Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong><br />
the physician members being funded on a blended capitation model. The<br />
Institute of Clinical Evaluative Sciences compared all five models in terms<br />
of emergency department visits in one year (2008/9–2009/10), and found that<br />
patients/clients enrolled in the community health centres and family health<br />
groups had considerably fewer emergency department visits that those enrolled<br />
with the family health organizations, the family health teams, and the family<br />
health networks (ICES, 2012).<br />
5.4 Inpatient care / specialized ambulatory care<br />
In <strong>Canada</strong>, virtually all secondary, tertiary and emergency care, as well as<br />
the majority of specialized ambulatory care, is per<strong>for</strong>med in hospitals. Based<br />
on the typology introduced by Healy & McKee (2002), the prevailing trend<br />
<strong>for</strong> decades has been towards the separatist model of acute care rather than a<br />
comprehensive model of hospital-based curative care. In the separatist model,<br />
the hospital specializes in acute and emergency care, leaving primary care to<br />
family physicians or community-based health care clinics and institutional care<br />
to long-term care homes and similar facilities. There are important exceptions<br />
and variations in <strong>Canada</strong>. In British Columbia, <strong>for</strong> example, a great deal of<br />
long-term care has been attached to hospitals. However, a clearly noticeable<br />
trend in <strong>Canada</strong> is <strong>for</strong> the consolidation of tertiary care in fewer, more<br />
specialized, hospitals, as well as the spinning off of some types of elective<br />
surgery and advanced diagnostics to specialized clinics.<br />
Historically, hospitals in <strong>Canada</strong> were organized and administered on a<br />
local basis, and almost all were administered at arm’s length from provincial<br />
governments (Boychuk, 1999; Deber, 2004). In the provinces and territories<br />
that have regionalized, hospitals have been integrated into a broader continuum<br />
of care either through direct RHA ownership or through contract with<br />
RHAs. Where the hospital is owned by the RHAs, the hospital boards have<br />
been disbanded and senior management are employees of the RHA. If the<br />
hospital is owned by religious or secular civil society organization – generally<br />
a non-profit-making organization with charitable status – it continues to have a<br />
board and senior management that is independent of the RHA. However, since<br />
independent hospitals derive most of their income stream from the RHAs, they<br />
generally con<strong>for</strong>m to the overall objectives of the RHA and are integrated to a<br />
considerable degree into the RHA’s continuum of care services.