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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<strong>Health</strong> systems in transition <strong>Canada</strong> 47<br />
In the provinces that are currently regionalized, provincial governments<br />
have laws that define, in very high-level directional terms, the division of<br />
responsibility and accountability between their respective ministries of health<br />
and RHAs. Some RHAs, such as the local health integrated networks in Ontario,<br />
are subject to targets based on per<strong>for</strong>mance measures. However, provincial<br />
ministers of health and provincial governments remain ultimately accountable<br />
to their residents <strong>for</strong> ensuring access to, as well as the timeliness and quality<br />
of, public health care goods and services.<br />
Although a similar accountability relationship exists in <strong>Canada</strong>’s three<br />
territories, these jurisdictions are constitutionally and fiscally dependent on the<br />
federal government. As such, they have been delegated the responsibility and<br />
accountability <strong>for</strong> the administration of public health care services as well as<br />
providing first-dollar coverage <strong>for</strong> medically necessary hospital and physician<br />
services. However, as a consequence of the territories having an inadequate tax<br />
base to fund such services – combined with the much higher cost of delivering<br />
services in the sparsely populated north – territorial governments are heavily<br />
reliant on federal fiscal transfers well beyond their per capita allocation<br />
under the <strong>Canada</strong> <strong>Health</strong> Transfer (Young & Chatwood, 2011; Marchildon &<br />
Chatwood, 2012).<br />
As noted above, the federal government provides some non-medicare<br />
health services to registered members of First Nation communities as well<br />
as eligible Inuit. In recent decades, this responsibility has been turned over<br />
to some indigenous communities through self-governing agreements (Minore<br />
& Katt, 2007). However, it is the Government of <strong>Canada</strong>’s position that the<br />
health programmes, services and insurance coverage it provides to First<br />
Nation and Inuit beneficiaries is on the basis of national policy and not due to<br />
any constitutional or Aboriginal treaty obligations, a position contested by a<br />
majority of First Nation and Inuit governments and organizations.<br />
While there is an active market <strong>for</strong> PHI that is either complementary or<br />
supplementary to medicare, PHI <strong>for</strong> medicare services is either prohibited or<br />
discouraged by provincial and territorial laws, regulations and long-established<br />
policy practices (Flood & Archibald, 2001) (see section 3.6). Both the federal<br />
and provincial governments are involved in regulating PHI, the vast majority<br />
of which comes in the <strong>for</strong>m of group insurance plans sponsored by employers,<br />
in which individual beneficiaries have limited or no choice of insurer (Hurley<br />
& Guindon, 2008; Gechert, 2010). The federal government is responsible <strong>for</strong><br />
regulating the solvency of insurance carriers, while the provincial and territorial