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The recognition of a health care service as medically necessary under the Canada Health Act is contingent on a variety of practical and political factors. This article examines how in vitro fertilization (IVF) came to be understood as a medically necessary service in Ontario, focusing on the establishment of public funding for one cycle of treatment. The article argues that the legitimacy of medical necessity in the contemporary period is tied to three interrelated factors: the recognition of a service as sufficiently "medical," as efficient and as urgent—that is, something to be funded now and not later. By applying this framework to the case of IVF in Ontario, the article demonstrates not only the ongoing malleability of medical necessity but also how the government of Ontario has mobilized the three aspects of medical necessity to make a case for the public funding of a highly contested health care service. [ABSTRACT FROM AUTHOR]

One of the promises of the Canada Health Act is portability-the principle of equitable access to health services wherever you live. Services for young children in northern and rural communities are structured with a one-size-fits-all funding model that inadvertently disadvantages lower population density areas. We use a socio-cultural approach to explore the barriers to access to rural early childhood services. With data from two research projects that each covered diverse rural contexts, we focused on service providers' and parents' experiences in accessing early intervention and early development programs and services for children with typical development, and those with developmental delay and/or diagnosed disabilities. The results affirm the value of rural and small town life and provide information for developing a more effective rural service delivery model for families with children with typical and atypical development. We demonstrate the way providers and parents make rural services work through 'relational functionality.' Parents and service providers rely on key community agents to help organize and innovate collaborative solutions to address lack of access to information, intermodal travel demands, and administrative divides. In short, we confirm an urbanistic policy bias in the per capita funding model. [ABSTRACT FROM AUTHOR]

The Canada Health Act (CHA) was adopted in 1984, to shore up a health-care system conceptualized in the 1960s. Under the CHA, universal coverage is limited to “medically necessary” hospital and physician services, to the exclusion of vital goods and services such as outpatient pharmaceuticals, dental care, long-term care, and many mental health services. Inequities resulting from these gaps in public coverage are partly to blame for pushing Canada’s health system to the bottom of recent international rankings. But there is more to modernizing Canada’s health care system, we argue, than filling these gaps in universal coverage. Every major health system review undertaken in Canada over the past decade has ended with a call for greater accountability, and rightly so: accountability is arguably the sine qua non of high-performing health systems. Whereas many countries have established open and rigorous processes for evaluating health goods and services, targeting public spending on those that deliver the biggest bang for buck, Canada’s governance mechanism for defining the medicare basket is passive, opaque and only tenuously evidence-driven. A move to expand medicare’s scope of coverage must be accompanied by improvements in this type of accountability. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports published within the journal related to 7th National Health Law Conference for meet emerging health challenges with the help of including global public health; the Canada Health Act; and end-of-life services.

Different categories of services present different policy issues for financing health care. This conceptual paper suggests four categories: (1) public health services for the entire population; (2) basic health care to individuals, where anticipated costs are small and relatively homogeneous; (3) potentially catastrophically expensive services to individuals, where costs are skewed but not predictable; and (4) potentially catastrophically expensive services to individuals, where anticipated costs are both skewed and predictable. Using Canadian and Manitoba data to illustrate some implications of the distribution of health expenditures, we suggest policies suitable for one category of services may not necessarily work for others. The small proportion responsible for incurring high health expenditures are not attractive candidates for voluntary risk pools, particularly in competitive markets. [ABSTRACT FROM AUTHOR]

A letter to editor is presented in response to article "Canada Health Act needs bite" by B. Sibbald and others in the 2016 issue.

The authors reflect on the Canada Health Act. Topics discussed by the authors include the five tenets of the Act including public administration, comprehensiveness and universality, the court case Chaoulli v. Quebec in which the court ruled that a one-year wait for a hip replacement violates provincial human rights law, and the advantages and disadvantages of health care delivery.