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144 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).
Health systems in transition Canada 145 In terms of holding governments and other public actors to account for the management of health systems at the national, provincial, regional and local levels, Canadians have benefited from more public reporting on indicators and performance measures. The work of the CIHI since its establishment in 1994 has been critical in providing the infrastructure and comparative methodologies to allow this to occur (Morris & Zelmer, 2005). In addition, the HCC’s mandate to provide health system information in an accessible form has also facilitated this type of public accountability. The council’s recent release of a popular guide to health indicators reflects this mandate (HCC, 2011c).
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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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Abstract Canada is a high-income co
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