Canada does not have a federal system of health care. Each province and territory is responsible for the provision, funding and administration of health care services.
The National Hospital Insurance Act of 1957 was passed to create a 50/50 cost sharing arrangement between the provinces/territories and the federal government on acute hospital care and diagnostic services. The goal was to ensure no Canadian would have to pay for a stay at the hospital. The provinces provided the hospital services and were reimbursed half of the cost by the federal government.
The Medical Care Act of 1966 extended this cost sharing arrangement to include physician services, with all provinces and territories opting into this plan, often referred to as “Medicare” by 1972. By 1977, the 50% cost-sharing arrangement was changed to combination of cash and tax transfers.
The Canada Health Act of 1984 replaced the Hospitals Act and Medical Care Act. It outlined universal standards and regulations for each province and territory to follow in the provision of health care. This Act mandates that the provinces provide each of their residents access to hospital, diagnostic, and physician services and that the access is universal (i.e. everyone has a basic level of access), publicly administered, portable across provinces (i.e. one province can claim $ back from another if providing a basic acute service), comprehensive, and affordable (i.e. patient is not charged in full or part). The combination of cash and tax transfers was replaced by single block funding transfers.
It is important to note that the Medical Care Act of 1966 and subsequent Canada Health Act of 1984 focused only on access to hospital services, diagnostics, and physician services. They made sure that residents of Canada could get basic medical care in each province/territory without a fee or undue hardship. When the Medical Care Act was first enacted in 1966, the intention was to eventually broaden the Act to include dental care, drugs, and home care, but due to shifts in federal economics and politics, this never occurred. Today, we still operate on a series of provincial and territorial health systems that only fund hospital and physician services.
The absence of drug access from the Canada Health Act means drugs are not a protected benefit in Canada. As a result, Canada lacks any national guidelines, strategy or bill of rights to govern how or when drugs are accessed.
Each province and territory is left to interpret the extent to which they think they are to cover drugs as part of acute hospital services. For example, each province or territory funds drugs administered during hospital surgeries/procedures, recovery, or inpatient hospital care. Most provinces also fund drugs that must be administered in a hospital setting (e.g. intravenous chemotherapy and immunotherapy given in an outpatient chemo unit).
Today, all drugs taken or administered OUTSIDE of a hospital, including many cancer treatments, are funded at the discretion of each province or territory. They aren’t required to fund any “take at home” (aka prescription) drugs to receive federal health transfers. In Atlantic Canada, the only drugs that are funded universally are those designed and approved to be administered in a hospital setting, certain vaccines required for public health measures, and some drugs designated for critical use under special programs.