Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong><br />
<strong>Organization</strong> and governance<br />
<strong>Canada</strong> has a predominantly publicly financed health system with approximately<br />
70% of health expenditures financed through the general tax revenues of the<br />
federal, provincial and territorial (F/P/T) governments. At the same time, the<br />
governance, organization and delivery of health services is highly decentralized<br />
<strong>for</strong> at least three reasons: (1) provincial and territorial responsibility <strong>for</strong> the<br />
funding and delivery of most health care services; (2) the status of physicians as<br />
independent contractors; and (3) the existence of multiple organizations, from<br />
regional health authorities (RHAs) to privately governed hospitals, that operate<br />
at arm’s length from provincial governments.<br />
Saskatchewan was the first province to implement a universal hospital<br />
services plan in 1947. Ten years later, the federal government passed the Hospital<br />
Insurance and Diagnostic Services Act which outlined the common conditions<br />
that provincial governments had to satisfy in order to receive shared-cost<br />
financing through federal transfers. In 1962, Saskatchewan extended coverage<br />
to include physician services and, in 1966, the federal government introduced<br />
the Medical Care Act to cost-share single-payer insurance <strong>for</strong> physician costs<br />
with provincial governments. By 1971, all provinces had universal coverage<br />
<strong>for</strong> hospital and physician services. In 1984, the federal government replaced<br />
the two previous acts with the <strong>Canada</strong> <strong>Health</strong> Act, a law that set pan-Canadian<br />
standards <strong>for</strong> hospital, diagnostic and medical care services.<br />
Most health system planning is conducted at the provincial and territorial<br />
levels although in some jurisdictions RHAs engage in more detailed planning of<br />
services <strong>for</strong> their defined populations. Some provincial ministries of health and<br />
RHAs are aided in their planning by provincial quality councils and specialized<br />
health technology assessment (HTA) agencies. In recent years, there has been a<br />
trend towards greater centralization in terms of reducing or eliminating RHAs.<br />
Most health professions self-regulate under legal frameworks established by<br />
provincial and territorial governments.<br />
The federal government’s activities range from funding and facilitating<br />
data gathering and research to regulating prescription drugs and public<br />
health while continuing to support the national dimensions of medicare<br />
through large funding transfers to the provinces and territories. The F/P/T<br />
governments collaborate through conferences, councils and working groups<br />
comprised of ministers and deputy ministers of health. In recent years, this<br />
has been supplemented by specialized intergovernmental bodies responsible<br />
<strong>for</strong> data collection and dissemination, HTA, patient safety, in<strong>for</strong>mation and