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