Canada - World Health Organization Regional Office for Europe

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