Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 29
Health Care in Canada concluded that the five principles had “stood the test
of time” and continued “to reflect the values of Canadians” (Romanow, 2002,
p.60). At the same time, the Romanow Commission recommended increasing
the modest conditionality of the Canada Health Act and adding a sixth
principle of accountability. However, most provincial governments oppose
additional conditionality of federal transfers, if only because it would reduce
their own fiscal flexibility and control over budgetary priority setting, and the
federal government has made no changes to the Canada Health Act since its
introduction.
In addition to providing financial security, universal medicare appears
to have had positive outcomes in reducing health disparities since it was
first introduced. In a study covering 25 years following the introduction of
universal medical care insurance in Canada, James et al. (2007) demonstrated
a major reduction in disparity as measured by the rates of death amenable to
medical care.
2.3 Organization
2.3.1 The provincial and territorial level
Each province and territory has legislation governing the administration of
a single-payer system for universal hospital and physician services that has
come to be known as medicare (Marchildon, 2009). In addition to paying for
hospital care, either directly or through funding for RHAs, provinces also set
rates of remuneration for physicians that are negotiated with provincial medical
associations (RHAs’ budgets do not include physician services). Provincial
governments also administer a variety of long-term care subsidies and services
as well as prescription drug plans that provide varying degrees of coverage
to residents. These non-medicare services have grown over time relative to
hospital and physician services and constituted roughly 40% of total provincial
and territorial health expenditures in 2011, compared with 23% in 1975 (CIHI,
2011e).
Provincial and territorial ministers of health are responsible for the laws and
regulations for the administration of universal coverage for medically necessary
hospital and physician services. In some jurisdictions, there are two separate
laws, one pertaining to inpatient services and the other to medical services,
while in other jurisdictions, both have been combined in a single law (see
section 9.3). In provinces and territories with RHAs, some of the minister of