Annotated Bibliography:

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Canadian Human Rights Commission (n.d). A Three-Minute Guide to the BNA Act, 1897. Human Rights in Canada: A Historical Perspective.

     Retrieved from https ://www.chrc-ccdp.gc.ca/historical-perspective/en/browseSubjects/bnaguide.asp

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     This quick guide describes the British North America Act, 1867.  Some of the key areas or responsibility for the Federal government as well as the Provincial and Territorial governments are listed.  Criminal law, marriage and divorce, currency and coinage, and the postal service are some examples of categories that belong in under the control of the Federal government. The establishment, maintenance, and management of hospitals, asylums, and charities are among the many responsibilities of the Provincial government.  Notably, religion is not mentioned in either jurisdiction.  This site explains that the split between powers is determined by the British North American Act from 1867, which was later renamed as the Constitution Act in 1982.  Different levels having different areas of power is felt to prevent competition and chaos.  Every province has slightly different political philosophies, budgeting systems, and overall governance; however, they all work within the same framework according to the rules of the Canada Health Act.

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Flood, C.M. & Thomas, B. (2016). Modernizing the Canada Health Act. Dalhousie Law Journal, 39(2) 398-411. Retrieved from 

     https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2907029

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     This paper provides a critique of the Canada Health Act (CHA) and suggests ways for modernization.  The core principles of the CHA are highlighted, which are comprehensiveness, accessibility, universality, public administration, and portability.  The authors explain how universal coverage is limited to “medically necessary” hospital and physician services, to the exclusion of vital goods and services.  It is argued that since physicians operate as self-regulated, independent contractors, this may attribute to unnecessary health care utilization based on physician-induced demand.  The authors define passive privatization, a term used to describe the dynamic growth of overall health spending which requires paying for health services through private insurance or out-of-pocket.  The authors call for a transparent, evidence-based process to be used to decide which services are included in the public basket.  The paper mentions the successful implementation of universal drug insurance in New Zealand, called Pharmac, despite considerable amounts of resistance through protest and political interference.  The authors suggest that the Minister appoint a task-force to evaluate the services and categories of care to be listed or delisted from coverage.  It is argued that a broader range of services should be included in the scope of coverage, beyond those supplied by physicians and in hospitals.  

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Martin, D., Miller, A.P., Quesnel-Vallee, A., Caron, N.R., Vissandjee, B., Marchildon G.P. (2018). Canada’s universal health-care system: achieving

     its potential. Canada’s Global Leadership on Health, 391(10131) p1718-1735. Retrieved from https://doi.org/10.1016/S0140-

     6736(18)30181-8

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     The authors explain how Canadian MediCare, a publicly funded system, is a point of national pride.  This paper includes a figure showing the governance and coverage of the Canadian health system.  Notably, excluded from public funding are dental care, vision care, complementary medicine, and outpatient physiotherapy.  Another useful figure highlights the key events in the adoption of the Canada Health Act.  This paper gives historical context and explains that Saskatchewan was a trailblazer, being the first to implement universal public health insurance in all of North America. The leader of this change was the Premier of Saskatchewan; He was a Scottish Canadian named Thomas Clement “Tommy” Douglas, who nearly lost a limb to osteomyelitis in his childhood since his family was unable to afford care. Douglas’ approach was later adopted by the rest of the country.  The authors describe issues with accountability due to physicians remaining independent professions and fragmentation in hospitals and health authorities, explaining that decisions about services are generated by independent boards with separate budgets.  Vulnerable groups due to lack of supplemental private insurance are mentioned.  The calls to action discussed in this paper aim to reduce wait times, improve overall governance and accountability, change the scope of coverage, and minimize health disparities.