Government, Social Services
Canada Health Act, Guaranteed Income Supplement, Welfare Canada, Old Age Security, Human Resources Development Canada
All levels of government share the responsibility for social welfare in Canada. The chief federal agencies responsible for social service programs are Health and Welfare Canada and Human Resources Development Canada. The latter agency administers comprehensive income maintenance programs, such as the national pensions, old-age security, and unemployment insurance (known officially as the Employment Insurance program). Nationwide coordination is considered to be necessary for these programs. Ottawa also provides services for indigenous peoples and veterans. In addition, Ottawa provides block grants to provincial governments to help cover their expenditures in health, education, and public assistance. Ottawa spent C$57.3 billion on social services and another C$8.3 billion on health care in the fiscal year 1995 to 1996. This represented 7.3 and 1.1 percent of GDP, respectively.
The Child Tax Benefit, Employment Insurance, the Canada Pension Plan, and the Canada Health and Social Transfer (CHST) program are the chief forms of federal welfare service. The Child Tax Benefit is a monthly stipend paid to low- and modest-income families with children to help cover the costs of child maintenance. Employment Insurance provides income for up to a year, in the event of job loss, to workers who receive a salary or an hourly wage. The Canada Pension Plan supplies retirement and disability income and survivors’ benefits to older workers, keyed to the amount of their lifetime earnings. It is supplemented by Old Age Security and the Guaranteed Income Supplement, which are paid to people over 65 regardless of how much they earned. The CHST program provides money to the provinces to administer programs for health care, higher education, social assistance, and other social services.
The administration of welfare services is mainly the responsibility of the provinces. Municipalities and other local entities actually provide the services, generally with financial aid from the province. Provincial governments also have the major responsibility for education and health in Canada, with municipalities assuming authority over matters delegated to them by provincial legislation. The provinces spend about 30 to 35 percent of their total budgets on health care and about 18 percent on social services.
State-funded medical health insurance was first enacted in Saskatchewan in 1947 by the provincial government. A national system was established with the Hospital Insurance and Diagnostic Services Act of 1957 and the Medical Care Act of 1966. In 1984 the Canadian Parliament consolidated these acts into the Canada Health Act. Under that law, the provinces must ensure that their health care systems meet the following criteria: (1) public administration—the health insurance plans must be administered by a public authority accountable to the provincial government; (2) comprehensive benefits—the plan must cover all medically necessary services prescribed by physicians and provided by hospitals; (3) universality—all legal residents of the province must be covered; (4) portability—residents must continue to be covered if they move or travel from one province to another; (5) accessibility—services must be made available to all residents on equal terms, regardless of income, age, or health needs. Private health insurance companies also operate in Canada, providing coverage for services beyond the regular system, such as ambulance fees and private hospital rooms.
Canada’s health system has successfully provided health services to all people regardless of income for many decades. Canada’s infant mortality rate, at 5 per 1,000, is one of the lowest in the world. Vaccination programs have brought diseases such as polio under control. Canadians have one of the highest life expectancies in the world and a generally high level of health throughout their lives. Most Canadians consider their health care system a sacred trust.
The incidence of most diseases in Canada is similar to that in other developed countries. The leading causes of death in 1993 were heart disease, 27.8 percent; cancer, 27.4 percent; and cerebrovascular diseases, 7.5 percent. There are no diseases unique to Canada. Infectious diseases are fairly rare, and incidence varies between socioeconomic groups. Tuberculosis, for example, once thought to be under control in Canada, is now widespread in indigenous communities. Attention also has focused on AIDS in recent years. The first known case in Canada was recorded in 1979; between then and July 1996 there were 13,810 documented cases and 9,969 deaths. In the early 1990s about 1,000 new cases were reported annually. The death rate of individuals with AIDS has declined dramatically in the past few years as new medications have been introduced.
However, the health system in the 1990s is being squeezed on the one hand by rising costs of delivery and on the other by reductions in funding from both Ottawa and the provinces. Costs are increasing for a variety of reasons: an aging population, increasing poverty, higher expectations for health services, population growth in some provinces and cities, intractable diseases such as cancer, new ones such as AIDS, and more-expensive treatment procedures. Governments concerned with deficit reduction are looking for ways to reduce costs; user fees for certain services, billing for extra physician visits, and private clinics have been suggested. Canadians are worried, however, about creating a two-tier system where the wealthy would have better access to care than the poor.
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