Canada Health Act Violates Abortion Services
Five Basic Principles Not Met
by Joyce Arthur (copyright © November 2000)
Abortion is possibly the only essential medical service that does not meet the basic principles of the Canada Health Act. The five principles are public administration, comprehensiveness, universality, portability, and accessibility. Abortion services fail at least 4 out 5 of these tests.
To meet the Comprehensiveness principle, provinces must pay for all insured health services provided by hospitals and medical practitioners. Abortions performed in hospitals are covered across Canada. But abortions performed in clinics are not. Quebec and Nova Scotia provide only partial funding to clinics, and New Brunswick and Manitoba pay nothing. In 1995, then-Health Minister Diane Marleau ordered these provinces to pay full fees for abortions at clinics; otherwise, she would reduce their federal transfer payments via penalties. It's now five years later and not one of the delinquent provinces has yet to pay in full for a clinic abortion, and only Nova Scotia has had transfer payments withheld (over $200,000 so far).
This lack of clinic funding causes direct harm to women, especially poor women, because compared to clinics, hospitals have longer waiting lists, and offer women little privacy and no counselling. Also, hospital abortions pose a greater medical risk to women due to the use of general anesthesia. A non-funded clinic abortion can cost between $400 and $900, a sum that is often out of reach for poor women, who are then forced to wait several weeks for a hospital abortion, or wait until they save enough for a clinic abortion. Dr. Henry Morgentaler has said: "Every week of delay increases the medical risks to women by 20 percent." This amounts to government-sponsored violence against women, with poor women being hurt the most.
The practice of not funding clinics violates not only the comprehensiveness principle of the Canada Health Act, but also the universality principle, which says that all residents of a province must be covered equally for insured services. Due to quotas, waiting lists, gestational limits, and other onerous restrictions at hospitals, large numbers of women are discriminated against because they are forced to go to a clinic and pay for a service that should be fully insured.
The public administration principle is possibly also violated by lack of clinic funding, because clinics are forced to privately administer the costs of an essential medical service, when it should be a non-profit public body doing this.
Portability allows people moving to another province to be covered for the first three months of their residency by the health care insurance of the province in which they used to live. This is called reciprocal billing. In 1995, then-Health Minister Diane Marleau declared abortion to be a medically necessary service, since women can't wait three months for an abortion. But some provinces, including New Brunswick, Newfoundland, and others, still exclude abortion from their reciprocal billing lists, because they have refused to consider it an essential medical service. This forces some women who have just moved from another province to pay in full for their abortions.
A federal committee called the Coordinating Committee for Reciprocal Billing is responsible for solving the reciprocal billing problem, but the Committee wants consensus from all provinces to develop one exclusions list for all of Canada. Very recently, a consensus to drop abortion from the excluded list has finally been reached, but New Brunswick is delaying implementation because of old provincial anti-abortion laws that the province says it must strike down first. Although portability for abortion services across Canada now seems attainable, a few provinces held up the Committee's progress for years because of their leaders' political and moral views on abortion. Even after an agreement is put in place, the portability principle will continue to be violated, because only abortions in hospitals will be covered under reciprocal billing, not clinic abortions. Lack of portability also violates the universality principle, since new residents are discriminated against and denied funding for a medically necessary service.
The accessibility principle is violated because abortion services vary widely from province to province and region to region. PEI refuses to provide any abortion services whatsoever, not even in hospitals. PEI will fund abortions for women who travel to another province, but most hospitals in the Maritimes won't do abortions on out-of-province women, forcing PEI women to travel to Ontario or Quebec, or pay for a clinic abortion in New Brunswick. In addition, many provincial governments, including Manitoba, Nova Scotia, and New Brunswick, fought tooth and nail to keep abortion clinics out of their province. They failed, but there are still no clinics at all in Saskatchewan, PEI, or the territories.
In fact, two-thirds of abortions in Canada are still performed in hospitals, even though clinics are a better alternative for women. In spite of this monopoly, only about a third of hospitals in Canada actually perform abortions, mostly in big cities. As a result, women from rural and remote areas are often forced to travel long distances to find abortion services.
Health Minister Allan Rock recently pledged to uphold the principles of the Canada Health Act and not permit a system of two-tier medicine; but two-tier medicine is defacto in place for abortion services. When the quality, cost, timing, and availability of an essential medical service depends solely on where you happen to live in Canada, women are not getting fair access and the Canada Health Act is clearly violated. Perhaps the greatest injustice is that these violations disproportionately affect poor women, rural women, and minorities.
The federal government must step in and compel the provinces to fund all abortion services equally, whether in a clinic or hospital, and must ensure that all provinces cover abortion under their reciprocal billing arrangements. Provincial governments must ensure that enough hospitals perform abortions in all areas of the province, and that fully funded clinics are opened wherever feasible.