Canada - World Health Organization Regional Office for Europe

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