Canada - World Health Organization Regional Office for Europe

8. Conclusions
In Canada, public and private coverage for health services is highly
segmented by health sector. Universal, first-dollar coverage is restricted
to medically necessary hospital and physician services. Other health goods
and services, including prescription drugs, rehabilitative care and long-term
care, are subject to targeted coverage or subsidies that cover some of the gaps
left by PHI and OOP payments, but where private funds are the major source
of financing, such as dental care, there are high levels of inequity in utilization
and health outcomes.
Setting and achieving pan-Canadian standards and objectives in a highly
decentralized federation requires considerable intergovernmental and intraprovincial
collaboration. The last two decades have produced a dense network
of intergovernmental agencies. While collaboration has succeeded in some
areas (e.g. ensuring universal accessibility to hospital and physician services),
it has been less effective in other areas (e.g. more effective use of IT). National
standards are extremely difficult to achieve in sectors other than hospital and
physician services. Historically, major shifts in policy direction may be easier
to achieve in unitary states with centralized health systems, but decentralized
systems may offer more opportunities for experimentation, as well as a rich
environment for evaluating natural experiments. This is the potential offered
by provincial health systems in Canada, a potential that could be more fully
exploited in future years.
While there has been a discernible movement to greater patient empowerment
in Canada in recent years, it remains relatively underdeveloped compared with
similar movements in most other OECD countries. This is despite the fact that
Canadians have a relatively poor view of at least some dimensions of their
system, including timeliness and patient responsiveness. Such low satisfaction
8. Conclusions