HEALTH POLICY IN
Nancy Miller Chenier
Political and Social Affairs Division
Revised 4 December 2002
TABLE OF CONTENTS
A. Government Responsibility for Health
B. Financing Health
C. Organizing Health
D. Groups with Particular Needs
E. Health Policy Challenges
1. Identifying and Acting on
Shared Values Concerning Health
Shifting to Health from Health Care
3. Controlling Health Costs
While Sustaining Health and Health Care
4. Organizing Health Providers
and Health Services Appropriately
Measuring, Tracking and Reporting on Health System Performance
HEALTH POLICY IN CANADA*
Canadian health policy has led
to one of the best health services systems in the world. The demands for these
health services are, however, growing at the same time as economic resources are
diminishing. Health policy initiatives have achieved the 1964 Royal Commission on
Health Services goal of access to medical care for all Canadians. The current
challenge is to enable all Canadians to achieve the best possible state of health and to
do this within the constraints imposed by a changing social, economic and political
of creating policies for health was reflected in the mandate of the Commission
on the Future of Health Care in Canada (the Romanow Report). In 2002,
the Commission recommended policies and measures that, while respecting all
relevant jurisdictions and powers, would ensure long-term sustainability of
a universally accessible, publicly funded system offering quality services.
Its proposals attempted to strike an appropriate balance between those for prevention
and health maintenance and those for care and treatment.
This paper addresses some of
the forces involved in the process of creating health policy or policies for health,
focusing on the federal governments responsibilities and some of the intricacies of
federal-provincial cooperation. It outlines the way health care is currently
financed and what this means in terms of organization, as well as highlighting some of the
challenges as new policy goals are identified.
BACKGROUND AND ANALYSIS
This focus on the concept of
health, rather than illness, has occupied considerable space in policy discussions over
the past two decades. At the federal level, the Lalonde Report in 1974 established
that the setting of health goals or strategies was essential and emphasized that health
care organization, particularly the provision of services, was only one of several
elements affecting health. This view was reiterated in the Epp Report in 1986, which
stressed that all public policy sectors income security, employment, education,
housing, agriculture and others have a bearing on health. In 1994, a federal,
provincial and territorial advisory committee identified five categories of factors that
determine the health of Canadians: social and economic environment; physical
environment; personal health practices; individual capacity and coping skills; and health
services. It argued that these could provide the basis for developing broad
population health strategies for improving the health status of the Canadian population.
In spite of these attempts to
refocus public policy, the belief that improvements in health can be attributed to
services provided by doctors and hospitals is still dominant. While health is
generally defined as a state of complete physical, mental and social well-being, rather
than merely the absence of disease, the strong relationship between health and social and
economic conditions is only gradually becoming part of the broader public knowledge.
Responsibility for Health
At Confederation, the Constitution
Act, 1867 made few specific references to health responsibilities. The federal
government was allocated jurisdiction over marine hospitals and quarantine while the
provinces were to establish, maintain and manage hospitals, asylums, charities and
charitable institutions. From 1867 to 1919, the Department of Agriculture covered
any related health concerns.
In the 74 years between the
establishment of the first federal health department and the emergence of a reconstituted
health department in 1993, federal government responsibility grew to include health
services for Indian and Inuit people, federal government employees, immigrants and civil
aviation personnel. It also included investigations into public health, the
regulation of food and drugs, inspection of medical devices, the administration of health
care insurance, and general information services related to health conditions and
Its role in health is derived
from the federal governments constitutional powers over criminal law, spending, and
peace, order and good government. Criminal law is the basis for legislation such as
the Food and Drugs Act and Controlled Substances Act. Spending power
comes from the federal role in levying taxes and appropriating funds and is the basis for
the Canada Health and Social Transfer (CHST) and the Canada Health Act. The
peace, order and good government clause of the Constitution gives the authority to
maintain and improve national standards in areas affecting health such as water and air
Over time, the provinces, by
virtue of their jurisdiction over matters of a local or private nature, also assumed an
increasing role in health matters. The advances made in public health in the last
decade of the nineteenth century were attributed to a combined effort by health
professionals, the voluntary community, and the departments of health established at the
municipal and provincial levels in the 1880s. The provinces oversee the licensing of
physicians, nurses and other health professionals and determine the standards for
licensing all hospitals. In addition, departments of health administer provincial
medical insurance plans and finance health care facilities and the delivery of certain
public health services.
