Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Health</strong> systems in transition <strong>Canada</strong> xix<br />
Provision of services<br />
Although it is difficult to generalize given the decentralized nature of health<br />
services administration and delivery in <strong>Canada</strong>, the typical patient pathway<br />
starts with a visit to a family physician, who then determines the course of basic<br />
treatment, if any. In most provinces, family physicians act as gatekeepers: they<br />
decide whether their patients should obtain diagnostic tests, prescription drugs<br />
or be referred to medical specialists. However, provincial ministries of health<br />
have renewed ef<strong>for</strong>ts to re<strong>for</strong>m primary care in the last decade. Many of these<br />
re<strong>for</strong>m ef<strong>for</strong>ts focus on moving from the traditional physician-only practice to<br />
interprofessional primary care teams that provide a broader range of primary<br />
health care services on a 24-hour, 7-day-a-week basis (although progress here<br />
is slow). In cases where the patient does not have a regular family physician or<br />
needs help after regular clinic hours, the first point of contact may be a walk-in<br />
medical clinic or a hospital emergency department.<br />
Illness prevention services, including disease screening, may be provided by<br />
a family physician, a public health office or a dedicated screening programme.<br />
All provincial and territorial governments have public health and health<br />
promotion initiatives. They also conduct health surveillance and manage<br />
epidemic response. While the Public <strong>Health</strong> Agency of <strong>Canada</strong> (PHAC)<br />
develops and manages programmes supporting public health throughout <strong>Canada</strong>,<br />
the responsibility <strong>for</strong> most day-to-day public health activities and supporting<br />
infrastructure remains with the provincial and territorial governments.<br />
Almost all acute care is provided in public or non-profit-making private<br />
hospitals although some specialized ambulatory and advanced diagnostic<br />
services may be provided in private profit-making clinics. Most hospitals<br />
have an emergency department that is fed by independent emergency medical<br />
service units providing first response care to patients while being transported<br />
to emergency departments.<br />
As <strong>for</strong> prescription drugs, every provincial and territorial government has a<br />
prescription drug plan that covers outpatient prescription drugs <strong>for</strong> designated<br />
populations (e.g. seniors and social assistance recipients), with the federal<br />
government providing drug coverage <strong>for</strong> eligible First Nations and Inuit users.<br />
These public insurers depend heavily on HTA, including the Common Drug<br />
Review (CDR) conducted by the Canadian Agency <strong>for</strong> Drugs and Technologies<br />
in <strong>Health</strong> (CADTH), to determine which drugs should be included in their<br />
respective <strong>for</strong>mularies. Despite the creation of a National Pharmaceuticals