JANUARY

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
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