The Fraying at the Edges of the Public Healthcare System in Canada.

Since the passage of the Canada Health Act (CHA) in the mid 1980s, advocates for private finance in Canada have challenged the CHA and its underlying access and equity principles. Such challenges have grown in recent years to encompass, among other things, facility fees, membership fees, private virtual care, private interprovincial surgery clinics and private practice nurse practitioners. The continued technological and organizational evolution of healthcare will expand and complicate this further over time. A multipronged approach is needed that includes expanded data to support research on the impacts of such activity, new regulatory frameworks and coordinated action across levels of government.