Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
public coverage does not fill in the cracks left by PHI, equitable access is a
major challenge. Since the majority of funding for health care comes from
general tax revenues of the F/P/T governments, and the revenue sources range
from progressive to proportionate, there is equity in financing. However, to the
extent that financing is OOP and through employment-based insurance benefits
that are associated with better-paid jobs, there is less equity in financing overall.
There are disparities in terms of access to health care but outside of a few
areas such as dental care and mental health care, they do not appear to be large.
For example, there appears to be a pro-poor bias in terms of primary care use
but a pro-rich bias in the use of specialist physician services, but the gap in both
cases is not large. There is an east–west economic gradient, with differences
between less wealthy provinces in eastern Canada and more wealthy provinces
in western Canada. This is systematically addressed through equalization
payments from federal revenue sources made to “have-not” provinces to ensure
that they have the revenues necessary to provide comparable levels of public
services, including health care, without resorting to prohibitively high tax rates.
While Canadians are generally satisfied with the financial protection offered
by medicare, they are less satisfied with access to health care. In particular,
starting in the 1990s, they became dissatisfied with access to physicians and
crowded emergency departments in hospitals, as well as lengthening waiting
times for non-urgent surgery. Based on the results of a 2010 survey of patients
by the Commonwealth Fund, for example, Canada ranked behind Australia,
France, Sweden, the United Kingdom and the United States in terms of patient
experience with waiting times for physician care and non-urgent surgery. Using
more objective indicators of health system performance such as amenable
mortality, however, assessment of Canadian health system performance is
more positive, with much better outcomes than those observed in the United
Kingdom and the United States, although not as good as Australia, Sweden and
France. Canadian performance on an index of health care quality indicators
has also improved over the past decade as provincial governments, assisted by
health quality councils and other organizations, more systemically implement
quality improvement measures. Finally, governments, health care organizations
and providers are making more efforts to improve the overall patient experience.