DIDIER, René

L'administration de la santé au Canada - Paris : IIAP, juil./sept. 1987

Ever since confederation in 1867, public health administration has undergone several phases of ever-increasing Federal intervention in what has begun as a provincial responsability. An initial period in which Federal Government individually negotiated and subsidizes provincial programmes gave way to massive participation in the field of health: 1957 and 1966 legislation enabled it to finance medical care and hospitalization by reimbursing outlays. Both parties were satisfied since the provinces retained control of the health care system while Federal Government gave substance to its dream of increased centralization and national unification. The level and cost of health care to the public then showed spectacular growth. In the subsequent economic crisis, the Government reduced its share of rising cost through 1977 & 1984 legislation, thus provoking numerous conflicts in the provincial health care sector. Despite an uncertain future, national health has become a field for which the Constitution has effectively split responsabilities: provincial exercise of helth care duties has contributed variety (e.g. in administration, financing, quality of care) while the Federal Government has, through financing, gradually contributed greater coherence, and a common approach to problem-solving in public health