These divisions of health
responsibility, both those emanating from constitutional interpretation and those derived
from practices established over time, contribute to the other complexities facing Canadian
health policy such as geographical diversity, socio-economic divisions, and international
pressures. Over the decades, various governments, both federal and provincial,
established health inquiries to appraise and review the beliefs and structures forming the
foundation for policy.
During the 1980s, every
province established a royal commission or other major inquiry to examine its health care
system. In 1994, the federal government appointed the National Forum on
Health. The Health Forums final report in 1997 concurred with the earlier
provincial assessments that the fundamental principles underlying the funding system for
health care and enshrined in the Canada Health Act universality,
comprehensiveness, portability, accessibility and public administration were
All reports argued that health
care resources were adequate but called for changes in their management and
allocation. They pressed for a definition of health that would address issues other
than medical care, such as education, housing, employment and the environment. They
advocated a shift from institution-based care to community-based care with more
opportunity for individuals to participate in health decisions with service
providers. The reports argued for better regional management of services and human
resources, including physicians, expressed concern about the efficiency and effectiveness
of the current system, and called for evaluations of medical practice and delivery
Cooperation and coordination
of federal with provincial and territorial governments being essential, various
mechanisms ensure that health officials meet to discuss issues and solutions.
The Conference of Ministers of Health and the Conference of Deputy Ministers
of Health are two such mechanisms with important implications for national health
policy. In addition to regular policy directives from these cross-jurisdictional
bodies, work continues on the September 2000 commitment by First Ministers to
an action plan for health system renewal and, more recently, on the negotiations
over the Romanow Commission's recommendations.
B. Financing Health
and fiscal arrangements have always had a significant impact on health policy. The
federal government was constitutionally given the power to generate financial resources
through taxation and borrowing and to spend such money on any activity, provided that the
legislation authorizing the expenditure did not infringe on provincial powers.
This power led to the National
Health Grants Program of 1948, seen by many as the first stage in the development of a
comprehensive health insurance plan for all Canada. The grants offering financial
support for planning and organization, public health, and hospital construction provided a
welcome source of new funds for the provincial health departments. For both levels
of government, they gave an opportunity to discuss annual expenditures and to compare
problems and solutions. The grants were followed by other cost-sharing measures
under the federal Hospital Insurance and Diagnostic Services Act, 1957 and the Medical
Care Act, 1966. These statutes, which specified that all provinces must meet
certain terms and conditions, were considered to be the second stage of a national health
Although all provinces had
joined the federal plan by 1971, problems were perceived by both parties to the
agreement. The federal government became concerned about its lack of control over
expenditures, while some provinces found the restriction to hospital and medical care
expenses too limiting at a time when a shift to community-based care and preventive
programs offered by non-medical personnel was beginning to be viewed as more effective.
After much discussion between
the federal and provincial governments, the previous funding conditions were replaced by
the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, 1977.
Each province was given block-funding, a set amount of federal money based on
its population and paid partly in cash and partly in tax points. These per capita
EPF payments by the federal government were to be spent on health but did not require that
the provinces make equivalent matching expenditures.
