Health care in Canada - AbsoluteAstronomy.com

Health care in Canada is delivered through a publicly-funded health care

Publicly-funded health care

Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...

system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act

Canada Health Act

The Canada Health Act is a piece of Canadian federal legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer...

. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician. Canada's provincially-based Medicare systems are cost-effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private insurance is only a minimal part of the overall health care system. Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes, although British Columbia is the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes. There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income).

A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions.

Pharmaceutical medications are covered by public funds for the elderly or indigent, or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. Preventive care and early detection are considered important and yearly checkups are encouraged. Early detection not only extends life expectancy and quality of life, but cuts down overall costs.

Public opinion

Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger."

A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada while a Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the U.S. In the same poll, when asked "overall the Canadian health care system was performing very well, fairly well, not very well or not at all?" 70% of Canadians rated their system as working either "well" or "very well". A 2003 Gallup poll found only 25% of Americans are either "very" or "somewhat" satisfied with "the availability of affordable healthcare in the nation", versus 50% of those in the UK and 57% of Canadians. Those "very dissatisfied" made up 44% of Americans, 25% of respondents of Britons, and 17% of Canadians.

Economics

The amount Canadians spend on health care in 1997 dollars has increased every year between 1975 and 2009 from $39.7 billion to $137.3 billion or a more than doubling of per capita spending from $1,715 to $4089. In 2009 dollars spending is expected to reach $183.1 billion ( a more than five percent increase over the previous year ) or $5,452 per person. Most of this increase in health care costs has been covered by public funds. The greatest proportion of this money goes to hospitals ($51B), followed by pharmaceuticals ($30B), and physicians ($26B). Total spending in 2007 was equivalent to 10.1% of the gross domestic product which was slightly above the average for OECD countries, and below the 16.0% of GDP spent on health care in the United States. The proportion spent on hospitals and physicians has declined between 1975 and 2009 while the amount spent on pharmaceuticals has increased.

Of the three biggest health care expenses, the amount spent on pharmaceuticals has increased the most. In 1997 the total price of drugs surpassed that of doctors. In 1975 the three biggest health costs were hospitals ($5.5B/44.7%), physicians ($1.8B/15.1% ), and medications ($1.1B/8.8% ) while in 2007 the three biggest costs were hospitals ($45.4B/28.2% ), medications ($26.5B/16.5% ), and physicians ($21.5B/13.4% ).

In 2009, the government funded about 70% of Canadians' health care costs. This covered most hospital and physician cost while the dental and pharmaceutical costs were primarily paid for by individuals. This is slightly below the OECD average. Under the terms of the Canada Health Act

Canada Health Act

, public funding is required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. There is considerable variation across the provinces/territories as to the extent to which such costs as out of hospital prescription medications, physical therapy, long-term care, dental care and ambulance services

Emergency medical services in Canada

Emergency medical services in Canada are the responsibility of each Canadian province or territory. As such, the services, including both ambulance and paramedic services, may be provided directly by the province, may be contracted to a private provider, or may be delegated to the local government...

are covered.

Canada has a publicly funded medicare

Medicare (Canada)

Medicare is the unofficial name for Canada's publicly funded universal health insurance system. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.Under the terms of the Canada Health...

system, with most services provided by the private sector. Each province may opt out, though none currently do. Canada's system is known as a single payer system, where basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most government funding (94%) comes from the provincial level. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. Pharmaceutical costs are set at a global median by government price controls.

Hospital care is delivered by publicly funded hospitals in Canada. Most of the public hospitals, each of which are independent institutions incorporated under provincial Corporations Acts, are required by law to operate within their budget. Amalgamation of hospitals in the 1990s has reduced competition between hospitals. As the cost of patient care has increased, hospitals have been forced to cut costs or reduce services. Applying perspective (pharmacoeconomic)

Perspective (pharmacoeconomic)

Perspective in pharmacoeconomics refers to the economic vantage point that is being taken in a pharmacoeconomic analysis, such as a cost-effectiveness analysis or cost-utility analysis...

to analyze cost reduction, it has been shown that savings made by individual hospitals result in actual cost increases to the Provinces.

