Defining basic services and de-insuring the rest: the wrong diagnosis and the wrong prescription.

The Canada Health Act of 1984 requires the provinces to cover all "medically necessary" services in order to be eligible for full federal contributions. However, neither the federal government nor any province has operationally defined the term "medically necessary service." As a result, coverage of certain medical services across the country is uneven. There is even greater variation in the coverage of nonmedical services (such as drugs and home care) that are not included in federal legislation. Recently, several provincial medical associations, with their respective provincial governments, have agreed to define and cover basic services and to de-insure services not found to be "medically necessary." The author argues that this process makes the wrong diagnosis of the cause of the woes of our health care system and then issues the wrong prescription. It also distracts decision makers from more worthwhile policies to reform the health care system.