Canada - World Health Organization Regional Office for Europe

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