Aspects of Medical Manpower under National Health Insurance in Canada

Abstract

caGaGm ANAD A has had universal hospital insurance since 1961 S and universal medical care insurance since 1971. Medical care insurance was enacted: 1) as an inevitable consequence of universal hospital insurance, 2) because of its successfiul adoption in Saskatchewan, and 3) because the federal government accepted the recommendations of the 1964-1965 Royal Commission on Health Services (the Hall Commission) that it enact federal-provincial cost sharing for medical care insurance. In this paper we will examine the effect of universal medical care insurance on medical (and to a small extent nursing) manpower in Canada. We also will look at some of the current issues at the interface between governments and physicians. Although the analysis is national, health care in Canada is primarily a provincial responsibility and manpower policies are made at the provincial level. However, in the early days of universal medical insurance, federal contributions to the funding of medical education gave rise to a strong federal presence in medical manpower policy. Since the late 1970S, federal support of medical education and health care has decreased. With or without financial support of medical education at the federal level, medical manpower is a national resource in all of Canada except Quebec; licensure is donejointly by the nine anglophone provinces and movement of physicians among them is essentially unrestricted. In recommending universal medical care insurance in 1964-1965, the Hall Commission report made a number of assumptions (1): 1. The existing physician to population ratio of 1:857 was a minimum optimal ratio. This ratio had to be maintained or improved because of anticipated increased use due to unmet need and increased demand for services. 2. Population growth at existing rates would continue.