Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
governments are responsible for regulating the actual insurance product,
including the design and pricing of the health coverage package as well as
consumer sale and service.
2.8.2 Regulation and governance of providers
Providers can be either organizations, such as RHAs, hospitals, long-term care
homes and medical clinics, or individual health professionals. Historically,
the vast majority of hospitals in Canada have been private, mainly non-profitmaking,
institutions that operated at arm’s length from provincial governments,
although some government regulation and supervision had long been accepted
by those hospitals accepting subsidies for indigent patients. However, with the
introduction of universal hospital coverage throughout Canada, the relationship
between hospitals and provincial governments became much closer, with
hospitals almost entirely reliant on public funding and governments ultimately
accountable for the use of public funds. With regionalization, hospitals have been
drawn into an even tighter relationship with provincial governments. Indeed, in
many provinces, the majority of hospitals are now owned and operated by the
RHAs, and the remaining independent hospitals are contractually obliged to
provide RHA residents with acute care services (Maddelena, 2006; Philippon
& Braithwaite, 2008). Except for Alberta and Quebec, accreditation remains
voluntary and nongovernmental in nature and is performed in all jurisdictions
by Accreditation Canada (see section 2.3.4).
Redress for medical malpractice and similar negligence based on the
common law of tort is pursued privately through the courts. 7 Both physicians
(as independent contractors as opposed to employees) and health organizations
(who are responsible for the quality and safety of the service delivered by their
salaried providers) can be sued. There is considerable debate concerning the
benefits of such lawsuits in terms of improving the standard and quality of
care. Moreover, there is some evidence that the incentives created by the
private tort system can potentially impede health care reform, especially the
establishment and effective functioning of multi professional primary health
care teams, by continuing to hold physicians accountable for any alleged
malpractice committed by a non-physician member of the team (Mohr, 2000;
Caulfield, 2004) (complaints procedures available to patients are described in
section 2.9.4).
7 In contrast to other provinces in Canada, Quebec has a civil code rather than common law, and medical
malpractice is governed under the provision regarding general civil liability under its civil code.