Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 21
The provinces exercise the primary policy responsibility for funding and
administering health care. In most provinces, health services are organized and
delivered by geographically organized RHAs, although in some there are severe
limitations on the scope of activities undertaken by RHAs (e.g. in Ontario,
RHAs have no responsibility over primary health care). RHAs have been
delegated by provincial ministers of health to administer hospital, institutional
and community care within defined geographical areas either by delivering
the services directly or by contracting with other health care organizations and
providers. However, RHAs are not responsible for pharmaceutical coverage
or physician remuneration. Instead, provincial ministries of health run drug
plans that subsidize the cost of prescription drug therapies for residents,
mainly for the poor or retired people who do not have access to PHI. Most
physicians have private practices but deliver services funded and paid for by
provincial ministries. Physicians receive remuneration based on fee-for-service
schedules or alternative payment contracts that are periodically renegotiated
with provincial ministries of health (see section 2.3.1).
Since health care is mainly a provincial responsibility, Canada’s ten
provinces and three territories are responsible for providing Canadians with
coverage for medically necessary hospital and physician services as well as
access to other health goods and services. Delivery is effected through private
profit-making, private non-profit-making and public organizations as well as by
physicians who receive remuneration from provincial ministries of health – 74%
on a fee-for-service basis and 26% through alternative forms of remuneration.
The federal government is responsible for food and drug safety, pharmaceutical
patents and price regulation for branded drugs, and the enforcement of the
Canada Health Act through funding transfers to the provinces. The Government
of Canada also provides public health surveillance as well as funding and
infrastructure for health data and health research. Through the Canada Health
Transfer to the provinces and territories, the federal government has the capacity
to enforce some national conditions for insured services as defined under the
Canada Health Act.
Fig. 2.1 is a highly simplified overview of the governance of publicly
financed health care in Canada.