LAWS3508A final paper (1)
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Jan 9, 2024
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Access to health: Amendments to the Canadian Health
Act and Introducing Universal Basic Income
LAWS3508A
Dr. Nadine Ijaz
Submission date: 2023-12-11
Word count: 2163
1
Canada's healthcare system, which is frequently applauded for its accessibility and inclusion,
serves as a model for nations striving to promote their citizen’s well-being. The Canadian Health
Act establishes how and what “medically necessary” and “medically required” services are
insured through provinces and territories. This includes hospital services, doctor services, and
surgical-dental services. (Tiedemann, 2019) However, with determinants for what is considered
medically necessary and medically required being so broad, it has resulted in 30% of health care
being required to be either paid for out of pocket, through employment-based insurance, or
private insurance, one of the most common being dental care and prescription drugs (Chowdhury
& Chowdhury, 2018). While the Canadian Health Act has greatly contributed to Canadians
accessing immediate medical care, there are still significant limitations involving broader
determinants of health that need expansion to truly obtain a comprehensive and complete
healthcare system. The Canadian Health Act should be amended to include clear guidelines for
what is considered medically necessary and medically required at the federal level. Including
prescription drugs or pharmacare and dental care as equally essential for coverage. The
significance of these amendments is highlighted by the substantial risks to health associated with
untreated dental care and unmet prescription needs, which are exacerbated by existing financial
and insurance constraints. Furthermore, exploring the possibility of universal income to improve
the quality of life for all Canadians is necessary, as these limitations in the Canadian Health Act
prevent a major section of the working Canadian population from accessing preventative health
treatments, leading to an insufficient healthcare system.
The question is then, why should non-surgical dental coverage be considered a medically
necessary and required health service under the Canadian Health Act? While limited dental
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benefit programs have been put in place to aid the low-income elderly and low-income families,
there still stands a significant issue of middle-to-low income working class Canadians without
adequate access. As well, the risk factors associated with delaying necessary dental treatments
and preventative care can lead to severe oral health issues and a negative impact on the overall
quality of life of Canadians. The term working poor describes those who maintain employment
but are considered low-income, ranging from $22,017 to $29,343 annually (Quiñonez &
Figueiredo, 2010). The gap in this issue lies in the fact that the working poor cannot qualify for
employment-based insurance or welfare insurance, as they make just enough to not qualify for
welfare but are not provided with insurance through employment. In the scholarly journal “Sorry
Doctor, I Can't Afford the Root Canal, I Have a Job: Canadian Dental Care Policy and the
Working Poor," Quiñonez and Figueiredo explore the gaps within dental care policy for the
working poor. It was also found that, when compared to the Canadian Community Health
Survey, the working poor were significantly less likely to seek out dental care due to cost, as
opposed to the Canadian Community Health Survey population that deemed it unnecessary. With
no access to insurance and limited funds to pay for these health resources, as many as 1.5 million
Canadians are at a higher risk of worse oral health than those who are insured (Quiñonez &
Figueiredo, 2010). In the current economic climate, an increasing number of Canadians are
unable to afford dental care without insurance. In order to have a comprehensive and complete
healthcare system, the current health access gap for the working poor should be addressed
through clear guidelines under the Canadian Community Health Survey.
Further, dental health should be viewed as medically essential under the Canadian Health
Act just as physician visits are considered due to the health risks associated with unattended oral
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disease and the need for proactive health protection. Poor oral health is more commonly
considered not to be a high risk but is, in some cases, related to higher mortality. In the paper
“Oral Health Problems and Mortality” (Jung et al.) the association between the status of a
person's oral health risk and mortality is discussed. It was found that bad oral health was
associated with higher mortality but could also be an indicator of overall negative health
behaviours causing detrimental oral health. It is widely agreed that a lack of oral treatment can
lead to other health conditions, such as an increase in cardiovascular disease due to infections
entering the bloodstream. Overall, if dental issues are not treated, they can result in a variety of
dental diseases as well as death. (Jung et al.) Furthermore, dental disease can be significantly
prevented through regular visits to the dentist, making it essential that non-surgical dental
coverage is recognized as a medically necessary and mandated service under the Canadian
Health Act. As well as to prevent the need for emergency medical intervention and
overwhelming both the medical system and hospitals when it inevitably progresses.
