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CANADA Organization of the Health System in Canada Canadian Constitution Provincial and territorial governments Transfer payments Federal government Statistics Canada Regional health authorities Ministers and Ministries or Departments of Health F/P/T Conferences of Ministers and Deputy Ministers of Health and Committees Minister of Health Canadian Institutes for Health Researh Mental health and public health providers Home care and long-term providers Hospital and medical services providers Canada Health Act. 1984 Health Canada Public Health Agency of Canada Patented Medicine Prices Review Board Provincial and territorial prescription drug programmes Canadian Agency for Drugs and Technologies in Health (1989) Canadian Institute for Health Information (1994) Canada Health Infoway (2001) Canadian Blood Services (1996) Canadian Patient Safety Institute (2003) Note: Solid lines represent direct relationships of accountability while dotted lines indicate more indirect or arm’s length relationships. Source: Adapted from G. P. Marchildon, “Canada: Health System Review,” Health Systems in Transition, vol. 15, no. 1, 2013, p. 22. Few formal disease registries exist, although many provincial cancer care systems maintain some type of patient registry. Provincial cancer registries feed data to the Canadian Cancer Registry, a national administrative survey that tracks cancer incidence. There is no national patient survey, although a standardized acute-care hospital inpatient survey developed by the Canadian Institute for Health Information has been implemented in several provinces. Each province has its own strategies and programs to address chronic disease (see below). What is being done to reduce disparities? By signing the Rio Political Declaration on Social Determinants of Health, Canada committed to reducing inequalities in health (Public Health Agency of Canada, 2011). Although no single body is responsible for addressing health disparities, several provincial or territorial governments have departments and agencies devoted to addressing population health and health inequities. Aboriginal health is a concern for federal as well as provincial and territorial governments; recent federal initiatives include the Aboriginal Diabetes Initiative, the National Aboriginal Youth Suicide Prevention Strategy, and the Maternal Child Health Program. The Public Health Agency of Canada includes in its mandate reporting on health disparities, and the Canadian Institute for Health Information also reports on disparities in health care and health outcomes (Canadian Institute for Health Information, 2015d). However, no formal and periodic process exists to measure disparities. 26 The Commonwealth Fund
What is being done to promote delivery system integration and care coordination? CANADA Provinces and territories have introduced several initiatives to improve integration and coordination of care for chronically ill patients with complex needs. These include Divisions of Family Practice (British Columbia) (Divisions of Family Practice, 2014), the Regulated Health Professions Network (Nova Scotia), and Health Links (Ontario). Also, Ontario has alternative community-based and multidisciplinary primary care models that are funded by the province and serve primarily vulnerable populations; these models include Community Health Centres and Aboriginal Health Access Centres. Also in Ontario, a pilot program that bundles payments across different providers is being expanded (from one to six communities) to improve coordination of care for patients as they transition from hospital to the community (Government of Ontario, 2015). As discussed above, some provinces also have implemented incentives to encourage physicians to provide guideline-based care for chronic disease. In Ontario, for example, Diabetes Education Programs (employing teams of diabetes education nurses and registered dieticians) support individuals and primary care physicians in providing guideline-based diabetes care (Government of Ontario, 2015a). Each province determines its own structure for the coordination of health and social care services. In Ontario, for instance, Community Care Access Centres are also responsible for coordinating services for vulnerable populations, particularly the elderly and individuals with disabilities, including health and social care services (e.g., supportive housing and meal delivery programs). In Ontario, there is a single ministry responsible for health and long-term care, with funding devolving to the regional level. What is the status of electronic health records? Uptake of health information technologies has been slowly increasing in recent years. Provinces and territories are responsible for developing their electronic information systems, with support from Canada Health Infoway; however, there is no national strategy for implementing electronic health records and no national patient identifier. According to Canada Health Infoway, provinces have systems for collecting data electronically for the majority of their populations (Canada Health Infoway, 2014). Interoperability, however, is limited (Ogilvie and Eggleton, 2012). In 2014, 42 percent of GPs reported using exclusively electronic records to enter and retrieve patient clinical notes, and 38 percent used a combination of paper and electronic charts (National Physician Survey, 2014). In the same survey, 87 percent of GPs report that their patients are not able to access their personal health record for any function, and only 6 percent reported that patients can request appointments online. How are costs contained? Costs are controlled principally through single-payer purchasing, and increases in real spending mainly reflect government investment decisions or budgetary overruns. Cost-control measures include mandatory global budgets for hospitals and regional health authorities, negotiated fee schedules for providers, drug formularies, and resource restrictions vis-à-vis physicians and nurses (e.g., provincial quotas of students admitted annually) as well as restrictions on new investment in capital and technology. The national health technology assessment process is one of the mechanisms for containing the costs of new technologies (see above). The federal Patented Medicine Prices Review Board, an independent, quasi-judicial body, regulates the introductory prices of new patented medications. This measure ensures that prices are not “excessive,” on the basis of their “degree of innovation” and by comparison with prices of existing medicines in Canada and in seven other countries, including the United States and the United Kingdom. The board regulates “ex-factory” prices but does not have jurisdiction over wholesale or pharmacy prices, or over pharmacists’ professional fees. However, prices of all patented drugs are reviewed regularly, and the board can intervene if price increases are deemed excessive. Since 2010, the Pan-Canadian Pricing Alliance also coordinates, across provinces, negotiations to reduce the prices of branded drugs. Jurisdiction over prices of generics and control over pricing and purchasing under public drug plans (and, in some cases, pricing under private plans) is held by provinces, leading to some interprovincial variation. “Choosing Wisely Canada” is a new publicly funded campaign that International Profiles of Health Care Systems, 2015 27
