Canadian medicare: historical reflections, future directions

Abstract

This special volume is a reflection by scholars from across Canada and around the world on Canadian medicare. Our goal was to marry history (and historical scholars) with policy (and policy scholars) to reflect on how history can help us better understand present policy problems in Canadian medicare. Many readers will be familiar with Winston Churchill's adage that 'those who fail to learn from history are doomed to repeat it'. Philosophers, writers, thinkers and academics have opined for centuries on the need for a fulsome understanding of history. Churchill also feared that erasing the past would lead to 'the most thoughtless of ages. Every day headlines and short views'(National Churchill Museum, 2012). In other words, blindness to the past hinders innovation and progress and propagates, at best, an inadequate status quo. This special edition of the Journal of Health Economics Policy & Law has been supported by Associated Medical Services (AMS), which, for more than 40 years, has advanced the assessment and use of knowledge, especially historical knowledge, to understand and improve health care in Canada. AMS' (2017) first priority upon becoming a charity in 1976 was to support scholarly work in the history of medicine. AMS (2017) created five History of Medicine Chairs in the 1970s and, in 2015, introduced the History of Medicine and Healthcare Post-Doctoral Fellowship and the Hannah Chair in the History of Aboriginal Health at the Northern Ontario School of Medicine. In celebration of its 80th anniversary, AMS hosted a conference in Toronto in May 2017 that focused on

Towards equitable dental care in Canada: Lessons from the inception of Medicare

“…Before the Second World War, health care services in Canada were largely paid for and delivered in private 5 . In 1947, Saskatchewan Premier Tommy Douglas led the implementation of the Saskatchewan Hospital Services Plan, the first universal health insurance plan for hospital‐delivered services in North America 1,6 . In 1962, the Medical Care Insurance Act was passed in Saskatchewan, combining hospital and physician‐provided services under the umbrella of provincially‐funded health care 6 .…”

“…The 1984 Canada Health Act served to consolidate the progress made by legislation over the preceding 4 decades and formalized provincial and territorial responsibility for the provision of health care services under a decentralized system. Transfer payments made through the Canada Health Transfer remained a federal responsibility provided the revised eligibility criteria of “portability, accessibility, universality, comprehensiveness, and public administration” were met 1,5,6 . The Canada Health Act remains the last major piece of federal health care legislation and its core mandate has been preserved, with only minor reforms in subsequent decades.…”

“…In 1947, Saskatchewan Premier Tommy Douglas led the implementation of the Saskatchewan Hospital Services Plan, the first universal health insurance plan for hospital‐delivered services in North America 1,6 . In 1962, the Medical Care Insurance Act was passed in Saskatchewan, combining hospital and physician‐provided services under the umbrella of provincially‐funded health care 6 . This prompted a 23‐day strike by Saskatchewan's doctors that concluded with the Saskatoon Agreement, which promised the retention of a private, fee‐for‐service delivery model and an opt out guarantee for physicians 1 .…”

Learning from health system reform trajectories in seven Canadian provinces

“…Flood et al . (2018) consider that provincial experimentation can generate a body of evidence, while also ‘furthering political discourse, catalysing public support, and ultimately contributing to reform’. Rich and detailed comparative study to discover the enablers and impediments to this learning process would help identify means of better supporting the spread of beneficial policies and practices.…”

“…Observers consider that cyclical reforms and reorganisations will continue, responding to the frustrations of stakeholders, including the public, with system functioning and results (Klein, 2019). Health systems in Canada are no exception to this pattern, with repeated reforms, conditioned by predominant ideologies, initiated in response to pressing contingencies (Flood et al ., 2018). A special issue of this journal in 2018 explored some of the policy choices confronting Canada, with lessons from comparable health systems.…”