Expanding Surgical Access in Canada Through Self-Governing First Nations
Trafford Crump1, Mariam Hegazy1
1Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC.
Healthcare Policy = Politiques De Sante
|May 26, 2026
Summary
First Nations in Canada may establish private surgical facilities on their lands to reduce long surgical wait times. Modern treaties offer a potential legal basis, but require further examination of health jurisdiction and legal ambiguities.
Area of Science:
- Health Services Research
- Indigenous Health Policy
- Canadian Healthcare Law
Background:
- Canada faces prolonged surgical wait times, leading to innovative healthcare models.
- Existing models sometimes compromise care continuity due to loopholes in the Canada Health Act (1985).
- First Nations lands present a unique context for exploring alternative healthcare delivery models.
Purpose of the Study:
- To assess the feasibility of establishing private surgical facilities on First Nations lands.
- To analyze the legal and jurisdictional frameworks governing First Nations' health services.
- To determine if modern treaties provide a basis for private healthcare initiatives.
Main Methods:
- Review of modern treaties and self-government agreements for First Nations near urban centers.
- Analysis of legal status and health jurisdiction provisions within these agreements.
- Identification of First Nations meeting inclusion criteria (within 200 km of urban centers).
Main Results:
- Five First Nations met the inclusion criteria for the study.
- Agreements grant varying degrees of self-governance in health services.
- Federal or provincial paramountcy may still apply, impacting First Nations' authority.
- Modern treaties may offer a legal foundation for private surgical facilities.
Conclusions:
- First Nations, under specific modern treaty provisions, may possess the legal standing to develop private surgical facilities.
- This could offer a solution to reduce surgical wait times in Canada.
- Further research is needed to clarify legal ambiguities and fully understand jurisdictional complexities.
