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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136<br />
<strong>Health</strong> systems in transition <strong>Canada</strong><br />
of the Canadian Constitution, and section 36(2) of the Constitution Act 1982<br />
stipulates that the Government of <strong>Canada</strong> is required to make “equalization<br />
payments to ensure that provincial governments have sufficient revenues<br />
to provide reasonably comparable levels of public services at reasonably<br />
comparable levels of taxation”.<br />
The <strong>Canada</strong> <strong>Health</strong> Transfer provides both explicit and implicit regional<br />
redistribution. Through the <strong>Canada</strong> <strong>Health</strong> Transfer, revenues that are collected<br />
on a national basis are redistributed to the provinces, and those provinces with<br />
shallower tax bases benefit from the revenues collected in provinces with deeper<br />
pockets. There is also explicit equalization currently built into the <strong>Canada</strong><br />
<strong>Health</strong> Transfer that assists less wealthy provinces. Under the <strong>Canada</strong> <strong>Health</strong><br />
Transfer and its predecessor, the <strong>Canada</strong> <strong>Health</strong> and Social Transfer, the <strong>for</strong>mula<br />
that calculated the share of each province involved a degree of equalization in<br />
which less wealthy provinces received slightly more per capita than wealthier<br />
provinces. After 2014, this element of equalization is to be terminated in<br />
favour of pure per capita payments. Nonetheless, as long as federal revenues<br />
fund some portion of provincial health care costs, there is some redistribution<br />
from wealthier parts of the country (where taxpayers pay more federal income<br />
and corporate taxes) to less wealthy parts of the country – an implicit <strong>for</strong>m of<br />
revenue redistribution that would not exist if provinces alone raised revenues<br />
<strong>for</strong> their own health care expenditures.<br />
7.4 <strong>Health</strong> outcomes, health service outcomes and<br />
quality of care<br />
7.4.1 Population health and amenable mortality<br />
Since the trends in health status have already been summarized in section<br />
1.5, this section will focus on improvements in population health that can be<br />
attributed to the health system. It is extremely difficult to disentangle the<br />
contribution of the health system to health, through organized programmes,<br />
policies and interventions to prevent and treat illness and injury. In the face of<br />
these difficulties, successive researchers have refined an approach known as<br />
amenable mortality to isolate the impact of the health system from the other<br />
determinants of health.<br />
Amenable mortality refers to death from selected diseases where death<br />
would not occur if those individuals had access to timely and effective health<br />
care. By isolating where death could be avoided and the condition in question