Canada - World Health Organization Regional Office for Europe

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