Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 9
the central government. Some provincial governments (e.g. Alberta) have
occasionally demanded less federal conditionality and greater flexibility in
terms of the Canada Health Act.
Unlike the provinces and territories, local or municipal governments are
not constitutionally recognized. Instead, they are political units created under
provincial government law. Municipal and county governments are delegated
authority and responsibility by the provinces for the delivery of local public
services and infrastructure. Historically, local governments played a role, albeit
modest, in the administration and delivery of health services. However, the
Saskatchewan model of single-payer hospital and medical care services with
a centralized payment system administered by provincial governments was
eventually adopted by other provinces and territories (Taylor, 1987; Tuohy 2009).
Elections take place on average every four years for the federal House of
Commons as well as for provincial and territorial legislatures under a “first-pastthe-post”
electoral system 3 based on F/P/T constituencies. Political competition
occurs largely with the context of competitive and adversarial political parties. 4
Except for the social democratic New Democratic Party (NDP), provincial
parties are organizationally separate from political parties at the federal level.
The Prime Minister is the leader of the majority party in the House of Commons
and appoints the cabinet of ministers from among the elected members, a system
that is replicated in the provinces and one territory – Yukon. Currently, there are
four national political parties that attempt to run candidates in all constituencies
in Canada: the Conservative Party of Canada, the NDP, the Liberal Party of
Canada and the Green Party of Canada. There is also a regional party – the Bloc
Québécois – but its influence was severely diminished after the 2011 federal
election. Established in the early 1990s to advance Quebec’s independence
from the Canadian federation, the Bloc regularly defends what it defines as
Quebec’s interests in the Parliament of Canada, and supports a progressive
decentralization of power and authority from the central government to the
provinces. In the federal election of 2006, the Conservative Party of Canada
under leader Stephen Harper defeated a Liberal Government that had been in
power since 1993. The Harper Conservatives were defeated on a motion of
non-confidence but won a second minority government in 2008 and a majority
government in 2011 (Table 1.6).
3 Each voter selects one candidate. All votes are counted and the candidate with the most votes in a defined
geographical constituency is the winner irrespective of the votes garnered by the candidate’s political party on
a national, provincial or territorial basis.
4 There are two exceptions to this rule: the territorial governments in Nunavut and the Northwest Territories are
formed by individual members elected without party affiliations, and cabinet membership is decided by the votes
of the members of the legislative assemblies.