Furthermore, Canadians' health goes far beyond just the need for adequate dental care but
also includes the need for coverage of outpatient prescription drugs. In the current age, it has
become harder to obtain quality employee insurance, afford private insurance, and work around
issues of income inequality (Marchildon, G., & Jackson, A. 2019). Outpatient prescription drugs
include any drug that is prescribed by a physician and fulfilled through a pharmacy or doctor's
office. This might include drugs such as birth control, antidepressants, and insulin. Many of these
prescriptions are vital for the well-being of Canadians and can be the difference between life and
death in some instances. Without a form of insurance coverage, many of these drugs become
unaffordable, affecting and impeding the quality of treatment prescribed by a physician. As
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discussed in the paper “Charting the Path to National Pharmacare in Canada” by Greg
Marchildon and Andrew Jackson, Canada is one of the few countries providing universal health
coverage that does not include outpatient prescription drugs as a part of the program. When it
comes to accessing health for Canadians, getting a prescription funded through a single-payer
plan at the federal level as opposed to a multi-payer plan would put Canada on the right path
towards having a comprehensive and complete healthcare system. As a result of a single-payer
system where the federal government is the one funding the care, there would be a decrease in
gaps in coverage. Prescriptions would be covered at a federal level, and the onus would not be on
Canadian residents to stress how they would get their necessary prescriptions covered, if at all.
This would be limited depending on their age, employment, or province. (Marchildon, G., &
Jackson, A. 2019) However, the lack of action may involve corporate greed, as pharmaceutical
and health insurance companies would lose profit if pharmacare was implemented. This is due to
decreases in health insurance needs and pharmaceutical companies having limits imposed on
which drugs the federal government would pick as the most cost-effective and proven to work.
Implementing prescription coverage into the Canadian Health Act could lead to not just covering
Canadian prescriptions but also holding pharmaceutical companies to higher data transparency.
Transparency with what is being given and the coverage of that drug go hand in hand. Overall,
transparency should be a prerequisite for funding and publishing. (Fierlbeck, K. et al. 2021). This
would lead to the best and most affordable drugs being federally funded, as opposed to the
money made from a more profitable multi-payer system, thus prioritizing the Canadian
individual's interests over the drug industry as well.
5
Further, outpatient prescriptions should be covered under the Canadian Health Act
because, for many, they are an essential part of preventative health, treating current conditions,
and the overall well-being of Canadians, as well as preventing the need for emergency medical
interventions. It was found in 2021 that as many as 21% of adults in Canada did not have
prescription insurance to cover costs. (Cortes, K. & Smith, L. (2022). For many uninsured
citizens, the costs of prescriptions can be too much to keep up with, resulting in a significant
number of people not receiving the medications they need. Moreover, access to medications and
prescriptions should be seen as essential for federal coverage under the Canadian Health Act.
This is because of the great effects on a person's quality of life and the substantial health risks
associated with not treating conditions due to financial or insurance constraints. Additionally,
prioritizing the needs of the individual’s access to health resources over the greed of pharmacy
and health insurance companies.
Exploring the issue further outside of the Canadian Health Act, another promising area
that could fill the gap within the healthcare system would be the implementation of universal
basic income. Universal basic income is a proposed system where the Canadian population is
given a minimum income for basic needs such as rent and food. By doing so, the Canadian
government would be investing in more preventative health-related issues and the overall health
outcomes of society. In 2017, Southern Ontario’s Basic Income pilot project took place, giving a
shining example of the potential that a model such as this had for lower-to-middle-class
Canadians. By examining the outcomes of what the possibility of implementing universal basic
income reveals, it is evident that there is a significant correlation between better socioeconomic
conditions and overall health outcomes improving alongside. By having a basic income,
low-income to middle-income Canadians would gain access to better quality foods, housing
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conditions, and opportunities to pursue higher education. As well as significant reductions in
stress, depression, and overall mental health struggles associated with the cost of living. It was
found that during the model, 79% had a positive change in overall well-being and 73.8% started
an educational or training program due to receiving basic income. (Ferdosi, M., et al. 2020). By
having a means to basic necessities, Canadians can put more resources into their overall health,
which would result in fewer visits to physicians (33%) and hospital emergency rooms (37%).
There was also easier access to dental care (74%), drug store medicines (83%) and professional
counselling services (50%) (Ferdosi, M., et al. 2020). Moreover, by examining the results of
what the possibility of implementing universal basic income could give Canadians, it is evident
that by improving the socio-economic conditions, overall health outcomes would improve as
well. This would lead to overall better access to health and less strain on the medical system, as
citizens would be able to afford the means to live healthier lives. There is a need for both
economic stability, such as the implementation of universal basic income and accessible
preventative care, to fill the gaps created by existing financial and insurance constraints.