Page 1 and 2: JANUARY 2016 2015 International Pro
Page 3: 2015 International Profiles of Heal
Page 6 and 7: Table 1. Health Care System Financi
Page 8 and 9: Table 3. Selected Health System Per
Page 11 and 12: The Australian Health Care System,
Page 13 and 14: AUSTRALIA low-income adults, childr
Page 15 and 16: AUSTRALIA In 2013, the federal gove
Page 17 and 18: What is being done to reduce dispar
Page 19: References AUSTRALIA Australian Bur
Page 22 and 23: CANADA What is covered? Services: T
Page 24 and 25: CANADA funding to 145 not-for-profi
Page 28 and 29: CANADA provides recommendations to
Page 30 and 31: CANADA Health Council of Canada (20
Page 32 and 33: CHINA Private health insurance: Com
Page 34 and 35: CHINA is not substantially more exp
Page 36 and 37: CHINA Organization of the Health Sy
Page 38 and 39: CHINA References Chen, X. (2014).
Page 40 and 41: DENMARK In addition, nearly 1.5 mil
Page 42 and 43: DENMARK Social psychiatry and care
Page 44 and 45: DENMARK Quality data for a number o
Page 46 and 47: DENMARK portion is small, it makes
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Page 50 and 51: ENGLAND immunization, and vaccinati
Page 52 and 53: ENGLAND Hospitals: Publicly owned h
Page 54 and 55: ENGLAND Organization of the Health
Page 56 and 57: ENGLAND How are costs contained? Ra
Page 58 and 59: ENGLAND Organisation for Economic C
Page 60 and 61: FRANCE VHI finances 13.8 percent of
Page 62 and 63: FRANCE The average income of primar
Page 64 and 65: FRANCE What are the key entities fo
Page 66 and 67: FRANCE inequities in prevention rel
Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
Page 72 and 73: GERMANY The 16 state governments de
Page 74 and 75: GERMANY management system, by the s
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GERMANY What major innovations and
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INDIA Private health insurance: The
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INDIA provide after-hour care, reim
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INDIA are provided by other ministr
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INDIA How are costs contained? Ther
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86
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ISRAEL Together, these two types of
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ISRAEL Primary care physicians are
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ISRAEL Organization of the Health S
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ISRAEL • Using electronic health
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ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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JAPAN incentives for providers to c
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JAPAN Organization of the Health Sy
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JAPAN The author would like to ackn
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THE NETHERLANDS receive faster acce
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THE NETHERLANDS Hospital payment ra
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THE NETHERLANDS Organization of the
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THE NETHERLANDS References Organisa
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NEW ZEALAND provided in GP clinics.
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NEW ZEALAND management (e.g., clean
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NEW ZEALAND including such informat
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NEW ZEALAND largely through efficie
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NORWAY Primary, preventive, and nur
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NORWAY Patients are free to choose
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NORWAY What are the major strategie
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NORWAY The National System for the
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SINGAPORE Medifund is the governmen
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SINGAPORE Public hospital funding i
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SINGAPORE Public consultation: The
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SINGAPORE To keep demand for servic
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SWEDEN What is covered? Services: T
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SWEDEN Hospitals: There are seven u
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SWEDEN Care, which promotes use of
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SWEDEN What major innovations and r
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SWITZERLAND Insurers offer premiums
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SWITZERLAND Hospitals: About 70 per
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SWITZERLAND Organization of the Hea
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SWITZERLAND To control pharmaceutic
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UNITED STATES What is covered? Serv
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UNITED STATES Administrative mechan
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UNITED STATES The Institute of Medi
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UNITED STATES adopted at least a ba
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The COMMONWEALTH FUND Affordable, q
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