Canada - World Health Organization Regional Office for Europe

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148 Health systems in transition Canada poses a challenge to Canadian Governments that have focused on improving the timeliness, quality and safety of health care. Recently, there have been improvements in quality outcomes as well as reductions in waiting times. As for health expenditure, Canada is almost identical to other OECD countries in terms of its recent experience, although the precise sources of cost pressures may vary. One of the most important recent cost drivers is health sector inflation, due mainly to recent increases in physician and nurse remuneration, as well as payments to other health care workers (CIHI, 2011b). This has been accompanied by a major increase in the utilization of prescription drugs. Overall, there has been a major reinvestment in public health care in Canada since the budget cutting of the early to mid-1990s. This has resulted in more doctors and nurses as well as an increase in the proportion of both relative to the general population. In addition, governments have invested heavily in capital infrastructure including medical equipment. In terms of imaging technologies such as CT and MRI scanners, Canada ranks average or higher than average among its OECD comparators. In a sense, Canadians have come full circle, from feast in the 1980s, to famine in the 1990s, and back to feast in the 2000s. The results of setting health reform priorities through F/P/T agreements have been mixed to poor. The decision by the federal government not to participate in future first minister meetings is in part a judgement on the lack of success in the past as well as a political view that the federal government should not be involved in an area that is within the primary constitutional jurisdiction of the provinces. With most governments in Canada running budget deficits, the lack of discussion between the two orders of government reduces the possibility of reaching a pan-Canadian consensus on health priorities in the years to come. As a consequence, innovation is more likely to come from individual provinces and territories in a more constrained fiscal environment than the one that governments in Canada enjoyed during the past decade.
9. Appendices 9.1 References Abelson J, Eyles J (2004). Public participation and citizen governance in the Canadian health system. In: Forest PG, Marchildon GP, McIntosh T, eds. Changing health care in Canada. Toronto, University of Toronto Press:279–311. ACHDHR (2007). A framework for collaborative health human resource planning. Ottawa, Health Canada on behalf of the Advisory Committee on Health Delivery and Human Resources. ACHDHR (2009). How many are enough? Redefining self-sufficiency for the health workforce, a discussion paper. Ottawa, Health Canada on behalf of the Advisory Committee on Health Delivery and Human Resources. Adams D (2001). Canadian federalism and the development of national health goals and objectives. In: Adams D, ed. Federalism, democracy and health policy in Canada. Montreal, McGill-Queen’s University Press:61–105. Alberta Health and Wellness (2002). A sustainable health system for Alberta: report of the MLA Task Force on Health Care Funding and Revenue Generation. Edmonton, Alberta Health and Wellness. Allin S (2008). Does equity in healthcare use vary across Canadian provinces. Healthcare Policy, 3(4):83–99. Anis AH (2000). Pharmaceutical policies in Canada: another example of federal provincial discord. Canadian Medical Association Journal, 162(4):523–526. Armstrong P, Armstrong H, Scott-Dixon K (2006). Critical to care: women and ancillary work in health care. Toronto, Women and Health Care Reform. Asanin J, Wilson K (2008). “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Social Science & Medicine, 66(6):1271–1283. Auditor General of Canada (2009). Report of the Auditor General of Canada to the House of Commons: Fall 2009. Ottawa, Minister of Public Works and Government Services Canada. Axelsson R, Marchildon GP, Repullo-Labrador JR (2007). Effects of decentralization on managerial dimensions of health systems. In: Saltman RB, Bankauskaite V, Vrangbæk K, eds. Decentralization in health care. New York: McGraw-Hill for European Observatory on Health Systems and Policies:141–166. 9. Appendices
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Canada - World Health Organization Regional Office for Europe

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