The existence of the manual was revealed in a new book, Chronic Condition, by the Globe and Mail’s Ottawa-based national affairs columnist, Jeffrey Simpson.
The manual, a copy of which was shown to the Citizen by a former government official, makes it clear that the legislation does not preclude private, for-profit clinics from operating under the umbrella of the public health care system.
The Canada Health Act, the manual says, “cannot be interpreted to mean that services cannot be provided on a ‘for profit’ basis.
“It simply states that the organization, commission, or agency that administers the provincial plan cannot record a profit on its operations.”
The role of private entrepreneurs in Canada’s health care system has generated endless debate, much of it driven by political ideology.
In his new book, Simpson contends the government manual proves that the Canada Health Act need not impede reform: that the law allows for a flexible approach to the delivery of medical care, one that embraces private enterprise, so long as the public system pays for it.
“A misunderstanding of the Canada Health Act has become a straitjacket for medicare,” Simpson writes.
“The correct interpretation of the act, at least from those who wrote it and were charged with its implementation, is the one contained in the federal government’s own manual, which, to repeat, has never been made public.”
Simpson uncovered the document as he researched the history of the 1984 Canada Health Act, an iconic piece of legislation that established the conditions provinces must meet in order to receive federal transfer payments for health services.
The law was used by the federal government to crack down on provinces that allowed extra-billing and user fees.
The interpretation manual was written by three senior departmental officials who had been hand-picked by then Liberal health minister Monique Bégin to draft the legislation.
A letter, dated July 5, 1984, accompanies the manual and notes that it is “intended as an internal reference document.” It describes the manual as “a distillation of the policy positions taken in briefing notes, ministerial statements, departmental policy papers and deliberations of the House of Commons committee.”
Considered a cabinet document, the interpretation manual was treated as confidential. Only a limited number of people inside government even knew of its existence.
Simpson believes the Canada Health Act has been misinterpreted for so long because interest groups and political parties have “twisted the meaning for their own purposes.”
The role of private enterprise in health care continues to generate controversy.
In Ontario, a noisy debate has recently erupted over the pending sale of Shouldice Hospital, in Markham, to Centric Health Corp., a Toronto-based, publicly-traded health care company.
Shouldice, one of a handful of privately-owned hospitals in Ontario, specializes in the treatment of hernias.
The for-profit hospitals, opened before Ontario outlawed such facilities, were granted exemptions from the 1973 Private Hospitals Act.
Centric Health has agreed to pay $14 million to buy Shouldice from its current owners, but the province must first approve the deal.
In a recent letter to Health Minister Deb Matthews, the Ontario Health Coalition urged her to reject the expansion of for-profit health care and make Shouldice part of the province’s public, non-profit hospital system.
Coalition chairman Ross Sutherland said private hospitals siphon health care workers from public hospitals and skim off easy-to-treat patients that offer the best profit margins. He characterized Centric Health as a U.S.-controlled “health care giant.”
“This is exactly what the framers of public medicare in Canada wanted to guard Canadians against,” Sutherland charged.
Centric Health has said the Shouldice will operate exactly as it did under its previous, private owner.
The health care firm now operates rehab, diagnostic, homecare and surgical facilities in four provinces.
The Canada Health Act’s interpretation manual speaks directly to the issue of private hospitals.
“The Canadian heath system has always had (under the original health insurance legislation) and will continue to have under the Canada Health Act a role for private, for-profit hospitals.”
Even within public hospitals, the manual notes, there are private enterprises such as snack bars and convenience stores.
Original Article
Source: canada.com
Author: Andrew Duffy
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