares its revenues with lower levels of government. Medicare is an example of fiscal federalism because the provinces and territories receive federal funding to provide a national standard of healthcare.

The Fraser Institute
The Fraser Institute is an independent, non-partisan, research institute that was founded in 1974 by economist Michael Walker and businessman T. Patrick Boyle, and named after the Fraser River in British Columbia. It conducts research into the role of government and the market and advocates for government policies based on free-market economics.

Gallup Polls
George Gallup, an American public opinion researcher and statistician, introduced the Gallup poll around 1935. A Gallup poll is a method of assessing public opinion by questioning a representative sample of the population. In 1942, for example, the Canadian government paid for a Gallup poll, which revealed that 75 per cent of Canadians supported health insurance. The federal government repeatedly used Gallup polls to gauge public support for its policies, including medicare.

Group Medical Services, Regina
Group Medical Services, Regina was established under Saskatchewan’s Benevolent Societies Act in 1939 to provide a prepaid health insurance plan to persons who did not own property or to municipalities where the 60 per cent enrolment needed for a municipal plan was not met. It expanded from 17,186 members in 1951 to 78,787 in 1961.

Health Promotion
Health promotion is a process that involves individuals taking control of their own health and governments dealing with economic, political and environmental threats to national and international well-being.

Health Surveys
Health surveys were proposed by Dr. John J. Heagerty in 1945 and were carried out in the 1940s and early 1950s at the provincial level, often with grants from and assistance by the federal Department of National Health and Welfare, to determine the number of health care personnel and facilities and the service demand in Canada. The surveys aimed to help provinces plan medical and hospital insurance programs that would meet their needs. In general, the surveys concluded that enrolment in prepaid plans should be encouraged, with governments paying the premiums of those who could not afford them rather than supporting universal publicly administered coverage.

Home Care
Home care refers to health care services provided in citizens’ homes and was recommended to the Hall Commission in many briefs and presentations as a way to alleviate the strain on Canada’s limited hospital facilities and medical personnel. The provision of home care has continued to be a significant issue for Canadians and their governments.

Hotels-Dieu
An Hotel-Dieu is a type of hospital founded and run by a nursing order of nuns. For example, the Hôtel-Dieu de Québec opened in Québec City in 1639 and was run by the Augustines de la Miséricorde de Jésus, a nursing order of French nuns.

Inflation
“Inflation” is a term used in economics to describe any rise in price level. For example, if a basket of goods that costs $40 in 1990 has increased to $42 by 1991, we say that the inflation rate is 5 per cent. Federal government spending for programs like medicare suffers from inflation because the government does not determine the price level of wages, salaries and technological innovations.

Just Society
A “just society” was a slogan Pierre Trudeau used in the 1968 federal election campaign to describe his vision for Canadian society. He argued that a just society protects personal and political freedoms, as well as the rights of minorities, provides equal opportunities to all its citizens and redresses regional imbalances in wealth.

Korean War
The Korean War began in 1950 when Communist North Korean troops crossed the 38th parallel and invaded South Korea. The war was waged between Chinese- and Soviet- advised Communist North Korean troops, and a United Nations force that included American, British, Canadian and South Korean soldiers. The war lasted until a ceasefire in 1953, and claimed 2.5 million lives.

La révolution tranquille
La révolution tranquille (the Quiet Revolution) refers to a period of social, economic, political and cultural change in Quebec that began with the election of Jean Lesage and the Liberals in 1960. During the Quiet Revolution, Quebec adopted new social values: for example, it advanced secularization by creating a Ministry of Education (thereby removing control of education from the Catholic Church) and shifting control of health and social services to lay experts. It increased its economic autonomy by creating Hydro-Québec and supporting Quebec businesses. Politically, it witnessed the rise of separatism.

