Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
the Canada Health Act. In particular, private citizens have occasionally taken
their provincial governments to court to have certain services added to the
basket using arguments based on the Charter of Rights and Freedoms, and
at least one scholar has argued that this is a useful mechanism for health care
accountability, particularly given the paucity of other processes available to
Canadian citizens (Jackman, 2010).
The Canada Health Act also stipulates that provincial and territorial
governments should acknowledge the transfer funding they receive from the
federal government, which is used to deliver public health care services to
their respective residents. Demands for greater transparency in terms of federal
transfers to provincial and territorial governments for health eventually led to
the federal government splitting its omnibus block transfer into two in 2004 –
the Canada Health Transfer dedicated to health, and the Canada Social Transfer
(McIntosh, 2004). This came years after federal–provincial wrangling over what
was the “real” value of the health portion of the block transfer, with the federal
government continually exaggerating its value, and the provincial governments
systematically underestimating its value (Marchildon, 2004).
Through their web sites, most provincial and territorial ministries of health
provide extensive information on their services, including a comprehensive
list of the provincial or territorial health care benefits and entitlements. With
some notable exceptions, provincial and territorial governments have also
been relatively transparent in terms of new health policy developments, in
part because of their extensive and public use of commissions and ministerial
advisory bodies during the past two decades. Inevitably, these processes
have involved public consultations and hearings. The Royal Commission on
the Future of Health Care in Canada, chaired by Roy Romanow, the former
Premier of Saskatchewan, conducted the most extensive set of consultations
with Canadians. Between 2001 and 2002, the Romanow Commission sponsored
open public hearings, televised forums, expert workshops, regional forums,
partnered dialogue sessions and a series of 12 one-day deliberative dialogue
sessions involving a random selection of almost 500 Canadian citizens
(Romanow, 2002; Maxwell et al., 2002; Maxwell, Rosell & Forest, 2003).
Beyond participating in parliamentary politics at the F/P/T levels of
government, direct public involvement in health governance has been limited
to more regional and local levels (Flood & Archibald, 2005). While there
was a movement towards citizen election to RHA boards in the early days
of regionalization, almost all RHA boards are now appointed by provincial
governments (Abelson & Eyles, 2004; Chessie, 2009) (see section 2.9).