Canada is ranked as the second largest country in size but 39th in population (CIA, 2009). These two factors combine to make it quite unique. The Canadian health system is just as unique. Bordering the United States, which has the antithesis of a single payer health system, Canada has maintained one of the most successful health systems in the world for the past 40 years.
With more than 80% of the population living in urban areas, the health system can make primary and acute care accessible to a large population (CIA, 2008)(WHO, 1996). Life expectancy is among the highest in the world for both men and women at 79.6 (StatCan, 2001). The infant mortality rate (IMR) for 2005 was 5.4 per 1000 births, making it one of the lowest in the world (StatCan, 2005). Since life expectancy is so high and IMR is so low, 12% of the population is over the age of 65, a high percentage of older population. Added to the fact that fewer people are having children, this means that Canada is in the fourth stage of a demographic transition.
The Canadian health system has some of the best health outcomes in the world, with death and disease rates lower than most. Still, only 52% of Canadians say they are satisfied (Gallup, 2003). One of the major complaints is long wait times for special services such as MRIs and other high demand treatments.
In 1957, the Hospital Insurance and Diagnostic Services Act (HIDS Act) was passed, establishing single payer insurance that implemented universal coverage for inpatient hospital care. The HIDS Act set into motion a foundation on which the Canadian health system as we know it was built. It evolved into the national health system, which provides universal coverage to 10 geographically and culturally diverse provinces (WHO, 1996).
Funding and Spending
Many people call the Canadian system “socialized medicine” but actually it more closely resembles a Medicare system where the heath insurance is government sponsored. This means that physicians are not hired by the state but are privately employed and are paid fee-for-service by the government using taxpayer dollars (Davis, 1999). In 2006, Canada spent $3,672 per capita, and health costs were 10.0% of Gross Domestic Product (GDP). Seventy percent of total health costs are publically funded (WHO, 2006); thirty percent comes either from private insurance, employer insurance, or out-of-pocket (Davis, 1999).
The Canadian health care system has two main levels of power. The first is the provincial, in which the health ministries take on the day-to-day management of health services. The ministers of health plan, finance, and evaluate all types of care, e.g. hospital, physician, and public health. Provincial health ministries must also fund all public health activities and negotiate fees (WHO, 1996).
The second level of power is at the federal level. The federal government's role is to set and administer national standards for the health care system. Another federal responsibility is providing health care delivery to veterans, native Canadians living on reserves, military personnel, federal prisoners, and the police. The final function is disease surveillance, prevention, and health promotion (WHO, 1996).
Primary Health Care and Public Health
The lion’s share of primary health care is delivered by a general practitioner or a family doctor. Since they are the first point of contact in the health system they filter access to specialists, admission to hospitals, and other health professionals (WHO, 1996).
The original intent of public health was to control and prevent communicable disease. Since communicable diseases have mostly been ameliorated in Canada, public health has extended its mission to include health promotion and equitable distribution of health services to all members of society, as well as prevention of non-communicable disease and support for mental health services (WHO, 1996).
The Role of the Private Sector
Besides a single payer health system, there also exists a private sector. Canadians might opt to go to the private sector because of dissatisfaction with the public system or to seek an alternative and complementary treatment. The government is not responsible for payment of claims for those who elect to choose that option. There are many doctors, chiropractors, dentists, and such who operate outside of the government provided system. In addition, there are private insurance companies that can supply employers with supplementary health insurance (WHO,1996).
One admirable aspect of the Canadian health system is that it doesn’t rest on its laurels. Building on its foundation of universal coverage, Canada strove even further to insure all of its people. Using the public health system to focus on health promotion and health equity, Canada has achieved some of the best health outcomes in the world. Today’s topsy-turvy economy raises many concerns regarding sustainability. Even in that arena, Canada has created many ways of cost containment, thus promising a continued healthy future for its healthcare system.
CIA , World FactBook. (2009). Canada: people.
Davis, J B.. (2001). Canada’s health system. Croatian Medical Journal 40(2).
Gallup. (2009). Healthcare System Ratings: U.S., Great Britain, Canada.
Statistics Canada. (2001). Life expenctancy.
Statistics Canada. (2005). Infant mortality.
World Health Organization (1996). Health Care Systems in Transition: Canada.
World Health Organization (2006). Canada: statistics.