Abstract

Canadian healthcare consistently underperforms. The Canada Health Act (1985) is far from ideal, but it has never been the main impediment to system improvement, and updating or replacing it has limited potential to effect transformational change. It is impractical to shift from a Beveridge-style tax-funded system to a Bismarckian social insurance approach. Improvement requires better policy, incentives aligned with goals and accountability for performance. The key ingredients are wisdom and courage.