Canada - World Health Organization Regional Office for Europe

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