League for Social Reconstruction
The League for Social Reconstruction was founded in Montréal and Toronto in 1931–1932 by left-wing intellectuals who supported socialist solutions to the problems of the Great Depression. The League was instrumental in creating the Co-operative Commonwealth Federation’s Regina Manifesto, which argued in section 8 that:
“With the advance of medical science the maintenance of a healthy population has become a function for which every civilized community should undertake responsibility. Health services should be made at least as freely available as are educational services today. But under a system which is still mainly one of private enterprise the costs of proper medical care, such as the wealthier members of society can easily afford, are at present prohibitive for great masses of the people. A properly organized system of public health services including medical and dental care, which would stress the prevention rather than the cure of illness should be extended to all our people in both rural and urban areas. This is an enterprise in which Dominion, Provincial and Municipal authorities, as well as the medical and dental professions can cooperate.”  http://www.saskndp.com/assets/file/history/manifest.pdf

Maritime Blue Shield
Maritime Blue Shield was introduced in 1948 as a prepaid medical plan that provided coverage for medical care, surgical care and hospitalization to individuals, families, employee groups and unions.

Medical Services Association of British Columbia
Created in 1940, the Medical Services Association of British Columbia was a prepaid medical insurance plan that provided subscribers in British Columbia with medical care. The plan covered 190,415 subscribers in 1951, expanding to 739,990 by 1967.

Medical Services Inc., Alberta
Medical Services Inc., Alberta, incorporated by provincial legislation in 1948 as Medical Services (Alberta) Inc., was a prepaid health insurance plan that provided medical services insurance to its subscribers. The plan grew from 31,833 subscribers in 1951 to 645,805 by 1967.

Medical Services Inc. (Saskatoon)
Started in 1946, Medical Services Inc. (Saskatoon) was a doctor-sponsored prepaid medical care plan that covered groups and individuals. It grew from 48,893 subscribers in 1951 to 217,795 by 1961.

Medical Services Insurance
This term described comprehensive public health insurance plans like Saskatchewan’s and contractually limited private doctor- or insurance company-sponsored plans that insured Canadians against the cost of medical services.

Medical Workshops
“Medical workshop” was a term used to describe a hospital where highly trained professionals carried out scientific diagnosis and treatment of all health issues, such as childbirth and surgery, in sterile and sanitary surroundings.

National Council of Women of Canada
The National Council of Women of Canada (NCWC) was founded on October 27, 1893 at a public meeting in Toronto chaired by Lady Aberdeen, wife of the Governor General of Canada, and attended by 1,500 women. Its purpose was to improve the lives of women and children through education and advocacy.

National Drug Formulary
Both the Romanow and Kirby reports on health highlighted the need to control rising drug costs through the creation of a central, national drug formulary that would list the generic and prescription drugs Canadians need and ensure that appropriate prices were negotiated with producers.

National Health Insurance
As the term was understood in Canada in the 1920s and 1930s, “national health insurance” applied to the programs operating in Great Britain and Germany. In considering such a plan for Canada, neither supporters nor opponents could see how to overcome the restrictions imposed by the British North America Act unless the provinces created plans that received funding from the federal government.

National Standards
The term “national standards” refers to maintaining a similar level of services throughout a country as determined by a central governing body.

Non-Participating Physician
This is a physician operating completely outside provincial or territorial insurance plans. Neither the physician nor the patient is eligible for any cost coverage for services rendered or received from the provincial or territorial health insurance plans. Any non-participating physician may therefore establish his or her own fees, which are paid directly by the patient.

North Atlantic Treaty Organization
The North Atlantic Treaty Organization (NATO) is a military alliance that was established on April 4, 1949 by the United States, Great Britain, Canada and other Western European countries to counter the Soviet presence in Eastern Europe. Article II of the North Atlantic Treaty, included at the insistence of Canadians, called for economic and cultural cooperation among members of the alliance.

Nurse Practitioners
Nurse practitioners have a greater scope of practise than registered nurses. They can assess, diagnose and prescribe; perform minor surgery and therapeutic interventions; make and modify patient treatment plans; and monitor treatment as part of a health care team.

Ontario “Days of Protest”
Between 1995 and 1998, the Ontario Federation of Labour united unions and other social organizations to resist the policies and spending cuts of Mike Harris’s Progressive Conservative government by staging a series of rolling general strikes, rallies and protests across the province. The action by labour groups and community organizations sent a clear message to the Harris government about the unpopularity of its policies.

