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