Five major phases in the policy and health spending cycle, 1957–2019
| Pan-Canadian signature policies | Significance | PT health spending growth rate (real per capita)9 | Perception |
|---|---|---|---|
| Major boom phase, 1957–1975 | 12.7% | Physician shortage | |
| Hospital Insurance and Diagnostic Services Act, 1957 | PT single-payer hospital care coverage across Canada, subject to federal legislative criteria, stimulated demand for more physician care | ||
| Royal Commission on Health Services report, 1964 | Predicted looming shortage and recommended expansion of medical education | ||
| Medical Care Act, 1966 | First step in establishing PT single-payer medical care coverage across Canada subject to federal legislative criteria | ||
| Growth phase, 1976–1989 | 2.9% | Oncoming physician surplus | |
| Established Programs Financing, 1977 | Tying federal health transfers to rate of economic growth rather than provincial health spending | ||
| Hall Review of Medicare, 1980 | Concern about looming surplus of physicians | ||
| Canada Health Act, 1984 | Elimination of extra-billing opportunity to increase income | ||
| Bust phase, 1990–1996 | −0.3% | Physician surplus | |
| Barer–Stoddart report, 1991 | Host of recommendations including 10% reduction in medical school seats | ||
| PT Ministers of Health, Banff communiqué, 1992 | PT ministers cherry-picked measures from the Barer–Stoddart report to reduce physician supply | ||
| Canada Health and Social Transfer cuts, 1995 | Federal government makes massive (30%) cut to social transfer to PTs, including health | ||
| Minor boom phase, 1997–2009 | 4.0% | Physician shortage | |
| Romanow Commission report, 2002 | Called for a reinvestment in health care by Ottawa to lever transformation of system | ||
| Ten-Year Deal on Canada Health Transfer, 2004 | Guarantee of 6% annual rate of growth in transfers to close the “Romanow gap” | ||
| Very low-growth phase, 2010–2019 | 1.0% | 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, 2017 | Provided limited funding for mental health and home care rather than for medical care | ||
Note: PT = provincial and territorial.