As early as 1979, the federal
government expressed concern that federal funds allocated for health were being diverted
by the provinces into non-health activities such as road building. In 1984, the Canada
Health Act was passed to establish criteria and conditions that must be met
before full payment may be made under the Act of 1977 in respect of insured health
services and extended health care services provided under provincial law. The
provisions of the two previous insurance Acts were consolidated in the new law, which
reaffirmed the principles public administration, comprehensiveness, universality,
portability, and accessibility underlying the national programs. Specific
conditions were set for provincial receipt of the full federal contribution. The
provinces were given three years to end extra-billing and user charges if they wanted to
recover withheld funds. After significant federal-provincial debate, all provinces
complied with the Canada Health Act by 1 April 1987.
After 1977, the federal
government made several unilateral modifications to the formula for the federal
contribution that limited the overall amount available to the provinces. This action
led some observers to conclude that the federal government would be unable to enforce the
standards of the Canada Health Act as cash transfers to the provinces ceased, since
it would not be able to penalize any province that breached the criteria specified in the
Act. Provinces claimed that financial pressures made it very difficult for them to
maintain the current level of services.
In 1995, the government gave
notice that a new block grant to the provinces, to be called the Canada Health and Social
Transfer, would begin in 1996-1997. It merged the Established Programs Financing
(EPF) and Canada Assistance Plan (CAP). The Finance Minister noted that the new
transfer would not be totally unconditional and that the Canada Health Act would
still be enforced. Critics have argued that the CHST continues the policy of
restricting expenditures without providing new approaches for increased efficiency in
maintaining or delivering health.
C. Organizing Health
In reality, Canadian health
policy has been predominantly health care policy, with the focus on the treatment of
diseases and injuries rather than on prevention. In Canada, where a universal public
insurance system called medicare provides for medical and hospital services, the two areas
of financing and of organizing health services have been closely interwoven. The
acceptance of medicare as a way of financing existing services has also implied acceptance
of existing ways of organizing those services.
Canada provides universal
health insurance coverage for its population through health insurance programs financed by
federal and provincial revenues. Provincial authorities design their own programs
according to national standards codified in the Canada Health Act. The health
insurance plans currently cover services offered mostly in the offices of physicians paid
on a fee-for-service basis and in hospitals, largely run by private, non-profit boards and
operating on global budgets.
Across the country,
hospitals and physicians take almost half of the estimated $100 billion for health care
spending. Physicians have a major influence on all the costs of the health care
system, including the number and type of procedures and interventions offered in both
private offices and publicly funded hospitals. As much as 78% of the increase in
health care costs in industrialized countries over the past 25 years has been attributed
to the number of physicians and the extent and level of services they provide for each
patient. By 2000, pharmaceutical drugs, particularly those prescribed by
physicians, accounted for a major portion of health expenditures.
Beyond the traditional health
care organization involving hospitals and physicians is a range of other services and
programs that contribute to health. Other health professionals, such as nurses,
chiropractors, midwives and physiotherapists, and other institutional arrangements, such
as community-based clinics, can deliver health services, perhaps more effectively and less
expensively than the existing methods. Changing the widely held belief that medical
care and hospital care are the major determinants of long-term improvements in health
status will be a major challenge for the next decades.
D. Groups with Particular Needs
The Canada Health Act
is intended to guarantee equal access to health services and health care; however, it does
not guarantee access to the conditions that lead to good health, which, as numerous
studies have pointed out, can include a persons economic status, age, gender,
occupation and ethnicity. In Canada, geographic location in urban or rural areas is
another influence. Addressing the health concerns and particular needs of different
groups requires varied initiatives.
Economic status is a primary
factor affecting mortality, morbidity, and disability. Thus, low-income groups die
younger, experience fewer years free of disability, and are more likely to have conditions
such as high blood pressure, chronic respiratory disease and mental health
disorders. In addition, they are less likely to use health services and to practise
health protective behaviour. Within the low-income category, groups identified as
having a higher chance of experiencing poor health include older people, the unemployed,
welfare recipients, single women supporting children and minorities such as natives and
Age is also a factor in
health; young people and the elderly have distinct health concerns. For young people
of both sexes, who in the teen and early adult years face major biological and social
changes, motor vehicle accidents are the largest single cause of death, followed by
suicide, cancer and homicide. For older Canadians, age-related chronic conditions
include heart disease, arthritis, and hypertension. Forms of senile dementia,
including Alzheimers Disease, are a growing concern.
