If you want to understand what keeps Canadian Medicare alive (I know you do!), it starts with the Canada Health Act. Think of it as the rulebook that stops provinces from drifting into a sliding into a health system that treats your bank account before it treats you. The act is simple on the surface, but it quietly shapes everything from your family doctor visit to your hip replacement. If you care about Medicare, this is the law to know.
Here is the act in plain English. The federal government gives provinces billions in health transfers every year. In return, provinces have to follow five core principles. If they break the rules, Ottawa can claw back funding. And it has done so many times.
Here are the five Canada Health Act principles and what they actually mean in real life.
1. Public Administration
Medicare plans must be run by a public authority on a not-for-profit basis. This does not mean there can never be private clinics. It means the provincial health plan that covers your medically necessary hospital and doctor services has to be run by the government, not by a private company. There is no carve-out that says a province can make part of it for profit or outsource pieces of the plan itself to private insurers.
What this allows: Private clinics providing services at the public rate and billing the provincial plan.
What this does not allow: A province turning its entire public healthcare plan into a for-profit insurance scheme.
2. Comprehensiveness
All medically necessary hospital and physician services must be covered under Medicare. The act does not define medically necessary. Provinces and physicians do that together, which is why coverage varies slightly across Canada.
What this allows: Coverage for surgeries, diagnostic imaging, hospital stays, physician visits, emergency care and more.
What this does not allow: Making people pay out of pocket for a Medicare covered surgery. You cannot charge for an MRI needed to diagnose a covered condition. You cannot make someone buy an add on package to access a basic procedure.
3. Universality
Every resident of a province or territory is entitled to equal medical coverage.
What this allows: Everyone with residency status is covered, regardless of income or health history.
What this does not allow: Two-tier entitlement. You cannot say that wealthy residents receive better public services. You cannot deny healthcare to someone because they are sick, poor or expensive.
4. Portability
Your Medicare coverage follows you across provinces and protects you when you travel.
What this allows: Temporary coverage when you are in another province, and limited emergency coverage outside Canada.
What this does not allow: Provinces refusing to cover you because you went away for a few months. They can ask you to maintain residency, but they cannot wipe out your Medicare protection overnight.
5. Accessibility
Medicare must be equally available to everyone. No one can be blocked because of cost, discrimination or physical barriers. This is the principle that gets violated the most when private clinics start up-selling.
What this allows: Clinics and hospitals to treat everyone equally under Medicare rules.
What this does not allow: Queue jumping by paying a fee. Clinics charging “assessment fees” to access a Medicare covered surgery. Add on bundles that are required rather than optional. Selling medically unnecessary upgrades that pressure patients into thinking they cannot get the basic Medicare version.
So can private care and Medicare co-exist? Yes. Here is how.
Private care is allowed as long as it does not replace, block or undermine the Medicare version of a medically necessary service.
Private care can co-exist with Medicare when it covers services not included in Medicare at all, like dental, vision or physio. It can also cover cosmetic procedures, elective upgrades or premium materials that go beyond the standard Medicare service. None of that violates the act.
What private care cannot do is create faster access to a Medicare covered treatment only if you pay. It cannot force people to buy add ons just to get the basic surgery. It cannot charge for medically necessary services that Medicare already pays for. That is exactly the kind of behaviour the act was written to stop.
What provinces can do without breaking the Canada Health Act
Provinces can contract private clinics to deliver publicly funded care. That has always been legal. They can also allow clinics to sell optional extras as long as people can still get the basic Medicare service for free. They can cover some services publicly and leave others to the private market. They have a lot of flexibility.
What provinces cannot do
They cannot allow extra billing for Medicare covered services. They cannot create financial barriers to access. They cannot build a two tier system inside the public system. They cannot let clinics upsell people into thinking they must pay to get the Medicare version. Every time this happens, it violates accessibility and comprehensiveness. And Ottawa has the power to dock health transfers, which it has done many times.
The point of the Canada Health Act is simple. It protects Medicare from being chipped away by private interests and political decisions that put profit above patients. It does not ban all private care, but it draws a clear line around the services Canadians expect to receive without paying out of pocket.
If Ontario and other provinces are going to keep expanding private clinics, the Canada Health Act is the only safeguard making sure Medicare stays publicly funded, publicly accessible and publicly accountable. Without it, the system would look very different.
Sources
Government of Canada. Canada Health Act Annual Reports.
Health Canada. Overview of the Canada Health Act.
Canadian Institute for Health Information.
Ontario Health Coalition. Reports on privatization and patient billing.
Medicare
Canada Health Act
Public health care
Privatization
Health policy
Canadian politics
