Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 57
pressure on governments to establish less difficult complaints procedures. As
a consequence, some provincial and territorial ministries of health (through
external ombudsmen offices or a ministry office), RHAs and hospitals have
established internal complaints procedures, although the main remedy remains
private – through complaints to private professional regulatory authorities at the
provincial and territorial level of government. These complaints can range from
concerns about the poor bed manners of some health professionals at one end of
the spectrum to allegations of life-threatening medical errors (for a discussion
of the possibility of obtaining redress through the tort system, see section 2.8.2).
2.9.5 Public participation, patient satisfaction and patientcentred
care
Other than through general participation in the political system, there are
few formal vehicles for direct public participation in health system decisionmaking.
At the time regionalization was introduced in Canada, one of the stated
objectives was to extend public participation through elected RHA boards. For
the most part, this objective was either not implemented or, when implemented
in a few jurisdictions, was altered subsequently (Lewis & Kouri, 2004; Chessie,
2009). Today, the majority of RHA board members are appointed by provincial
ministers or ministries of health and participation is largely limited to input
from self-selected or appointed citizen advisory groups (Chessie, 2010).
Based on the results of recent Commonwealth Fund surveys of all patients
(HCC 2010b) and sicker patients (Schoen et al., 2011) in 11 high-income countries,
Canadians expressed considerable dissatisfaction about numerous aspects of
provider access and the quality of the services they received (Table 2.5). In the
more general 2010 survey, Canadians had among the poorest outcomes in terms
of access to a doctor or nurse, waiting times for elective surgery or to see a
specialist, and the highest reliance on emergency departments for care (Schoen,
Osborn & Squires, 2010). Consequently, 61% of the patients sampled felt that
the Canadian health system was in need of fundamental reforms or to be rebuilt
completely, which was lower than in Australia (75%) and the United States
(68%) but higher than France (58%), Sweden (53%) and the United Kingdom
(37%). However, the 2011 survey results for sicker patients reflect better-thanaverage
results in terms of health system coordination and shared decisionmaking
with specialist physicians.