Canada - World Health Organization Regional Office for Europe

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136 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
Health systems in transition Canada 137 treated (at least until a certain age), amenable mortality seeks to capture the extent to which the health system has, or has not, been effective at avoiding death (Nolte & McKee, 2004, 2008). This methodology is based on a host of mortality indicators that are then aggregated in a single amenable mortality scale. Table 7.3 Amenable mortality rates and rank in Canada and selected OECD countries for last available year Amenable mortality rate (age-standardized Last available year avoidable deaths per of data 100 000 population) Rank among 31 OECD countries Annual rate of change in amenable mortality from 1997 to last available year (%) Australia 2004 68 7 – 5.1 Canada 2004 74 11 – 3.4 France 2006 59 1 – 2.8 Sweden 2006 68 5 – 3.3 United Kingdom 2007 86 19 – 5.2 United States 2005 103 24 – 1.7 Source: Gay et al. (2011). Table 7.3 highlights the results of Canada and its comparators based on a larger study of 31 OECD countries in which age-standardized avoidable mortality ranged from a low of 59 to a high of 200 deaths per 100 000 population (Gay et al., 2011). While Canada’s amenable mortality rate was at the low end, it did not rank as high as France (in first position), Sweden and Australia. On the other hand, Canada performed considerably better than the United Kingdom and the United States. In addition, the annual rate of decline in amenable mortality, although substantially slower than the rates in Australia and the United Kingdom, was modestly higher than the rates of decline in Sweden and France, and double the rate in the United States. These results are consistent with a Canadian case study comparing the progress made (as measured by rates of decline in amenable mortality in the poorest neighbourhoods relative to the richest neighbourhoods) in 25 years following the introduction of universal medicare. While medicare has had an enormous impact on reducing the amenable mortality gap between poor and rich, this reduction in the disparity gap is due almost entirely to improving access to medical care as opposed to other types of health intervention. When examining amenable mortality in terms of public health interventions, there was little change over the same period, thus emphasizing the unrealized potential of public health policies, programmes and interventions (James et al., 2007).
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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The European Observatory on Health
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Canada - World Health Organization Regional Office for Europe

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