Canada: Where Are We Going?

Abstract

As medical care in Canada enters the new millennium, our basic tenet of universal access to health care is in question. The Canada Health Act, enacted in 1984, established the rules by which the federal government transfers funds to provincial governments to provide health care to their constituents. Provincial governments are required to provide all medically necessary hospital and physician services to all insured persons, without co-payments. Key aspects of The Canada Health Act include: Public Administration, Comprehensiveness, Universality, Portability, and Accessibility. This key piece of legislation has driven the health care agenda in Canada since its implementation. In the absence of clear definitions of these principles, however, many issues have been left vague and subject to considerable variability between provinces over time. In the coming years, the definitions of “comprehensiveness,” “universality,” and “accessibility” related to provision of critical care in Canada will likely require the added qualifier of “acceptable,” given that the potential demand for critical care will progressively increase over the next decades. Recent events, such as the SARS outbreaks and the H1N1 influenza pandemic, have brought to light numerous vulnerabilities within the Canadian healthcare system. This chapter will explore factors in the Canadian healthcare environment that will influence developing regional and national standards for what is considered “acceptable” critical care, and will provide some predictions about the future of critical care in Canada.