Does the Canada Health Act Actually Help Canadians?

The Canadian Health Care Act (CHA), established in 1984, has been critiqued for its vague language and lack of clarity regarding what constitutes “medically necessary” goods and services (Flood & Thomas, 2016). Originally designed to cover hospital expenses and doctors' appointments, while excluding essential services like out-patient pharmaceuticals, dental care, long-term care, and comprehensive mental health support, the CHA has led to a fragmented healthcare system across provinces and territories (Flood & Thomas, 2016).

To modernize CHA, it is imperative to establish a transparent evaluation process for healthcare policy making (Buskens, et., al, 2021). Such a review process would allow for regular assessment of CHA guidelines, aligning them with evolving social expectations and population needs (Flood & Thomas, 2016). This should also balance technological advancements in research and medical practices with financial constraints (Buskens, et. al. 2021).This approach ensures a more adaptive and responsive CHA that better reflects the dynamic healthcare landscape in Canada.

Modernizing the CHA involves refining its inclusion and exclusion criteria, where unsubstantiated or outdated treatments are removed from coverage, and new or more efficient treatments are included (Flood & Thomas, 2016). A modern CHA should include national Pharamcare which extends beyond the confines of a hospital setting (Chowdhury & Chowdhury, 2018). Fertility treatment should also be discussed for possible inclusion within a modern CHA.

Pharmaceutical Coverage under CHA:

A national Pharmacare program is crucial for modernizing the CHA (Chowdhury & Chowdhury, 2018). While the CHA currently provides 100% coverage for pharmaceuticals prescribed in hospitals, many of these medications form part of long-term disease management plans (Flood & Thomas, 2016). Its inclusion to CHA would uphold the values of universality, portability and accessibility, extending benefits to patients beyond the confines of hospitals (Flood & Thomas, 2016).

The high cost of Canadian medications, partly attributed to patent fees borne by manufacturers, could be absorbed at the federal level to reduce per capita pharmaceutical costs (Chowdhury & Chowdhury, 2018). A universal pharmacare program would enhance the bargaining power of the publicly funded health care system addressing the cost disparity (Chowdhury & Chowdhury, 2018).

To ensure the effectiveness and efficiency of a universal Pharmacare under the CHA, regular evaluations and negotiations and negotiations with vendors (Buskens, 2021). These measures would help maintain evidence-based practices, support long-term disease management, and alleviate the financial burden which currently rests on individuals and private insurance providers.

Medically Assisted Reproduction (Fertility):

The consideration of fertility treatments, including medically assisted reproduction therapy (MAR) and reproductive assistance treatment (RAT), within the CHA requires a comprehensive examination of social and economic factors (Buhler et al, 2022). Depression and generalized anxiety disorder (GAD) are 25-50% higher in populations with fertility challenges (De Beradis et al, 2014). Suicidal thoughts are prevalent in over 9% of patients who have undergone more than 2 rounds of RAT or with infertility diagnoses (Cousins et al, 2015). While there is currently debate among primary health providers regarding the possible link between infertility and mental health disorders, it is necessary to provide annual mental health screening and treatment integration for MAR and RAT patients (Martens et al, 2023).

Infertility awareness ribbon

The financial burdens accrued through MAR is often distributed among public systems, private insurance providers, and patients (Buhler, et al, 2022). Due to its complex nature, it is important the panel conducting any review process for inclusion of MAR treatments into the CHA implements a cost analysis evaluation which examines cost and benefits so as to reduce reliance on low cost, low efficacy treatment methods (Buhler, et al, 2022). To guide the inclusion of MAR treatments into the CHA, a comprehensive cost analysis evaluation should include both direct and indirect costs (Buhler et al, 2022). This analysis should encompass factors such as the increased cost to the public healthcare system due to multiple pregnancies resulting from RAT, and long-term medical care for patients and fetuses with associated complications (Buhler et al, 2022).

An appropriate understanding of the multi-factorial social, emotional, and economical impacts of MAR and ART for Canadians may lend towards inclusion of certain treatments into CHA. Understanding the multifaceted social, emotional, and economic impacts of MAR and RAT for Canadians in crucial when considering the inclusion of these treatments in CHA. It requires a thorough evaluation process that accounts for the diverse factors at play, ensuring that any decisions made align with the principles of universality, accessibility, and fiscal responsibility that underpin the CHA. Modernizing the CHA in these ways will enable it to serve the evolving healthcare needs of Canadians.

References

Buhler, K.,Borget, I., Cedrin-Durnerin, I., D’Hooghe, T., Connolly, M.P., Lispi, M., Luyten, J., Revelli, A., Scotland, G., Verbeke, E. (2022). Economic Evaluation of Medically Assisted Reproduction: An Educational Overview of Methods and Applications for Healthcare Professionals. Best Practice & Research Clinical Obstetrics and Gynecology, 85, 217-228. https://doi.org/10.1016/J.BPOBGYN.2022.01.008

Buskens, E., Feenstra, T., L., Jorg, F., Kan, K., Lokkerbol, J., Mihalopoulos, C., Schoervers, R. A. (2021). More Than Cost-Effectiveness? Applying a Second-Stage Filter to Improve Policy Decision Making. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 24(4), 1413-1433. https://doi.org/10.1111/hex.13277

Cattapan, A. (2022). Medical Necessity and the Public Funding of In Vitro Fertilization in Ontario. Canadian Journal of Political Sciences, 53(1), 61-77. https://doi.org/10.1017/S000842391900074X

Cousins A., Duffy., M.E., Freizinger M, Gregas M., Wolfe, B.E. (2015). Self-Report of Eating Disorder Symptoms Among Women With and Without Infertility. Journal of Obstetrics and Gynecology Neonatal Nursing, 44, 380-388. https://doi.org/10.1111/1552-6909.12573

Chowdhury, M. Z. I., & Chowdhury, M. A. (2018). Canadian Health Care System: Who Should Pay for All Medically Beneficial Treatments? A Burning Issue. International Journal of Health Services, 48(2), 289–301. https://www.jstor.org/stable/48513076

De Beradis, D., Mazza, M., Marini, S.(2014). Psychopathology, Emotional Aspects and Psychological Counselling in Infertility: A Review. La Clinica Terapeutica,165(3): 163-169. https://doi.org/10.7417/CT.2014.1716

Domar, A. & Rooney, K.L. (2018). The Relationship Between Stress and Infertility. Dialogues of Clinical Neuroscience, 20(1):41-47. https://doi.org/10.31887/DCNS.2018.20.1/klrooney

Flood, C., M. & Thomas, B. (2016). Modernizing the Canadian Health Act. Dalhousie Law Journal, 39(2), 396-411.

Martens, M., Schroer, M., Williams, T. (2023). Identifying Mental Health Issues Associated with Infertility. The Journal for Nurse Practitioners, 19(2). https://doi.org/10.1016/J.NURPRA.2022.09.024