Ontario Health Services Restructuring Commission
Appointed in 1996, the Health Services Restructuring Commission was asked to review acute care facilities, to recommend rationalization of services, including closing hospitals, and to evaluate new approaches such as electronic health and management information systems, public accountability through outcomes measurement, and increased spending on home care and long-term care.

Ontario Medical Services Insurance Plan
The government of John Robarts introduced the Ontario Medical Services Insurance Plan (OMSIP) on July 1, 1966 to fund “low income and high risk groups.” In 1966, the provincial plan covered 585,000 people, while private insurance provided coverage for 6,154,000, for total coverage of 95.2 per cent of the population — “without a universal government program” (Malcolm G. Taylor, Health Insurance and Canadian Public Policy: The Seven Decisions That Created the Canadian Health Insurance System and Their Outcomes, 2nd ed. [Montréal and Kingston: McGill–Queen’s University Press, 1987], pp. 340–41).

OPEC
OPEC is an acronym for the Organization of the Petroleum Exporting Countries. Formed in 1960, OPEC helped its members profit from their oil reserves by limiting the world supply and raising its price. In October 1973, a 70 per cent oil price increase triggered significant inflation in oil-dependent countries, forcing governments like Canada’s to adopt wage and price controls as an anti-inflationary measure.

Opted-out Physician
These are physicians who operate outside the provincial or territorial health insurance plans, and who bill their patients directly at provincial or territorial fee schedule rates. The provincial or territorial plans reimburse patients of opted-out physicians for charges up to, but not more than the amount paid by the plan under fee schedule agreement.

Outport
An outport is a small, isolated coastal community in Newfoundland and Labrador. Harbour Grace, Newfoundland is an example of an outport.

Pandemic Planning
After the 2003 SARS outbreak, all levels of government created pandemic planning groups, with the aim of preparing federal, provincial and regional plans to combat future disease outbreaks. These plans have been posted on agency Websites and are being refined constantly.

Patient Wait Times Guarantees
The Romanow and Kirby reports on health recommended that patients be given patient wait times guarantees with regard to the maximum length of time that they would have to wait for treatment by specialists, advanced diagnostic tests and surgery.

Pharmaceutical Benefits
The high cost of drugs for chronic diseases emerged as a policy issue in the 1960s and has continued to demand attention. Several provinces introduced provincial drug benefit plans in an effort to control rising costs, while others restricted provincial support to seniors and people on public assistance. Both the Romanow and Kirby reports in 2002 identified a national drug formulary and a national pharmacare plan as logical extensions of medicare.

Planned Economy
A planned economy is an economy in which industrial investment, production, development, etc., are determined by an overall national governmental plan.

Population Health
“In January 1997, the Federal, Provincial and Territorial Advisory Committee on Population Health (ACPH) defined population health as follows: Population health refers to the health of a population measured by health status indicators and as influenced by social, economic, and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services” (Bruce L. Smith, “Public Policy and Public Participation: Engaging Citizens and Community in the Development of Public Policy,” [Population and Public Health Branch, Atlantic Regional Office, Health Canada, September 2003], p. 83).

Portability
Although each province designed its own set of health services, Canadians travelling to other jurisdictions expected to receive health care when needed and to have their costs reimbursed by their provincial plans. Conflict arose, however, when provincial plans did not cover certain services or when payment rates differed.

Prepayment
Prepayment — paying for health care in advance through insurance premiums or tax-based programs — was recommended as a way to alleviate public concern about the increasing costs of hospital and medical services.

Preventive Services
Preventive services use existing knowledge about health and hygiene to ensure that certain health conditions do not occur. For example, vaccination against a disease such as smallpox would be a preventive service.

Prohibition
Prohibition is the prevention by law of the manufacture, sale and consumption of alcoholic beverages. Many Canadian provinces and municipalities adopted Prohibition as a way of limiting the social and economic costs of alcohol abuse in their communities during the First World War.

Public Administration
This key principle in the federal medicare proposal reflected the belief of politicians, bureaucrats and the public that health care plans should be publicly administered and not a source of profit for private companies and their shareholders. 

