Under the Canada Health Act (CHA), only “medically necessary” hospital and physician services are universally covered. Other services such as prescription drugs, dental care, and long-term care are not. (Flood & Thomas, 2016). This is problematic, as many Canadians experience gaps in their health care access due to a procedure, treatment or medication deemed ineligible under what is considered “medically necessary.” Reportedly, some Canadians even forgo having a test done, or a follow up appointment, or filling a medication prescription, simply because they must pay for it out of pocket, and may not be able to afford to do so. (Flood & Thomas, 2016).
Arguments for modernizing the CHA include expanding upon the ambiguous definition of what is “medically necessary” to include prescription drugs, diagnostic tests, mental health services outside of hospital, home care, and dental care (Flood & Thomas). But how do we decide which services should be removed or added? What is needed, however, is health care system that is flexible and adaptable; fluctuating with the needs of Canada’s citizens in mind, in accordance to ever advancing medical technology and a system that takes into account the empirical evidence that supports the positive impact that a broader range of services will actually have a beneficial affect on Canadians’ overall health (Flood & Thomas, 2016).
I am very fortunate to have an amazing drug coverage plan under my benefits from work. My spouse requires medications to manage his ADHD, and a month’s supply is approximately $400.00. If we did not have coverage through my employer, my husband would not even consider filling a prescription as we simply could not afford it without private insurance from my work. This scenario is likely true for many other Canadians and why some individuals delay or simply avoid filling prescriptions due to exorbitant costs of medication (Flood & Thomas).
From a mental health perspective, there are massive deficiencies with the current CHA. “Mental health has long been recognized as a fundamental aspect of one’s health. (Canadian Civil Liberties Association CCLA, 2017). However, many mental health services are ineligible to qualify as “medically necessary” (CCLA). We know that 1 in 5 Canadians will experience a mental health challenge in their lifetime and the remaining 4 in 5 Canadians will experience the effects of mental illness, as they provide care for their loved ones. (Chandler & Flood, 2016).
For many individuals living with mental health challenges and their loved one experience a “fragmented system that does not meet their needs” (Chandler & Flood, 2016). Consider that individuals living with mental health challenges may require prescription medication to manage their symptoms, which accounts for the largest portion of Canada’s mental health spending (Chandler & Flood), but Canada still lags behind in providing these necessary medications and treatment modalities outside of hospital care. A natural consequence then, is that Canadians may place their mental health concerns on the backburner due to barriers to access mental health services. Changes must be made to expand the definition of medically necessary to include mental health supports and services as essential, as it could very well lead to decreased stigma and could also encourage more Canadians to make their mental health a priority (CCLA).
Canadian Civil Liberties Association (CCLA). (2017, February 9). The Current State of Mental
Health in Canada. Retrieved January 23, 2021 from The Current State of Mental Health in Canada - CCLA
Chandler, J. A., & Flood, C. M. (2016). Law and mind: Mental health law and policy in Canada. LexisNexis Canada.
Flood, C. M. & Thomas, B. P. (2016). Modernizing the Canada Health Act. Ottawa Faculty of Law Working Paper No. 2017-08. Retrieved from https://ssrn.com/abstract=2907029\
Health Canada. (2005, May 16). Canada Health Act - Links to Provincial and Territorial Health Care Web Resources. Retrieved January 20, 2021 from https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/provincial-territorial-health-care-resources.html
Photo 1: Asylum for the Insane (CAMH) (Photographer unknown)
Photo 2: CAMH revitalized (Photographer unknown)
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