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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2. <strong>Organization</strong> and governance<br />
<strong>Canada</strong> has a predominantly publicly financed health system with<br />
approximately 70% of health expenditures financed through the<br />
general tax revenues of the F/P/T governments. At the same time, the<br />
governance, organization and delivery of health services is highly decentralized<br />
<strong>for</strong> at least three reasons: (1) provincial (and territorial) responsibility <strong>for</strong> the<br />
funding and delivery of most health care services; (2) the status of physicians<br />
as independent contractors; and (3) the existence of multiple organizations,<br />
from RHAs to privately governed hospitals that operate at arm’s length from<br />
provincial governments (Axelsson, Marchildon & Repullo-Labrador, 2007).<br />
The Canadian provinces and territories are responsible <strong>for</strong> administering<br />
their own tax-funded and universal hospital and medicare plans. Medically<br />
necessary hospital, diagnostic and physician services are free at the point of<br />
service <strong>for</strong> all provincial and territorial residents. Historically, the federal<br />
government played an important role in encouraging the introduction of<br />
these plans, discouraging the use of user fees and maintaining insurance<br />
portability among provinces and territories by tying contributory transfers to<br />
the upholding of these conditions. Beyond the universal basket of hospital and<br />
physician services, provincial and territorial governments subsidize or provide<br />
other health goods and services, including prescription drug coverage and<br />
long-term care and home care. In contrast to hospital and physician services,<br />
these provincial programmes generally target sub populations on the basis of<br />
age or income and can require contributory user fees.<br />
Saskatchewan was the first province to implement a universal hospital<br />
services plan in 1947, closely followed by British Columbia and Alberta. The<br />
federal government passed the Hospital Insurance and Diagnostic Services Act<br />
in Parliament in 1957 which outlined the common conditions that provincial<br />
governments had to satisfy in order to receive shared-cost financing through<br />
federal transfers. In 1962, Saskatchewan extended coverage to include physician<br />
2. <strong>Organization</strong> and governance