Table 1:

Five major phases in the policy and health spending cycle, 1957–2019

Pan-Canadian signature policiesSignificancePT health spending growth rate (real per capita)9Perception
Major boom phase, 1957–197512.7%Physician shortage
Hospital Insurance and Diagnostic Services Act, 1957PT single-payer hospital care coverage across Canada, subject to federal legislative criteria, stimulated demand for more physician care
Royal Commission on Health Services report, 1964Predicted looming shortage and recommended expansion of medical education
Medical Care Act, 1966First step in establishing PT single-payer medical care coverage across Canada subject to federal legislative criteria
Growth phase, 1976–19892.9%Oncoming physician surplus
Established Programs Financing, 1977Tying federal health transfers to rate of economic growth rather than provincial health spending
Hall Review of Medicare, 1980Concern about looming surplus of physicians
Canada Health Act, 1984Elimination of extra-billing opportunity to increase income
Bust phase, 1990–1996−0.3%Physician surplus
Barer–Stoddart report, 1991Host of recommendations including 10% reduction in medical school seats
PT Ministers of Health, Banff communiqué, 1992PT ministers cherry-picked measures from the Barer–Stoddart report to reduce physician supply
Canada Health and Social Transfer cuts, 1995Federal government makes massive (30%) cut to social transfer to PTs, including health
Minor boom phase, 1997–20094.0%Physician shortage
Romanow Commission report, 2002Called for a reinvestment in health care by Ottawa to lever transformation of system
Ten-Year Deal on Canada Health Transfer, 2004Guarantee of 6% annual rate of growth in transfers to close the “Romanow gap”
Very low-growth phase, 2010–20191.0%Physician shortage but also physician surplus
2011 decision to reduce health transfer escalator to 3%Although did not take effect until Trudeau administration, the policy was continued
Bilateral health transfers, 2017Provided limited funding for mental health and home care rather than for medical care
  • Note: PT = provincial and territorial.