Recession 1981–1982
A recession is generally defined as a decline in a country’s gross domestic product (the value of goods and services produced within the country) for two or more consecutive quarters of a year. Some economists argue that the recession experienced by Canada in 1981–1982 was caused by the anti-inflationary policies of the federal government and the Bank of Canada, especially high interest rates that discouraged spending.

Recession 1989–1992
In 1989–1992 Canada experienced a recession, meaning its real gross domestic product fell for two or more consecutive quarters. Some economists attributed this recession to the anti-inflationary policies of the Bank of Canada, while others argued that it was triggered by the signing of the Free Trade Agreement between Canada and the United States in 1989.

Red Cross Outpost Hospitals
Red Cross outpost hospitals were located in remote communities and staffed by Red Cross nurses and doctors, who were paid by the organization to provide health services that ranged from delivering babies to performing emergency surgery to controlling or preventing epidemics.

Referendum 1995
In 1995, in response to the failure of the Meech Lake Accord, the Parti Québécois government offered Quebecers a choice between continuing their existing relationship with Canada or giving their provincial government a mandate to alter the relationship. They were asked the question: "Do you agree that Québec should become sovereign, after having made a formal offer to Canada for a new economic and political partnership, within the scope of the Bill respecting the future of Québec and of the agreement signed on 12 June 1995?" In response, 50.56 per cent of Quebecers voted “No,” affirming the province’s relationship with Canada.

Report on Social Security for Canada
The Report on Social Security for Canada, written by Leonard Marsh, reviewed Canada’s existing social programs and offered proposals to meet its future needs, including a recommendation for national health insurance. Unfortunately, Marsh’s proposals lacked the support they needed to be put into effect in the 1940s, but by the early 1970s many of them had been implemented, including national health insurance.

Revenue Guarantee
In 1972 the federal government introduced a major reform of the personal and corporate income tax systems that affected provincial tax collections. The 1972-77 fiscal arrangements guaranteed that for five years the provinces would not suffer a loss of income tax revenue as a result of adopting income tax acts modeled on the 1972 federal act, provided that their rates were equivalent to those levied under the old act.

Rockefeller Foundation
The Rockefeller Foundation was established by John D. Rockefeller Sr. in 1913 to “promote the well-being of mankind throughout the world.” The Rockefeller foundation’s charitable grants supported research into the costs of curative and preventive services, funded the creation of health units in Quebec and Western Canada, provided scholarships for foreign doctors and nurses to study at the University of Toronto’s School of Hygiene, and aided biomedical research at McGill University and the University of Alberta.

Salaried Service
Salaried service was the opposite of fee-for-service payment: doctors were paid a salary rather than a fee for each service they provided. In Saskatchewan, the community clinics that opened in 1962 provided a model for salaried service that illustrated the benefits, for both doctors and patients, of combining preventive and curative services.

Sanatoria
A sanatorium is an institution for the treatment and care of people suffering from tuberculosis. Canada’s first tuberculosis hospital was the Muskoka Cottage Sanatorium, which opened in Gravenhurst, Ontario in 1897.

Shared-Cost Program
A shared-cost program is one in which the federal government provides funding for eligible costs to enable provinces and territories to deliver services that are their constitutional responsibility.  For example, medicare is a shared-cost program because the federal government shares part of the cost of each province’s health services. 

Socialism
Socialism is a concept of social organization where the community as a whole owns, administers and controls the means of production, capital, land and property, in the interests of all. For example, according to socialist theory, all electrical utility companies should be publicly owned and administered according to the needs of the people, rather than being privately owned and managed to make the highest profits for company owners.

Socialized Medicine
Socialized medicine is a system of medical care that is financed and administered by the state.

Social Union Framework Agreement 1999
The Social Union framework is a federal government policy option that attempts to renew Canada’s social programs by allowing provinces to opt out of national programs while receiving federal funding for programs with similar goals.

Social Welfare Policies
Social welfare policies are government policies designed to enhance the well-being of society as a whole by providing such services as health insurance to address social problems.

Special Committee on Social Security
The Special Committee on Social Security was announced in the Throne Speech on January 28, 1943 as a government-appointed, all-party committee charged with studying existing federal and provincial social insurance legislation, as well as the social insurance programs in other countries. Its goals were to determine the policies, constitutional arrangements and financial requirements necessary to create a Canadian social security system.

