Canada’s publicly-funded health care insurance is governed by the 1984 federal Canada Health Act (CHA) that has five key principles: public administration, universality, comprehensiveness, portability, and accessibility. The principles should mean all insured Canadian residents are entitled to financially-unimpeded coverage of all medically necessary hospital and physician visits, which continues when a resident moves to another province or travels within Canada.
In practice, portability means Canadians can receive emergency care anywhere in Canada without out-of-pocket payment, but for urgent or non-urgent care, patients are only allowed to see a specialist physician in their home province. It doesn’t matter whether you have a family physician or not, or live hours from a hospital with the type of specialist your health condition requires.
In rural and remote parts of Canada, distance is frequently a major challenge for patients. The issue of access is even more frustrating if you live near a border of your home province many miles from a provincial health care facility but much closer to a facility in a neighbouring province.
Although provinces covered access to out-of-province specialists through virtual appointments during the pandemic, they have generally ceased paying for such services. For residents of B.C. border communities, such as Cranbrook, Kimberley and Fernie in the province’s southeast, access to an Albertan health care facility, including specialists in Calgary, is much easier than travelling long distances to B.C. health centres through mountain passes, which can be treacherous or impossible in winter. The inability to access specialized health care services in Alberta is a long-running issue for these communities.
To try to overcome some of their concerns, B.C. and Alberta have signed a new partnership to allow B.C. patients living in border regions to access elective surgeries in Alberta. B.C. is recommending patients speak to their primary care providers about having surgeries performed in Alberta. The caveat is that B.C. patients will require an Alberta physician to accept them for care, when there is already a shortage of doctors resulting in long wait times in Alberta.
The need to negotiate the cross-province partnership highlights a lack of portability and accessibility in Canadian health care. Such issues can occur in less populated parts of Canada, especially northwest Ontario and the prairies where provincial borders tend to be arbitrary lines on maps that may separate smaller communities in one province from a larger town or city with a wider range of health services in another.
The federal government claims the country’s health care system is “universal.” But when provinces and territories require non-emergency health care services be delivered within their own borders, regardless of patients’ inconvenience or expense, health care is not universal, portable or accessible. While the same level of comprehensiveness of service may not be possible in every corner of Canada, the universality, portability and accessibility principles should mean all Canadians have a reasonably similar degree of access to all health care services unrestricted by administrative borders.
The CHA provides principles, not specifics for health care access. Determining whether the principles are being violated is open to interpretation. As such, the CHA fails to ensure portable, universal access to comprehensive health services for many Canadians.
Nigel Rawson and John Adams are Senior Fellows with the Macdonald-Laurier Institute. John Adams is also co-founder of Canadian PKU and Allied Disorders Inc.
The views expressed are those of the author(s). National Newswatch Inc. publishes a range of perspectives and does not necessarily endorse the opinions presented.