Executive Summary

2024 is a pivotal year in the evolution of Canadian healthcare, continuing a 20-year cycle of significant policy shifts since the birth of Medicare. Key turning points occurred in 1984 and 2004 and another is set to happen in 2024. The agreement at the 2023 First Ministers Meeting was just a first step in this pivot.

Central challenges include boosting transparency, addressing healthcare workforce shortages, and enhancing access to primary care. Moreover, the systems need to broaden their scope to encompass prescription coverage, mental health services, non-physician roles, the needs of an aging population, virtual care, and the recently added dental care program. The COVID-19 pandemic sharply highlighted these areas for improvement and expansion by revealing systemic weaknesses.

This report offers an analysis of the trade-offs in Canada's healthcare and sparks a dialogue on core funding principles. It is divided into two sections:

1. A concise history of Medicare, marking critical evolutions every 20 years in 1966, 1984, 2004, and the current 2024 period. It examines the growth of Canada's national healthcare within the bounds of provincial jurisdiction.
2. Proposals for 2024 reforms, following up on the 2023 First Ministers Meeting initiatives. This involves reassessing the Canada Health Act principles and integrating new emphases on equity, outcomes, wellness and consumer choice. These elements are crucial for driving forward the next stage of Canadian Medicare.