Canada - World Health Organization Regional Office for Europe

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