Gender brings another
dimension to health policy considerations. Women live longer than men but suffer
more from chronic poor health. Women use health services more than men, at least
partly because of their childbearing role. Heart disease is the number one killer of
women, yet heart treatments have been developed particularly for men and evidence suggests
that women receive less medical care. Young women face particular problems, such as
eating disorders and unintended pregnancies.
The nature of jobs and the
workplace affects the health of workers. Men and women often face daily exposure to
hazards such as chemicals, noise, radiation, infectious agents, and psychosocial stress
that lead to poor health. While injuries and deaths are acknowledged to be related
to industrial jobs, the fact that long-term illnesses often result from exposure to
hazards in non-industrial settings is taking longer to be accepted.
Services responsive to the
linguistic and cultural differences of Aboriginal people, immigrants and cultural
minorities are often unavailable. Adverse social and economic conditions among
native people contribute to the high suicide rate of the young and the high rate of
diabetes and tuberculosis among older people.
E. Health Policy Challenges
Several common but not
mutually exclusive themes have emerged from the reports of federal, provincial and
territorial inquiries and policy negotiations. Serving as the base for current
policy deliberations and decisions, these broad themes include: (1) Identifying and
acting on shared values concerning health; (2) Shifting to health from health care; (3)
Controlling health costs while sustaining health and health care; (4) Organizing
health providers and health services appropriately; (5) Measuring, tracking and reporting
on health system performance.
1. Identifying and
Acting on Shared Values Concerning Health
One broad policy challenge
is to ensure that decisions affecting the health status and the health care of Canadians
are based on a clearly understood and widely held set of principles and values. A
health system that reflects the values of Canadians will, in turn, shape them through
decisions on delivery of health care. Like other components of any health system,
cost and values are interconnected. It is probable that Canadians will ultimately
decide as a country that they can afford to make expenditures on things that they value
At both the federal
and the provincial levels, efforts have been made to identify values to guide
health policy decisions. The Romanow Commission found that quality and
accessibility stand out as the principles most strongly supported by Canadians.
The 1997 National Forum on Health, as well as the Clair and the Fyke provincial
commissions, identified health-related values such as accountability, quality,
equality of access, efficiency and effectiveness, collective and personal responsibility.
There appears to be a broad consensus that Canadians see health care as an entitlement
for all, while accepting that some trade-offs are necessary.
While opinion polls
continue to find strong public support for the principles outlined in the 1984 Canada
Health Act of public administration, comprehensiveness, universality, portability and
accessibility, some observers suggest that they are not consistent with the need to manage
and adjust the health care system. There are renewed suggestions that greater public
participation can contribute to defining and implementing shared national values.
Technological and other innovations in health care that give society the ability to create
life, to improve life and to prolong life raise numerous ethical questions that affect all
stages of human life. The value that Canadians place on each of these stages is
among the variables that will ultimately affect the allocation of resources.
2. Shifting to Health from
Although not yet reflected
in reality, policy discussions have long acknowledged the need for a shift of resources
from health services designed to control, cure, or alleviate disease to efforts to
maintain and enhance health by addressing a broad range of social, economic, genetic and
other health determinants. The intent is to develop new initiatives designed to
reduce the long-term demand for health care services.
Provincial and territorial
governments have made a commitment to promote programs and policies which extend beyond
care and treatment and which make a critical contribution to the health and wellness of
their citizens. The federal government is strongly supportive of population health
approaches and is working to develop strategies to promote overall wellness. All
levels of government, recognizing that the health care sector cannot act alone, have
explored an intersectoral approach that links health to relevant economic, educational,
social, environmental and employment interventions.
