Canada - World Health Organization Regional Office for Europe

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