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