Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
services, these provincial programmes generally target sub populations on the
basis of age or income and can require user fees. On the private side, out-ofpocket
(OOP) payments and purchases of private health insurance (PHI) are
responsible for most health revenues. The vast majority of PHI comes in the
form of employment-based insurance for non-medicare goods and services,
including prescription drugs, dental care and vision care. PHI does not compete
with the provincial and territorial “single payer” systems for medicare.
Physical and human resources
The non-financial inputs into the Canadian health system include buildings,
equipment, information technology (IT) and the health workforce. The ability
of any health system to provide timely access to quality health services depends
not only on the sufficiency of physical and human resources but on finding
the appropriate balance among these resources. Both the sufficiency and the
balance of resources need to be adjusted continually by F/P/T governments in
response to the constantly evolving technology, health care practices and health
needs of Canadians.
Between the mid-1970s and 2000, capital investment in hospitals declined.
Small hospitals were closed in many parts of Canada and acute care services
were consolidated. Despite recent reinvestments in hospital stock by provincial
and territorial governments, in particular in medical equipment, imaging
technologies and ICT, the number of acute care beds per capita has continued
to fall, in part a result of the increase in day surgeries. While most of Canada’s
supply of advanced diagnostic technologies is roughly comparable to levels
in other OECD countries, it scores poorly in terms of its effective use of
ICT relative to other high-income countries. However, in recent years, some
advances have been made in this area.
After a lengthy period in the 1990s when the supply of physicians and
nurses, as well as other public health care workers, was reduced because of
government cutbacks, the health workforce has grown since 2000. Private
sector health professionals have seen even more substantial growth during this
period. Medical and nursing faculties have expanded in order to produce more
graduates. At the same time, there has been an increase in the immigration of
foreign-educated doctors and nurses and lower emigration to other countries
such as the United States.