Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
Strategy following the 10-Year Plan agreed to by first ministers in 2004,
there has been little progress on a pan-Canadian catastrophic drug coverage
programme.
Rehabilitation and long-term care policies and services, including home
and community care, palliative care and support for informal carers, vary
considerably among provinces and territories. Until the 1960s, the locus of
most mental health care was in large, provincially run psychiatric hospitals.
Since deinstitutionalization, individuals with mental illnesses are diagnosed
and treated by psychiatrists on an outpatient basis even though they may spend
periods of time in the psychiatric wards of hospitals. Family physicians provide
the majority of primary mental health care.
Unlike long-term care and mental health, almost all dental care is privately
funded in Canada. As a consequence of access being largely based on income,
outcomes are highly inequitable. Complementary and alternative medicine
(CAM) is, with a few exceptions (e.g. chiropractors in some provinces) also
privately funded and delivered.
Due to the disparities in health outcomes for Aboriginal peoples, as well as
the historical challenge of servicing some of the most remote communities in
Canada, F/P/T governments have established a number of targeted programmes
and services. While Aboriginal health status has improved in the postwar period,
a large gap in health status continues to separate the Aboriginal population from
most other Canadians.
Principal health reforms
Since 2005, when the first edition of this study was published, there have been
no major pan-Canadian health reform initiatives. However, individual provincial
and territorial ministries of health have concentrated on two categories of
reform, one involving the reorganization or fine tuning of their regional health
systems, and the second linked to improving the quality, timeliness and patient
experience of primary, acute and chronic care.
The main purpose of regionalization (i.e. the introduction of RHAs to
manage services as purchasers or purchaser–providers) was to gain the benefits
of vertical integration by managing facilities and providers across a broad
continuum of health services, in particular to improve the coordination of
“downstream” curative services with more “upstream” public health and illness
prevention services and interventions. In the last ten years, in an attempt to