Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 143
There have been few studies of the technical efficiency of health systems in
Canada, in part because of the challenge posed by the large number of inputs as
well as outputs in a complex health system whether it is a RHA or a provincial
health system. However, there is increasing interest among OECD countries,
including Canada, in conducting some “value for money” assessments (OECD,
2010a,b).
At least to some extent, the recent application of “lean production”
methodologies in some provincial health systems and RHAs is an effort to
achieve greater technical efficiency. First developed by the Japanese care
manufacturer Toyota to achieve greater technical efficiency and higher quality
in automobile production, lean techniques were first adapted to three hospitals
in Ontario in 2005, followed by a RHA and a Catholic hospital in Saskatchewan
one year later. The objective of these lean projects ranged from reducing surgical
waiting times to improving patient safety (Fine et al., 2009). There has not yet
been a systematic evaluation of these and subsequent lean initiatives in Canada,
but one comparative study of its impact on 15 hospital emergency departments
in three countries – Australia, Canada and the United States – found that there
was a decrease in waiting times, total length of stay and the proportion of
patients leaving emergency departments without being diagnosed or treated,
as well as improvements in patient satisfaction (Holden, 2011).
7.6 Transparency and accountability
Health systems in Canada are more transparent today than in decades past due
to a number of trends and movements. Canadians, whether in their various
roles as citizen, taxpayer or patient, demand greater transparency of their
governments and health care organizations than in the past. On the supply side,
they now have access to information from a number of new provincial and
intergovernmental organizations including the Health Council Canada, which
provides accessible reports on the state of Canadian health care. In addition, a
number of think tanks also provide reports on health system issues that are of
concern and interest to Canadians.
Health Canada provides a yearly report to governments and the general
public on the Canada Health Act, including any information concerning
provincial governments that may be in breach of the Act and its five basic
criteria of public administration, comprehensiveness, universality, portability
and accessibility (Health Canada, 2011). However, concerns have been raised
about what is actually included in the basket of universal health services under