Health care costs per capita vary across Canada with Quebec ($4,891) and British Columbia ($5,254) at the lowest level and Alberta ($6,072) and Newfoundland ($5,970) at the highest. It is also the greatest at the extremes of age at a cost of $17,469 per capita in those older than 80 and $8,239 for those less than 1 year old in comparison to $3,809 for those between 1 and 64 years old in 2007.

18th century

Hospitals were initially places which cared for the poor; others were cared for at home. In Quebec

Quebec

Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....

(formerly known as New France

New France

New France was the area colonized by France in North America during a period beginning with the exploration of the Saint Lawrence River by Jacques Cartier in 1534 and ending with the cession of New France to Spain and Great Britain in 1763...

and then as Lower Canada

Lower Canada

The Province of Lower Canada was a British colony on the lower Saint Lawrence River and the shores of the Gulf of Saint Lawrence...

), a series of charitable institutions, many set up by Catholic religious orders, provided such care. As the country grew, hospitals grew with them. They tended to be not-for-profit, and were run by municipal governments, charitable organizations, and religious denominations (both Catholic and Protestant). These organizations tended to be at arm's length from government; they received subsidies from provincial governments to admit and treat all patients, regardless of their ability to pay. Dr. David Parker of the Maritimes was the first to operate using anesthetic. One of the first "modern" operations, the removal of a tumour, was performed by William Fraser Tolmie

William Fraser Tolmie

William Fraser Tolmie was a Canadian surgeon, fur trader, scientist, and politician....

in British Columbia

British Columbia

British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...

19th century

The first medical schools were established in Lower Canada in the 1820s. These included the Montreal Medical Institution, which is the faculty of medicine at McGill University

McGill University

Mohammed Fathy is a public research university located in Montreal, Quebec, Canada. The university bears the name of James McGill, a prominent Montreal merchant from Glasgow, Scotland, whose bequest formed the beginning of the university...

today; in the mid-1870s, Sir William Osler

William Osler

Sir William Osler, 1st Baronet was a physician. He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. Sir William Osler, 1st Baronet (July 12, 1849 – December 29, 1919) was a physician. He was...

changed the face of medical school instruction throughout the West with the introduction of the hands-on approach. The College of Physicians and Surgeons of Upper Canada was established in 1839 and in 1869 was permanently incorporated. In 1834, William Kelly, a surgeon with the Royal Navy

Royal Navy

The Royal Navy is the naval warfare service branch of the British Armed Forces. Founded in the 16th century, it is the oldest service branch and is known as the Senior Service...

, introduced the idea of preventing the spread of disease via sanitation measures following epidemics of cholera

Cholera

Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

. In 1871, female physicians Emily Howard Stowe and Jennie Kidd Trout

Jennie Kidd Trout

Jennie Kidd Trout was the first woman in Canada legally to become a medical doctor, and was the only woman in Canada licensed to practice medicine until 1880, when Emily Stowe completed the official qualifications....

won the right for women to be admitted to medical schools and granted licenses from the College of Physicians and Surgeons of Ontario

College of Physicians and Surgeons of Ontario

The College of Physicians and Surgeons of Ontario is the governing body for medical doctors in Ontario, Canada.The college issues certificates of registration for all doctors to allow them to practise medicine as well as:...

. In 1883, Emily Stowe led the creation of the Ontario Medical College for Women, affiliated with the University of Toronto

University of Toronto

The University of Toronto is a public research university in Toronto, Ontario, Canada, situated on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution of higher learning in Upper Canada...

. In 1892, Dr. William Osler

William Osler

wrote the landmark text The Principles and Practice of Medicine
The Principles and Practice of Medicine
The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine is a medical textbook by Sir William Osler. It was first published in 1892 while Osler was Professor of Medicine at Johns Hopkins University. It established Osler as the world's leading authority...

, which dominated medical instruction in the West for the next 40 years. Around this time, a movement began that called for the improved health care for the poor, focusing mainly on sanitation and hygiene. This period saw important advances including the provision of safe drinking water to most of the population, public baths and beaches, and municipal garbage services to remove waste from the city. During this period, medical care was severely lacking for the poor and minorities such as First Nations

First Nations

First Nations is a term that collectively refers to various Aboriginal peoples in Canada who are neither Inuit nor Métis. There are currently over 630 recognised First Nations governments or bands spread across Canada, roughly half of which are in the provinces of Ontario and British Columbia. The...

