Canada - World Health Organization Regional Office for Europe

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