Mr. Speaker, I rise to speak on Private Members' Bill C-284, an act to amend the Canada Health Act.
Let me say at the outset that I am extremely sympathetic and supportive of the plight and concerns of emergency response workers. Their devotion to preserving and protecting the lives of others often puts them unwittingly at risk of injury or exposure to disease. They are not aware of what the patient is carrying.
I understand and support the motive behind Bill C-284. Unfortunately, the Canada Health Act is the wrong instrument. The amendment is not within the scope of the act. The Canada Health Act sets out the broad principles under which the provinces are expected to operate medicare. An amendment dealing with the disclosure of infectious diseases is inconsistent with this purpose.
While the protection of health care workers from contagious diseases is an extremely worthwhile public health objective, the Canada Health Act is not the proper vehicle by which to achieve this. Let me explain.
Our health care insurance system is composed of 12 interlocking plans which are managed at the provincial and territorial levels. The federal health insurance legislation, which is what the Canada Health Act of 1984 is, establishes the criteria provincial plans must meet in order to qualify for a full share of federal health care transfers. Federal transfer payments may be reduced or withheld if a province contravenes the conditions of the act.
I will discuss these criteria, the cornerstones of Canada's health care system.
There is accessibility, which means access to medically required services regardless of ability to pay. That translates into no charges at point of service. There is comprehensiveness, which means a comprehensive range of medically required services. Universality means the coverage of all provincial residents must be given equally regardless of pre-existing conditions or diseases. Portability ensures that benefits go from province to province and abroad. Finally, public administration of medicare means that the plan must operate on a non-profit basis.
In addition to those five principles, the Canada Health Act requires that provinces provide medicare information to the federal minister when she needs it. In order to qualify for federal cash contributions, provinces also need to give recognition to the fact that the federal government does transfer payments.
The Canada Health Act also discourages extra billing or user fees. If this is broken, there will be automatic dollar for dollar reductions or withholdings of federal cash contributions to that province or territory. The threat that user charges and extra billing would erode accessibility to medicare was a major reason for the development of the Canada Health Act in the first place. It was enacted to protect those five fundamental principles of medicare I just spoke about. Nearly all provinces have committed themselves to upholding these principles even while making needed reforms to the system.
Canadians support the five principles and feel that medicare is a defining Canadian value. Results of a recent poll indicate that support for these national principles is higher than ever.
The Canada Health Act which defines medicare is close to the hearts of Canadians. It is something too risky to tamper with. The amendments to change the Canada Health Act as proposed in Bill C-284 by my hon. colleague cannot be supported.
The amendments ask that the name and nature of an infectious or contagious disease be disclosed to emergency response workers who may have been unknowingly exposed to that disease. While I support this objective, the amendments themselves affect the definition of hospital services. This will change the Canada Health Act criteria which deal only with the principles and funding of medicare. Rules are are set out concerning the non-compliance with the Canada Health Act and are part of the act.
In short, Bill C-284 asks that provincial and territorial plans impose a responsibility on hospitals to disclose to emergency response employees whether a patient to whom they are providing service has an infectious or contagious disease which is fine. However, it seeks to do this by making it a criteria of the Canada Health Act.
The disclosure of infectious or contagious diseases is a public health issue. It is not of the same nature as the principles and funding issues in the Canada Health Act. The protection of emergency response personnel is not even close to the purpose of the Canada Health Act.
Moreover, the act deals with the organization and delivery of health care services at the provincial and territorial levels and not with the regulation of internal operations of hospitals which falls under provincial and territorial jurisdiction. It would be intrusive to ask the federal government to impose on or intrude into the federal-provincial primary responsibility for hospital management which is a constitutionally protected right.
Moreover, Bill C-284 raises issues with regard to civil laws and rights and privacy laws in the provinces and territories. The federal government cannot really interfere in these issues.
What I am trying to say is that worthwhile though the member's intent may be, the Canada Health Act is not the proper place to regulate such matters which constitutionally fall under provincial jurisdiction and should be better handled at that level. The federal government cannot dictate to a province or territory how to run its health care plan, much less tell it how to run institutions. All it can do under the Canada Health Act is to place conditions on transfer payments to the provinces and territories.
At a meeting of health ministers in Victoria recently, provincial and territorial ministers reaffirmed their support for the principles of the act and agree to continue to collaborate in interpreting and applying its provisions. Provincial and territorial ministers agreed with the federal Minister of Health to work together to develop a vision for the future of medicare.
Contrary to the misunderstanding of certain parties, the Canada Health Act is not an impediment to the management changes which are needed to meet medicare's challenges. In fact, the flexibility inherent in the act has always been one of its strengths.
Since the enactment of the act in 1984, the federal government has attempted to work with the provinces in order to make the act a viable piece of legislation. The federal government recognizes that provinces and territories have primary responsibility for the management, organization and the delivery of health care services, including institutions and health care providers. Sufficient flexibility to operate and administer their health care insurance plans is obviously necessary if they are to meet the regional and local needs and conditions.
At the August conference, provincial premiers and territorial leaders were unanimous in their support of the publicly funded national health care system and reaffirmed their commitment to the principles of the Canada Health Act. It would be dangerous therefore, to tamper with those principles when they have received such wholehearted support. If we want medicare to survive, we must be vigilant against seemingly innocuous tampering as against more blatant threats such as user charges which as we know arise now and then.
I come back to the point that while the protection of health care workers is a serious concern and one which I share with the hon. member, the Canada Health Act is not the vehicle with which to address it. At the same time, the department has been involved with the prevention of infectious diseases and the protection of emergency response personnel for a very long time and is continuing to work with them on issues of concern. Let me give a few examples of our recent achievements in this area.
In 1994 a national symposium on risk and prevention of infectious diseases for emergency response personnel was held to explore the same question the member is talking about and to look at implementing where possible preventive and protective actions for those workers.
In June of this year a consensus conference was held with the objective of establishing guidelines the provinces and territories could use to develop and implement an infectious disease notification protocol for emergency responders. These guidelines are good examples of how the provinces and territories look to the federal government to provide a leadership and co-ordinating role in discussing issues related to health protection.
I have confidence in the ability of emergency response workers as the ones who are best qualified to seek solutions in conjunction with their provincial and territorial governments, health professionals and experts in infectious diseases. They have our support.
The Canada Health Act which protects our universal and comprehensive health care system agrees with that commitment. However, facing the challenges and finding solutions to problems which arise over the years took commitment as well and the commitment is still there today.
Today we can look back with pride on our past accomplishments, but we cannot be satisfied to rest on our laurels. The systems and the federal provincial relationships face many challenges and the issue raised by Bill C-284 is such a challenge. To this end, we as a federal Ministry of Health have taken the appropriate steps to support the concerns and efforts of the emergency response workers. At the same time the federal government cannot support an amendment which has no place in the Canada Health Act.
I encourage all hon. members to participate in the discussion of this issue with emergency response workers at the constituency level and to take appropriate steps to assist them in this important and worthy objective.