Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 75
All provincial ministries of health continue to control physician budgets
and manage prescription drug plans centrally, both of which fall outside the
authority of RHAs. Long-term care facilities and organizations either have a
contractual relationship with RHAs or are operated directly by RHA staff. The
same applies to ambulance and palliative care organizations. In the case of the
contractual arrangements, RHAs negotiate the terms of contract including the
amount and terms of payment.
The major change initiated by regionalization is the shift from institutionspecific
and service-specific funding to one based on comprehensive funding
to RHAs responsible for multiple health sectors and with the latitude to allocate
funds to each sector based on the needs of a defined population (McKillop,
2004). Whether this has actually improved overall results in terms of the quality
of care, efficiency or overall cost requires further study. More research is also
needed concerning the precise payment methods used by RHAs and their
impact on health system outcomes.
3.4 Out-of-pocket payments
Since universal medicare in Canada precludes extra billing or user fees, OOP
payments are only relevant to the mixed and private health sectors. Informal
payments are almost non-existent in Canada: they have not been documented
in any provincial or territorial health system.
OOP payments make up more than 50% of expenditure on privately financed
health services and products. In particular, OOP payments form the chief source
of funding for vision care, over-the-counter pharmaceuticals and CAM.
3.5 Private health insurance
PHI is relegated to non-medicare sectors such as dental care, prescription drugs,
long-term care and support, as well as a few non-medically necessary physician
and hospital services. As a share of private health spending, PHI has grown
relative to OOP expenditure since the late 1980s. In 2008, PHI spending per
capita was C$624, and PHI was more important than OOP payments in funding
prescription drugs and dental care. Of the C$20.9 billion expended through PHI
in 2008, $8.5 billion was spent on prescription drugs, $6.0 billion on dental
care and $1.2 billion on hospital accommodation – mainly on private rooms
(CIHI, 2010b).