Mr. Speaker, I rise to speak on the subject of a private member's bill, C-284, an act to amend the Canada Health Act.
Under the Canadian Constitution the responsibility for health care falls primarily under the jurisdiction of the provincial and territorial governments. In other words, the provinces and the territories have a primary responsibility for the provision and delivery of health care services to the people of Canada.
This means that they act as planners, managers and administrators of their own health care systems. In practical terms, this includes negotiation of budgets with hospitals, approval of capital plans and the negotiation of fee agreements with medical associations. For its part the federal government by law is responsible for the promotion and preservation of the health of all Canadians. The Department of Health is responsible for bringing together parties on health issues of a national and interprovincial concern.
The federal government also assumes a responsibility for setting national policies and for providing health care services to specific groups such as treaty Indians as well as the Inuit.
It is appropriate when describing federal responsibilities in health care to note what the federal government cannot do. It cannot interfere in provincial and territorial responsibilities as defined under our Constitution. Nor can it be seen to be infringing on these responsibilities.
Bill C-284 attempts to require provincial and territorial health insurance plans to impose a responsibility on hospitals to disclose to emergency response employees whether a patient to whom they are providing service has an infectious or a contagious disease. I sympathize with the concerns of emergency response workers. They must be commended for accepting the fact that they are at
risk to exposure to diseases that may not be completely preventable in serving the public.
Indeed my wife and several members of my family are employed in the health care field as well as in the emergency response field. Therefore I understand and support the motives behind Bill C-284.
However, it is the provinces and territories that are responsible for all matters dealing with their hospitals. This represents what would be perceived as an intrusion on provincial and territorial responsibilities under our Constitution. It is not an easy solution as one would think. There is in this country a longstanding partnership between the federal, provincial and territorial governments with regard to health care.
The enactment of the Hospital Insurance and Diagnostic Services Act of 1957 and the Medical Care Act, 1966-67 established a framework for this partnership between governments. At this time the federal government provides a sharing of the cost of medically necessary hospital and physician services in return for the adherence of the provincial and territorial health insurance plans through the principles of a national program.
Federal legislation, the the Hospital Insurance and Diagnostic Services Act and the Medical Care Act recognized the constitutional position of provincial and territorial governments and left each with the responsibility of administering its respective plans.
Concerns over hospital user fees and extra billing by physicians led to the passage of the Canadian Health Act in 1984. This was achieved with all-party support. The federal government's aim in passing the Canada Health Act was to reaffirm its commitment to the original guiding principles expressed in earlier legislation. It was also to provide a mechanism to promote the provinces' and territories' compliance with the act's criteria, conditions and extra billing and user charge provisions.
In short, the Canada Health Act was intended to encourage reasonable access to necessary health care services on a prepaid basis for every resident of Canada. The provinces and territories have retained their responsibility of administering their health insurance plans under the Canada Health Act. They continue to be responsible for negotiations with physicians and hospitals.
Since the introduction of government sponsored health insurance, physicians have been free of the administrative constraints of managed care found in the United States and this continues under the Canada Health Act. Hospitals retain the freedom to charge for semi-private or private rooms and for meals and accommodations for chronically ill patients who are more or less permanently resident in hospitals.
The Canada Health Act's criteria are known to most Canadians and regarded as the defining principles of medicare. The principles of public administration, comprehensiveness, universality, portability and accessibility are valued and cherished by Canadians who will not accept changes to them. The results of a recent poll indicate that support for these national principles remain at an all-time high.
Provincial and territorial ministers of health share this support. On many occasions the provincial and territorial ministers reaffirmed their support for the principles of the act and their agreement to continue co-operation in interpreting and applying its provisions.
The Canada Health Act's criteria relate to the organization and delivery of health care services at the level of provincial and territorial health insurance plans. Bill C-284 proposes to add disclosure of infectious or contagious diseases to the Canada Health Act's criteria. However this addition deals with a hospital requirement, while the Canada Health Act pertains to provincial and territorial health insurance plans.
If such legislation could be enacted we would be concerned that it may give false assurances to emergency workers and their families that if they are not informed they are not infected. Unfortunately some diseases may not be detectable, at least using current methods, until some time after the infection. Solutions must be sought to meet this problem.
Health Canada has been involved with the prevention of infectious diseases and the protection of emergency response personnel for a very long time. 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 risks emergency responders face and the preventive and protective activities presently available.
In June 1995 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 a good example of how the provinces and territories look to the federal government to provide a leadership role in issues related to health protection.
I also have confidence in the ability of emergency response workers themselves, as those who are admirably qualified to find solutions, to join with us to alleviate the risk of infection along with the provincial and territorial health departments, along with health professionals and experts in infectious diseases. Given the large burden for our health that emergency response workers carry, I am sure that provincial and territorial governments are sympathetic, supportive, and eager to co-operatively find solutions. I know I am.
The evolution of federal, provincial, and territorial relations in health care has maintained a distinction in federal, provincial, and territorial roles in health care, which is consistent with the Constitution's definition of jurisdiction. This is clearly stated in the preamble of the Canada Health Act:
that it is not the intention of the Government of Canada that any of the powers, rights, privileges or authorities vested in Canada or the Provinces under the provisions of The Constitution Act, 1867 (formerly the British North America Act, 1867), or any amendments thereto, or otherwise, be by reason of this Act abrogated or derogated from or in any way impaired;
Some would argue that to pass Bill C-284 would disrupt this historical distinction and balance and for this reason it cannot be supported by the federal government.
I encourage all hon. members to participate in discussions about this important concern in their communities in order to find a way to protect the emergency response workers whose job it is to protect us all. Few would argue the fact that the problem is serious. It is incumbent on all levels of government to hammer out a solution. The time is now.