Moreover, the Canadian Health Act should be amended to include clear guidelines for
what is considered medically necessary and medically required at the federal level. Including
prescription drugs or pharmacare and dental care as equally essential for coverage. The need for
dental care coverage is justified when looking at the substantial issue of the working poor and the
lack of sufficient access to dental care. For the uninsured, dental care is unfathomable and if
treatment is delayed, it can lead to severe oral health issues or medical emergencies. This makes
it just as medically necessary as other areas covered under the Canadian Health Act. Along with
this, the Canadian Health Act should include outpatient prescriptions covered under a
7
single-payer system. This would minimize gaps in coverage, promote increased transparency in
the pharmaceutical market, and have serious impacts on quality of life, as well as the severe
health risks connected with untreated diseases due to financial or insurance limits.
Overall, broadening the Canadian Health Act to include prescriptions and dental care
would be a critical step in aiding the inequities and financial struggles faced by many Canadians.
As well, introducing a universal basic income would also lead to a more sufficient healthcare
system that would promote a truly comprehensive healthcare model and the overall well-being of
Canadians. In essence, this approach addresses existing financial and insurance constraints while
recognizing the role that socioeconomic factors play in health outcomes. The broader relevance
lies in the systemic issues of creating a better healthcare system to ensure equal access to health
resources for all. By providing non-surgical dental care and prescription medications as
necessary services, the Canadian Health Care Act can rectify existing gaps in the system.
Further, by exploring the idea of universal income and addressing the socioeconomic side of the
discussion, it displays how economic factors play a role in creating an equal healthcare system.
Areas of future exploration that could benefit would be to examine in greater depth Canada’s
current healthcare system against others across the world. Examples include the Australian
healthcare system and the Netherlands healthcare system. This could help further promote
Canada's implementation of a more comprehensive healthcare model by seeing how some of the
top healthcare-performing countries implement health access laws. As well, it would be
beneficial to further explore the involvement of stakeholders within the healthcare system. This
could lead to more information regarding potential resistance to reforming the Canadian Health
8
Act including areas of substantial income for insurance companies and pharmaceutical
companies.
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9
References
Tiedemann, M. (2019). The Canada Health Act: An Overview.
https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/201954E
Chowdhury, M. Z. I., & Chowdhury, M. A. (2018). Canadian Health Care System: Who Should
Pay for All Medically Beneficial Treatments? A Burning Issue.
International Journal of Health
Services
,
48
(2), 289–301. https://www.jstor.org/stable/48513076
Quiñonez, Carlos, DMD, MSc, PhD, FRCDC, & Figueiredo, R., D.D.S. (2010). Sorry Doctor, I
Can't Afford the Root Canal, I Have a Job: Canadian Dental Care Policy and the Working Poor.
Canadian Journal of Public Health, 101
(6), 481-5.
https://proxy.library.carleton.ca/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-
journals%2Fsorry-doctor-i-cant-afford-root-canal-have-job%2Fdocview%2F840386807%2Fse-2
%3Faccountid%3D9894
Kim, J. K., Baker, L. A., Davarian, S., & Crimmins, E. (2013). Oral health problems and
mortality. Journal of dental sciences, 8(2), 10.1016/j.jds.2012.12.011.
https://doi.org/10.1016/j.jds.2012.12.011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885153/
Marchildon, G., & Jackson, A. (2019).
Charting the Path to National Pharmacare in Canada
.
Broadbent Institute.
https://books-scholarsportal-info.proxy.library.carleton.ca/uri/ebooks/ebooks4/cpdc4/2019-06-03
/1/10099349
Fierlbeck, K., Graham, J. E., & Herder, M. (2021).
Transparency, power, and influence in the
pharmaceutical industry: policy gain or confidence game?
University of Toronto Press.
https://books-scholarsportal-info.proxy.library.carleton.ca/uri/ebooks/ebooks6/upress6/2021-07-0
5/1/9781487529055
Cortes, K. & Smith, L. (2022).
Pharmaceutical access and use during the pandemic.
Statistics
Canada
https://www150.statcan.gc.ca/n1/en/pub/75-006-x/2022001/article/00011-eng.pdf?st=H4PAHitu
Ferdosi, M., et al. (2020).
Southern Ontario’s Basic Income Experience.
McMaster University
http://hdl.handle.net/11375/28173