20th century

The twentieth century saw the discovery of insulin by Frederick Banting

Frederick Banting

Sir Frederick Grant Banting, KBE, MC, FRS, FRSC was a Canadian medical scientist, doctor and Nobel laureate noted as one of the main discoverers of insulin....

and his colleagues, Charles Best, J.J.R. Macleod, and J.B. Collip in 1922. For this, Frederick Banting

Frederick Banting

Sir Frederick Grant Banting, KBE, MC, FRS, FRSC was a Canadian medical scientist, doctor and Nobel laureate noted as one of the main discoverers of insulin....

and J.J.R. Macleod

John James Richard Macleod

John James Rickard Macleod FRS was a Scottish physician and physiologist. He was noted as one of the co-discoverers of insulin and awarded the Nobel Prize for this discovery.-Biography:...

of the University of Toronto

University of Toronto

won the 1923 Nobel Prize in Physiology and Medicine. Dr. Wilder Penfield

Wilder Penfield

Wilder Graves Penfield, OM, CC, CMG, FRS was an American born Canadian neurosurgeon. During his life he was called "the greatest living Canadian"...

, who discovered a successful surgical treatment for epilepsy called the "Montreal procedure

Montreal procedure

The Montreal procedure is a surgical procedure pioneered by Dr. Wilder Penfield of Montreal, Canada, in the 1930s. It is effective in the treatment of epilepsy....

", founded the Montreal Neurological Institute

Montreal Neurological Institute

The Montreal Neurological Institute and Hospital is an academic medical centre dedicated to neuroscience research, training and clinical care. The Institute is part of McGill University and the Hospital is one of the five teaching hospitals of the McGill University Health Centre, in Montreal,...

in 1934.

The early 20th century saw the first widespread calls for increased government involvement and the idea of a national health insurance system had considerable popularity. During the Great Depression

Great Depression

The Great Depression was a severe worldwide economic depression in the decade preceding World War II. The timing of the Great Depression varied across nations, but in most countries it started in about 1929 and lasted until the late 1930s or early 1940s...

calls for a public health system were widespread. Doctors who had long feared such an idea reconsidered hoping a government system could provide some stability as the depression had badly affected the medical community. However, governments had little money to enact the idea. In 1935, the United Farmers of Alberta

United Farmers of Alberta

The United Farmers of Alberta is an association of Alberta farmers that has served many different roles throughout its history as a lobby group, a political party, and as a farm-supply retail chain. Since 1934 it has primarily been an agricultural supply cooperative headquartered in Calgary...

passed a bill creating a provincial insurance program, but they lost office later that year and the Social Credit Party scrapped the plan due to the financial situation in the province. The next year a health insurance bill passed in British Columbia

British Columbia

British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...

, but its implementation was halted over objections from doctors. William Lyon Mackenzie King

William Lyon Mackenzie King

William Lyon Mackenzie King, PC, OM, CMG was the dominant Canadian political leader from the 1920s through the 1940s. He served as the tenth Prime Minister of Canada from December 29, 1921 to June 28, 1926; from September 25, 1926 to August 7, 1930; and from October 23, 1935 to November 15, 1948...

promised to introduce such a scheme, but while he created the Department of Health he failed to introduce a national program.

The beginning of coverage

It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan

Saskatchewan

Saskatchewan is a prairie province in Canada, which has an area of . Saskatchewan is bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, and on the south by the U.S. states of Montana and North Dakota....

had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open union hospital

Union Hospital

Union Hospital may refer to:* Union Hospital , Tai Wai, Shatin, Hong Kong* Union Hospital , Terre Haute, Indiana, United States* Union Hospital , Elkton, Maryland, United States...

s under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas

Tommy Douglas

Thomas Clement "Tommy" Douglas, was a Scottish-born Baptist minister who became a prominent Canadian social democratic politician...

' Co-operative Commonwealth Federation

Co-operative Commonwealth Federation

The Co-operative Commonwealth Federation was a Canadian political party founded in 1932 in Calgary, Alberta, by a number of socialist, farm, co-operative and labour groups, and the League for Social Reconstruction...

government in Saskatchewan

Saskatchewan

passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.