State Medicine
State medicine is a system of health care where the state provides medical services to all of its citizens.

Sustainability
Critics have claimed that Canada’s health care costs are not sustainable while supporters have argued that spending on health care has not crowded out personal or provincial spending on other goods and services. Between 1975 and 2005, Canada’s health care spending increased from 7 to 9.8 per cent of its gross domestic product, compared to the United States, where it increased from 7 to 15.3 per cent. While costs for doctors and hospitals have remained stable, payments for prescription drugs have tripled since the 1970s. And with tax decreases in many provinces, the amount spent on health care will appear to increase, as spending in other areas declines. As surveys demonstrate that Canadians are willing to pay higher taxes for excellent health care, the challenge is how to reform the current public health care system to improve performance while ensuring value for money within current budgets.

Tax-Point Transfers
Tax-point transfers occur when the federal government reduces its tax room and makes it available to the provincial governments. The federal government used tax-point transfers as part of its financing agreements for medicare because it controlled the program’s cost by limiting expenditure according to revenue collected.

Third-Party Payment
Third-party payment refers to the practice of an insurance company paying a health care provider directly for services rendered to an insured subscriber, rather than paying the insured person for the losses incurred. For example, a doctor who received payment directly from an insurance company for services rendered to a patient enrolled with that insurance company has received a third-party payment.

“Third Way”
The “third way” was an Alberta government policy option that would allow private insurers and doctors to provide medical care, giving patients and doctors an alternative to the public system. The option generated protests, as groups like the Alberta Friends of Medicare argued that, instead of improving service or efficiency, the “third way” would undermine the public system.

Trades and Labour Congress
The Trades and Labour Congress was founded in Toronto in 1883 and merged with the Canadian Congress of Labour in 1956 to form the Canadian Labour Congress. It lobbied on behalf of its member unions for better working conditions and improved social services, such as free public health care.

Underfunding
Federal and provincial medical associations and provincial governments used this term to arouse public concern about a decline in the quality of and access to hospital and medical services.

Universal Access
Universal access refers to all medical services covered under medicare being accessible to all Canadians, regardless of their income. For example, Canadians do not pay each time they visit a doctor’s office or a hospital because they have universal access.

Universal Coverage
This concept provoked heated debate between those who argued that all Canadians should have health care coverage that gave them access to medically necessary health care services and those who believed that only those unable to pay for such services should receive government subsidies.

Universal Social Security
Universal social security is a system where the state provides financial assistance for every citizen whose income is inadequate or non-existent as a result of disability, unemployment, old age, etc. In Canada, medicare is an example of universal social security because it is provided to all, regardless of income.

User Fees
In response to federal spending cuts, most provinces imposed additional fees for health services not falling under the Canada Health Act, such as home care, extended care and out-of-hospital drugsThis affected the poor and the elderly and aroused public concern about the future of medicare.

Victim Blaming
By stressing the influence that lifestyle advertising, peer pressure and economic status have on the behaviour patterns of individuals, “victim blaming” critiques the argument that alcoholism, smoking and unprotected sexual intercourse are “self-imposed” health risks.

Victorian Order of Nurses
The Victorian Order of Nurses (VON) was founded in 1897 as a non-profit national health care association and registered charity. Currently, it has more than 16,000 staff and volunteers, who deliver community health care services in over 1,300 communities across Canada.

War Measures Act
The War Measures Act was a federal law enacted in 1914 that allowed the government to rule by decree during times of “war, invasion or insurrection, real or apprehended.” The act also empowered the government to suspend normal civil rights, censor media and intervene in the economy, giving it sweeping emergency powers that it used during the First and Second World Wars and the 1970 October Crisis.

X-rays
An X-ray is a form of radiation, discovered by Professor W. C. Röntgen of Würzburg in 1895, that is able to pass through opaque substances and produce images of tissues, bones and organs within the body. X-rays also have a curative effect in certain skin diseases, and they are an important diagnostic and curative tool in modern surgical and medical practice.



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    Date Created: March 31, 2010 | Last Updated: April 21, 2010