Children are one group to
which all governments are making efforts to apply this approach. Here, interventions
are designed based on evidence that, for every dollar invested in a young child, future
savings from reduced health, welfare and criminal justice costs amount to seven dollars.
The notable disparities between the health of Canadas Aboriginal population
and the health of the general Canadian population present another area where it is argued
that intersectoral coordination across social, economic, and other areas could increase
general health status and life expectancies and lower rates of infant mortality and
3. Controlling Health
Costs While Sustaining Health and Health Care
Questions about health care
costs, the adequacy of public funding and its sustainability in the future are an enduring
part of health policy discussions. Achieving consensus on how much public money to
spend, what future spending priorities to establish, where to obtain any additional money,
and whether the funding can achieve the desired health outcomes continues to be difficult,
if not impossible.
costs have been central from early days, and perceptions continue that the health
care system is in the midst of a funding crisis. In the late 1960s, the
Conference of Ministers of Health established a committee and seven task forces
to enquire into ways of restraining health service costs. The CHST currently
dominates funding discussions between the federal and provincial governments.
Provincial governments regularly call on the federal government to restore the
cash component of the CHST and to establish an appropriate escalator so that
transfers keep pace with economic and social factors, such as ageing and health-care
technology, that affect the health care system. The federal government,
in turn, regularly produces figures that show substantial federal support for
health care in Canada. In 2002, the Romanow Commission argued that current expenditure
patterns provide slim grounds for arguments that the system is fiscally unsustainable.
Several factors recur in
debates over cost and sustainability. The proportion of Canadians aged 65 and over
and the related health costs continue to increase, with recent data suggesting that they
account for over 40% of provincial and territorial health care expenditures. This
leads some to see the elderly as an expensive problem and others to see a need to adapt
services and technologies to the needs of the group. Drugs continue to consume an
increasing share of Canadas health care dollar, recently constituting the
second-largest category of health expenditures next to hospital services. The importance
of drugs in treating disease, maintaining health and quality of life, and preventing and
reducing the need for surgery and hospital stays is well recognized. Currently,
public coverage for prescription drugs varies considerably from province to province,
generating calls for a national pharmacare program. New and emerging technologies
range from those used in cardiac care to organ transplantation to diagnostic imaging to
genetic manipulation to telehealth, and are expected to increase dramatically in use.
Decisions about their use and about resource allocation have been a shared federal and
provincial concern for several years. Although such technologies can improve the
speed and accuracy of diagnosis, cure disease, lengthen survival, alleviate pain,
facilitate rehabilitation, and maintain independence, concerns have been raised about the
availability, assessment and cost.
4. Organizing Health
Providers and Health Services Appropriately
Current policy analysis
focuses on the issue of appropriate care by appropriate providers in appropriate
settings. At present, the dominant model involves solo practice physicians serving
as the first line of entry into a health care system where the hospital is the central
setting for care delivery. Overall, the health care sector employs about one in ten
Canadians and depends on a steady supply of well-trained health care providers who can be
appropriately distributed throughout the country.
Ways to shift boundaries
between physicians and providers of alternative therapy, such as chiropractors
and naturopaths, and between physicians and others who play important educational
roles, such as nurses, pharmacists and nutritionists, are being re-examined.
Analysts agree that primary care activities focusing on health promotion, illness
and injury prevention, and chronic disease management would be appropriate for
an interdisciplinary team as the first contact point in the health care system.
Quebecs Clair Commission emphasised primary care through group physician
services for medical care, along with the existing network of Centres locaux
de services communautaires (CLSCs) for the broader social dimensions.
Saskatchewans Fyke Commission called for Primary Health Service Networks
employing providers such as physicians, nurses, dieticians, etc. The Romanow
Commission has also added its recommendations on primary care to the debate.
