Now they are clawing back this expansion. The core elements are just as firmly enshrined in law and practice as they were decades ago. This is not to say that the recent wave of de-insurance is not without consequences. Aside from the regressiveness of de-insurance, the other main consequence is to reveal yet again the arbitrariness of the definition of medical necessity. Most insurance involves the pooling of risk in a population, all of whom hope never to experience the event that triggers a payout.
Health care is different.
It is expected that the population will use the services at regular intervals, and the service use is, in many cases, not a sign of a catastrophic or unwelcome bit of bad luck, but as an important and positive universal service. Fourth, even within the narrow definition of medical necessity as enshrined in the Canada Health Act , the system has expansionist tendencies. Doctors and hospitals can do many more things than they could 30 years ago. Hospitals are involved in a much wider range of diagnostic and therapeutic activities, even while average length of stay declines persistently. Therefore, restricting the definition of medical necessity to hospitals and doctors does not necessarily mean restricting the range of services to which the public has access as a matter of entitlement.