Canada Health Act 2.0: Are the Fundamental Principles Still Current, or Do They Need to be Revisited?

Abstract

The Canada Health Act was passed in the run-up to the 1984 Federal Election to meet a political problem - perceived inequities in access to care due to extra-billing by physicians and hospitals. At that time, health care as a right of citizenship was still a topic of debate. Health care was for the sick, and effective interventions were few and inexpensive. The provision of health care was seen as a morally justified social cost. Today the problem is different. We are in the midst of the largest transformation in biological understanding since the invention of the microscope. New treatments are being found powerfully effective, yet costly. A new, high value added, economic sector has developed: health innovation. Health care is an unquestioned social right. Yet, although a disproportionate amount of the foundational science has come from Canada, increasingly we are unable to access the medical, economic and social benefits of a global health economy. We need a permissive, catalytic, legislative framework (CHA 2.0) that will bring together the economic strength of health innovation and the delivery of its benefits to the health and wellness of Canadians. It would espouse the following seven principles: 1. Health care and health innovation are parts of a nationally critical health economy, with a global perspective. 2. Public and private sector involvement and accountability. 3. Change and innovation mandated and rewarded. 4. Labour mobility across jurisdictions, and role mobility across professions. 5. Patient-centred care. 6. Holistic and comprehensive, based on evidence. 7. Outcome (not process) driven, and transparent in implementation.