Beyond primary care, statutory and professional barriers have changed, and exclusive
scopes of practice have been replaced with shared responsibilities and more
interdisciplinary practices, such as using midwives and nurse practitioners
to alleviate and share demands on physicians.
Pressure is also being
exerted to find new ways to deliver services necessary for health outside institutional
settings and within the community. Questions about the appropriate setting for
health care service delivery arise when issues like home care are considered. As
individual provinces gradually reduced the use of inpatient hospital services due to
factors such as increased day surgery procedures, expanded discharge planning programs,
and reduced hospital beds through restructuring in the early 1990s, there was a renewed
focus on home care. Nationally, the increased need for home care services raised
questions about access, costs and standards. Although many home care services are
currently aimed at the frail elderly, they may be appropriate for people with minor health
problems and disabilities as well as for those who are acutely ill and require intensive
and sophisticated services and equipment. Services extending along a continuum that
incorporates medical interventions as well as social supports could be available to
children recovering from acute illness, adults with chronic diseases such as diabetes,
persons with physical or mental disabilities, and individuals needing end-of-life care.
5. Measuring, Tracking
and Reporting on Health System Performance
Renewed attention has been
directed to measuring, tracking and reporting on the performance of Canadas health
system. Such information is intended to assist individuals, governments, and health
care providers in making more informed choices; promoting the identification and sharing
of best practices; and increasing understanding of the desired use and outcomes of health
Most observers concur that
decisions about health and health care should be based on reliable and valid evidence that
can then be used to determine whether particular current practices, procedures, programs
or general approaches are working effectively to achieve the desired result. Access
to good health data can document both the level of resources consumed by health care and
the benefits thereby produced. There is a need for overall co-ordination to ensure
that definitions and concepts are consistent among provinces and that systems for
collecting and synthesizing data are compatible. At the national level, the Canadian
Institute for Health Information is already collecting information required for
establishing sound health policy, managing the health system, and increasing awareness of
health determinants. Provincially, organizations such as Saskatchewans Health
Services Utilization and Research Commission are working to refine indicators for
population health and the health care system.
Frequent questions include
how well the health system delivers services and whether they can be delivered in a more
cost-effective way. Health researchers suggest that these questions need to be asked
across all sectors: in standard medical care, where many hospitalizations and surgical
procedures may be inappropriate or unnecessary; in new diagnostic and treatment
technologies, where their introduction might occur without proper evaluation of the full
costs and benefits and without withdrawal of the older technologies; and in the area of
health promotion, where interventions may have limited effect on health behaviours.
Health policy development in
Canada faces many challenges. One of the most significant is defining health and
designing the means of achieving it. There is clear recognition that we need to move
from a system focused predominantly on health care to one more oriented to improved health
status. To accomplish this, Canadians must identify those aspects of their society
that they value the most; examine carefully what approaches will provide the best results;
and support any shifting of resources deemed necessary to move in the direction of greater
health for all. Many players will be involved: governments, physicians,
hospital administrators, insurance companies and, ultimately, individual Canadians.
The Constitution Act, 1867
granted legislative authority over quarantine and the establishment and maintenance of
marine hospitals to the federal government, and over the establishment, maintenance and
management of hospitals, asylums, charities and eleemosynary institutions to the
The Hospital Insurance and
Diagnostic Services Act, 1957 provided conditional grants from the federal government
to the provinces for the development of a national hospital insurance program. The
plans were to be universally available to provincial residents, portable, and publicly
administered. In addition, they were to ensure that adequate hospital standards and
complete records and accounts were maintained.
The Medical Care Act, 1966
established the basis for national insurance to cover medical services provided outside
Fiscal Arrangements and Established Programs Financing Act, 1977 changed the
cost-shared conditional funding arrangements for health insurance and replaced them with
block funding involving tax transfers and cash payments tied to the GNP. The
previous legislation relating to hospital insurance and to medical care insurance was
The Canada Health Act, 1984
established criteria and conditions that had to be met before full payment could be made
under the Act of 1977 in respect of insured health services and extended health care
services provided under provincial law. The five criteria were comprehensiveness,
universality, portability, public administration and accessibility.
