Canada - World Health Organization Regional Office for Europe

7. Assessment of the health system
In assessing performance, the Canadian health system has been effective in
financially protecting Canadians against high-cost hospital and physician
services. At the same time, the narrow scope of universal services covered
under medicare has produced important gaps in coverage. With regard to
prescription drugs and dental care, for example, depending on employment
and province or territory of residence, these gaps are filled by PHI and, at least
for drug therapies, by provincial plans that target seniors and the very poor.
Where public coverage of drugs and dental care does not fill in the cracks left
by private coverage, equitable access is a major challenge. Since the majority
of funding for health care comes from general tax revenues of the F/P/T
governments, and the revenue sources range from progressive to proportionate,
there is equity in financing. However, to the extent that financing is OOP and
through employment-based insurance benefits that are associated with betterpaid
jobs, there is less equity in financing.
There are disparities in terms of access to health care but, outside a few areas
such as dental care and mental health care, they do not appear to be large. For
example, there appears to be a pro-poor bias in terms of primary care use but
a pro-rich bias in the use of specialist physician services, but the gap in both
cases is not large. Canada’s east–west economic gradient, with less wealthy
provinces in the east and more wealthy provinces in the west, is systematically
addressed through equalization payments from federal revenue sources made
to “have-not” provinces to ensure they have the revenues necessary to provide
comparable levels of public services including health care without resorting to
prohibitively high tax rates.
While Canadians are generally satisfied with the financial protection offered
by medicare in particular, they are less satisfied with other aspects determining
access. In particular, starting in the 1990s, they became dissatisfied with access
to physicians and crowded emergency departments in hospitals as well as
7. Assessment of the health system