Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
CADTH makes a formulary listing recommendation; and (3) health ministries
make their own formulary and benefit coverage decisions on the basis of
their own drug formulary committees, policy environments and political
pressures. Provincial decisions can be influenced by the presence or absence
of a significant pharmaceutical industry presence. In Canada, the majority of
pharmaceutical production is concentrated in two cities – Toronto (Ontario)
and Montreal (Quebec).
2.8 Regulation
While provincial governments have primary jurisdiction over the administration
and delivery of public health care services, health ministries delegate actual
delivery to physicians and individual health care organizations. Health
facilities and organizations – from independent hospitals and long-term care
establishments to RHAs – are regulated by provincial governments. RHAs
are delegated authorities rather than governments and as such have no
law-making capacity. As a consequence, RHAs operate under provincial laws
and regulations. The medical and financial coverage provided to employees
under provincial and territorial WCBs are regulated by provincial and territorial
governments.
Health organizations, including RHAs and independent health facilities,
are accredited on a voluntary basis through Accreditation Canada, a memberbased,
non governmental organization. Most health care providers, including
physicians, nurses, dentists, optometrists, chiropractors, physiotherapists,
occupational therapists, are organized as self-governing professions under
provincial and territorial law.
2.8.1 Regulation and governance of third-party payers
Provincial and territorial ministries of health are the principal third-party
payers in Canada. All these governments administer their own single-payer
medicare coverage systems under their own laws and regulations (see section
9.3.2). As the principal payers, provincial ministries and RHAs work through,
and contract with, a range of independent health care organizations including
hospitals, day surgeries, diagnostic clinics, medical laboratories, emergency
transportation companies, long-term care organizations and primary health
clinics. Although this institutional arrangement appears similar to the internal
market in the United Kingdom, it does not imply the same purchaser–provider
arrangements as in the National Health Service (Boyle, 2011).