The Budget Implementation
Act, 1996 set out new criteria for transfers to the provinces. The aim is to
give the provinces more discretion over how funds are divided among health, post-secondary
education, and social assistance.
1867 The British
North America Act, now the Constitution Act, 1867, contained few specifics
1948 The Health
Grants Program offering federal cost-shared financial support provided the first stage in
the development of a national health insurance plan.
hospital insurance was established through the Hospital Insurance and Diagnostic
1964 The Royal
Commission on Health Services under Emmett Hall pressed for a national health service that
was universal, comprehensive, accessible, portable and publicly administered.
funding for insured medical services was provided under the Medical Care Act.
1974 Marc Lalonde,
Minister of National Health and Welfare, published A New Perspective on the Health of
Canadians: A Working Document.
1977 The Federal-Provincial
Fiscal Arrangements and Established Programs Financing Act made it a condition of
federal payments that the provincial plan would satisfy certain criteria.
1980 Emmett Hall
released the report of the Health Services Review 79, called Canadas
National-Provincial Health Program for the 1980s. Extra-billing by physicians
and hospital user fees were seen as endangering the principle of reasonable access to
1981 A House of
Commons Task Force on Federal-Provincial Fiscal Arrangements concurred that extra-billing
and user fees were detrimental. It concluded that federal funding for health care
1984 The Canada
Health Act consolidated previous federal legislation and strengthened the federal
commitment to the principles of universality, accessibility, portability,
comprehensiveness and public administration.
1986 Jake Epp,
Minister of National Health and Welfare, published Achieving Health for All: A
Framework for Health Promotion.
1990 The Senate
Standing Committee on Social Affairs, Science and Technology tabled its report Accessibility
to Hospital Services Is There a Crisis? It concluded that inefficiencies
in acute-care hospitals could be and were being addressed through innovative
administrative responses to recognized problems.
1991 The House of
Commons Standing Committee on Health and Welfare, Social Affairs, Seniors and the Status
of Women tabled its report The Health Care System in Canada and Its Funding: No Easy
Solutions. The report concluded that increased spending on the existing system
would not solve its problems. Instead, more cost-effective and appropriate
distribution of human and other resources was needed.
Marleau, Minister of Health, nominated 22 Canadians as members of the National Forum on
Health. With a four-year mandate and a budget of $12 million, four working groups
focused on determinants of health, evidence-based decisions, societal values, and resource
provincial and territorial Ministers of Health adopted the population health framework and
strategic directions proposed in the discussion paper Strategies for Population Health:
Investing in the Health of Canadians.
1997 The National Forum
on Health final report, Canada Health Action: Building on the Legacy, recommended
that the key features of the health care system be preserved with adaptations to include
home care, pharmacare, and primary care reforms. It also recommended development of
an integrated child and family strategy, strengthening of community action, establishment
of an Aboriginal Health Institute, and acknowledgement of the link between health, social
and economic policies. It advocated the development of an evidence-based health
system where decisions would be made on the basis of appropriate, balanced, and
2000 The First
Ministers produced an Action Plan for Health System Renewal addressing issues related to
funding, access to care, health promotion and wellness, supply of health providers, health
information, home care, pharmacare, and accountability.
Standing Senate Committee on Social Affairs, Science and Technology, after a
multi-year and multi-faceted study of the state of the Canadian health care
system and the evolving role of the federal government, produced its final
Commission on the Future of Health Care in Canada under Roy Romanow, established
with a broad-ranging and multidimensional mandate, released its final report
titled Building on Values: The Future of Health Care in Canada.
It called for its recommendations to serve as a roadmap for a collective Canadian
journey to renew health care.
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