Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 135
care access, Canada ranks behind Australia, France, Sweden, the United
Kingdom and the United States. However, when it comes to the pressure on
emergency rooms after regular hours due to the lack of 24/7 primary care,
Canadians face roughly the same difficulty as patients in Australia, France,
Sweden and the United States. In light of these poor results, it is not surprising
that a majority of Canadians (61% in the sample) feel that the health system
is in need of either major reform or rebuilding compared with the much larger
percentage of Australians and Americans that have come to the same conclusion
about their respective health systems.
7.3.2 Equity of access to health care
The introduction of universal medicare improved access to, and the benefits
derived from, hospital and physician services (Enterline et al., 1973; van
Doorslaer & Masseria, 2004; James et al., 2007). Despite this important public
policy change in the 1950s and 1960s, inequities persist. Although these
inequities are concentrated in non-medicare sectors where financing is largely
private, they are also present in some services associated with medicare. Lower
income Canadians tend to use acute inpatient services more than higher income
Canadians but there is a pro-rich bias in terms of the use of specialist physician
services, as well as day surgeries (Allin, 2008; McGrail, 2008).
While the evidence concerning primary care is mixed, one fine-grained
study of British Columbia found that there was a higher use of primary care
physicians among poorer Canadians (McGrail, 2008). One study found
persistent inequities based on both education and income in the utilization
of mental health services (Steele et al., 2007) – a troubling result given the
increased incidence of mental illness in Canada. Other studies highlight the
degree to which inequities exist in the use of non-medicare services, including
dental care, rehabilitation, physiotherapy, occupational therapy and speech
pathology (Hutchison, 2007; Grignon et al., 2010).
In Canada, the goal of achieving greater regional equity has also shaped
health system financing. This “geographical” equity is pursued through two
instruments: the first is equalization and the second is the Canada Health
Transfer, two of the federal government’s largest annual expenditures. First
introduced when universal hospital insurance was established nationally,
equalization payments from the federal government provide provincial
governments that have shallower tax bases with the funding capacity to
administer programmes such as medicare. By the early 1980s, equalization was
considered such an important dimension of the federation that it was made part