Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 141
be healthier at least as measured by age-standardized mortality rates. This is
known as the healthy immigrant effect, an effect that declines as their years in
Canada increase (Ng, 2011). In terms of access to health care services, the lack
of language proficiency (in either English or French depending on province
of residence) is a barrier, especially for immigrant women (Pottie et al., 2008).
While there is evidence that barriers other than language, such as lower income
and sociocultural differences, also act as barriers in accessing health care
services, there are fewer health access disparities between immigrants and
non-immigrants in Canada compared with immigrants and non-immigrants in
the United States (Asanin & Wilson, 2008; Siddiqi, Zuberi & Nguyen, 2009).
The exceptions to the healthy immigrant effect are women from the United
States and sub-Saharan Africa (Ng, 2011).
There are other important gender differences in terms of health outcomes
and health service patterns in Canada. In particular, there is some evidence that
women, particularly older women, are less likely than men to receive critical care
that they need, and are more likely to die from critical illnesses (Fowler et al.,
2007). In addition, older women are at increased risk of receiving inappropriate
medications. These results cannot be generalized across all domains in part
because gender-based analyses are not a routine part of health research,
including clinical trials, despite the Canadian Institute of Health Research’s
policy supporting gender-based analysis. More importantly, without further
gender-based analyses, it is extremely difficult to understand the underlying
reasons for these gender-based differences in outcomes (Bierman, 2007).
In Canada, the majority of voluntary caregivers are women. In addition,
they work at this task, on average, much more intensively than men (Brazil
et al., 2009). Women also occupy the vast majority of the lower paid health
worker positions in hospitals and long-term care homes and carry out the tasks
of cleaning and caring for patients and residents. They also occupy most of the
ancillary and support positions in health system (Armstrong, Armstrong &
Scott-Dixon, 2006).
7.5 Health system efficiency
7.5.1 Allocative efficiency
Allocative efficiency stipulates that a health system distributes services in
“accord with the value that individuals place on those goods and services”
(Hurley, 2010, p.36). Where health goods and services are funded privately – as