Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
Canada - World Health Organization Regional Office for Europe
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<strong>Health</strong> systems in transition <strong>Canada</strong> xxi<br />
capture economies of scale and scope in service delivery as well as reduce<br />
infrastructure costs, there has been a trend to greater centralization, with<br />
provincial ministries of health reducing the number of RHAs. Two provinces,<br />
Alberta and Prince Edward Island, now have a single RHA responsible <strong>for</strong><br />
coordinating all acute and long-term care services (but not primary care) in<br />
their respective areas.<br />
Influenced chiefly by quality improvement initiatives in the United States<br />
and the United Kingdom, provincial ministries of health have established<br />
institutions and mechanisms to improve the quality, safety, timeliness and<br />
responsiveness of health services. Six provinces have established health<br />
quality councils to accelerate quality improvement initiatives. Two provincial<br />
governments also launched patient-centred initiatives aimed at improving the<br />
experience of both patients and caregivers. Most ministries and RHAs also<br />
implemented some aspects of per<strong>for</strong>mance measurement in an ef<strong>for</strong>t to improve<br />
outcomes and processes. Patient dissatisfaction with long wait times in hospital<br />
emergency departments and <strong>for</strong> certain types of elective surgery such as joint<br />
replacements has triggered ef<strong>for</strong>ts in all provinces to better manage and reduce<br />
waiting times.<br />
In contrast, there has been more limited progress on the intergovernmental<br />
front since the first ministers’ 10-Year Plan to Strengthen <strong>Health</strong> Care in 2004.<br />
Following that meeting, provincial and territorial governments used additional<br />
federal cash transfers to invest in shortening waiting times in priority areas,<br />
reinvigorating primary care re<strong>for</strong>m and providing additional coverage <strong>for</strong><br />
home care services that could substitute <strong>for</strong> hospital care. While a number of<br />
provincial and territorial governments introduced some <strong>for</strong>m of catastrophic<br />
drug coverage <strong>for</strong> certain groups of their own residents, they achieved very<br />
little in <strong>for</strong>ging a pan-Canadian approach to prescription drug coverage and<br />
management.<br />
Assessment of the health system<br />
In assessing per<strong>for</strong>mance, the medicare system has been effective in financially<br />
protecting Canadians against high-cost hospital and medical care. At the same<br />
time, the narrow scope of universal services covered under medicare has<br />
produced important gaps in coverage. In the cases of prescription drugs and<br />
dental care, <strong>for</strong> example, depending on employment and province or territory<br />
of residence, these gaps are filled by PHI and, at least in the case of drug<br />
therapies, by provincial plans that target seniors and the very poor. Where