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> 49<br />
Damage awards and, there<strong>for</strong>e, malpractice insurance costs are lower in<br />
<strong>Canada</strong> than the United States <strong>for</strong> a number of reasons, including the more<br />
restricted practice of contingency billing by lawyers; the lower damages<br />
awarded by Canadian courts, in which judges rather than juries assess the<br />
quantum of damages; and the policy of physician associations to fight rather<br />
than settle “nuisance” claims (Mohr, 2000). Un<strong>for</strong>tunately, these differences<br />
have not produced an environment in which Canadian physicians are more<br />
prepared than their American colleagues to report medical errors to patients<br />
(Levinson & Gallagher, 2007).<br />
There has been no major empirical study and reassessment of medical<br />
malpractice in <strong>Canada</strong> since the Prichard study commissioned by F/P/T<br />
deputy ministers of health in the late 1980s (Prichard, 1990). Despite the<br />
serious problems associated with the private tort system, the Prichard Report<br />
nonetheless rejected the policy alternative of governments moving to a no-fault<br />
compensation system, and medical malpractice remains in place in every<br />
province and territory.<br />
There are three different approaches taken by provinces and territories to<br />
provider regulation in <strong>Canada</strong>. The first approach – licensure – grants members<br />
of a profession (e.g. doctors and RNs) the exclusive right to provide a particular<br />
service to the public. The second – certification – allows both members and<br />
non-members of a profession (e.g. psychologists) to provide services to the<br />
public, but only certified or registered members can use the professional<br />
designation. The third approach – the controlled acts system – regulates a<br />
specific task or activity.<br />
While the specific regulatory approach <strong>for</strong> provider groups can vary<br />
considerably across provinces and territories, there is remarkable consistency<br />
in approach among certain professions such as physicians, nurses and<br />
dentists across all jurisdictions. Moreover, there have been considerable<br />
intergovernmental ef<strong>for</strong>ts to address the issue of portability of qualifications<br />
among provinces due to each registered health profession having its own rules<br />
concerning the registration of its members within a province or territory. The<br />
self-regulated professions are expected to ensure that members are properly<br />
educated and trained and to en<strong>for</strong>ce minimal quality of care standards.<br />
In some provinces (British Columbia, Alberta, Saskatchewan, Ontario,<br />
Quebec, and New Brunswick), governments have also established health quality<br />
councils to work with the health professionals and health care organizations to<br />
improve quality standards and outcomes as well as report quality outcomes<br />
to the general public. However, none of these organizations has a mandate to