WEEK 11: CANADIAN FEDERALISM AND HEALTH POLICY

Question 1

Timeline of federalism and health policy

Answer 1

1980-1984 = maintaining govt roles
1984-1988 = restraining social program costs
1988-1997 = restructuring role of govt
1997-present = repairing social union

Question 2

Pre-1980

Answer 2

1957 Hospital Insurance and Diagnostic Services Act

1966 Medical Care Act (MCA)
- Funded through Canada Assistance Plan (CAP)
- 50/50 cost-sharing

1977 Established Programs Financing (EPF)
- Shift from cost-sharing to block funding
- Transfer of tax points to provinces/territories
- Increases based on economic and population growth

Answer 3

1980-1984: Maintaining Government Roles

1984-1988: Restraining Social Program Costs
- Weakening of government commitments to health and social programs (between 1986
and 1998, reductions of $41.2 billion in health transfers)

1988-1997: Restructuring the Role of Government
- Concern with government budget deficits
- Significant curtailment of federal (and sometimes provincial/territorial) health care
spending

• 1995 Canada Health and Social Transfer
• Federal contribution at rate based on previous year with adjustment for GDP at provincial level
• One funding envelope for health care, social spending, and post-secondary education
• Federal spending cuts of $6 billion

Question 4

1997-2016: repairing the social union

Answer 4

• Recognition that the “social union” was deteriorating
• 1999 budget: increase in health and social transfers of $11.5 billion

Health Accords
- 2000 Health Accord: Increase of $21.2 billion over 5 years
- 2003 Health Accord: Established Health Council of Canada, separated CHST into CHT
and CST
- 2004 Health Accord: Increase of $41 billion over 10 years

• 2011: Federal Conservative government unilaterally announced scaling back of increases
  starting in 2014
• 2015: Liberals win federal election promising new Health Accord