The Political and Economic Sustainability of Health Care in Canad ...

Chapter 1

Examining Provincial Variability

Canadian Fiscal Federalism,
Public–Private Relationships, and
Economic and Political Sustainability

The Canadian health care system is a complex conglomeration of more than thirteen public plans. Ten provincial and three territorial plans, as well as a number of federally administered plans that cover specific populations (e.g., aboriginals and veterans), all provide full coverage for most hospital and physician services and offer partial coverage for many other services that vary significantly across the plans. Those plans share a set of common principles currently embodied in a piece of federal legislation, the Canada Health Act of 1984 (CHA), and are funded through a mix of taxes, premiums, and (limited) user contributions (Forest 2010). Provinces and territories receive financial support from the federal government for operating their public health care plans, but these revenues come with conditions and constraints. In particular, it is essential that such provincial and territorial plans guarantee first-dollar coverage for all necessary hospital and medical services and that they accept responsibility for the