In 1950, Alberta created a program similar to Saskatchewan's. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population.

In 1957, the Diefenbaker federal government passed the Hospital Insurance and Diagnostic Services Act to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act
Canada Health Act
The Canada Health Act is a piece of Canadian federal legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer...

.

By 1961, all ten provinces had agreed to start HIDS Act programs. In Saskatchewan, the act meant that half of their current program would now be paid for by the federal government. Premier Woodrow Lloyd decided to use this freed money to extend the health coverage to also include physicians. Despite the sharp disagreement of the Saskatchewan College of Physicians and Surgeons, Lloyd introduced the law in 1962 after defeating the Saskatchewan Doctors' Strike

Saskatchewan Doctors' Strike

The 1962 Saskatchewan Doctors' Strike was a 23-day labour action exercised by medical doctors in the Canadian province of Saskatchewan in an attempt to force the Co-operative Commonwealth Federation government of Saskatchewan to rescind its program of universal medical insurance...

in July.

Medical Care Act

The Saskatchewan program proved a success and the federal government of Lester B. Pearson

Lester B. Pearson

Lester Bowles "Mike" Pearson, PC, OM, CC, OBE was a Canadian professor, historian, civil servant, statesman, diplomat, and politician, who won the Nobel Peace Prize in 1957 for organizing the United Nations Emergency Force to resolve the Suez Canal Crisis...

introduced the Medical Care Act in 1966 that extended the HIDS Act cost-sharing to allow each province to establish a universal health care plan -an initiative that was supported by the New Democratic Party

New Democratic Party

The New Democratic Party , commonly referred to as the NDP, is a federal social-democratic political party in Canada. The interim leader of the NDP is Nycole Turmel who was appointed to the position due to the illness of Jack Layton, who died on August 22, 2011. The provincial wings of the NDP in...

(NDP). It also set up the Medicare

Medicare (Canada)

system. In 1984, the Canada Health Act

Canada Health Act

was passed, which prohibited user fees and extra billing by doctors. In 1999, the prime minister and most premiers reaffirmed in the Social Union Framework Agreement

Social Union Framework Agreement

The Social Union Framework Agreement, or SUFA, was an agreement made in Canada in 1999 between Prime Minister Jean Chrétien and the premiers of the provinces and territories of Canada, save Quebec Premier Lucien Bouchard...

that they are committed to health care that has "comprehensiveness, universality, portability, public administration and accessibility."

Government involvement

The various levels of government pay for about 70% of Canadians' health care, although this number has decreased somewhat in recent years. The Constitution Act, 1867

Constitution Act, 1867

The Constitution Act, 1867 , is a major part of Canada's Constitution. The Act created a federal dominion and defines much of the operation of the Government of Canada, including its federal structure, the House of Commons, the Senate, the justice system, and the taxation system...

(formerly called the British North America Act, 1867, and still known informally as the BNA Act) did not give either the federal or provincial governments responsibility for health care, as it was then a minor concern. The Act did give the provinces responsibility for regulating hospitals, and the provinces claimed that their general responsibility for local and private matters encompassed health care. The federal government felt that the health of the population fell under the Peace, Order, and Good Government part of its responsibilities. This led to several decades of debate over jurisdiction that were not resolved until the 1930s. Eventually the Judicial Committee of the Privy Council JCPC decided that the administration and delivery of health care was a provincial concern, but that the federal government also had the responsibility of protecting the health and well-being of the population.

By far the largest government health program is Medicare

Medicare (Canada)

, which is actually ten provincial programs, such as OHIP in Ontario

Ontario

Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....

, that are required to meet the general guidelines laid out in the federal Canada Health Act

Canada Health Act

. Almost all government health spending goes through Medicare

Medicare (Canada)

, but there are several smaller programs. The federal government directly administers health to groups such as the military, and inmates of federal prisons. They also provide some care to the Royal Canadian Mounted Police

Royal Canadian Mounted Police

The Royal Canadian Mounted Police , literally ‘Royal Gendarmerie of Canada’; colloquially known as The Mounties, and internally as ‘The Force’) is the national police force of Canada, and one of the most recognized of its kind in the world. It is unique in the world as a national, federal,...

and veterans, but these groups mostly use the public system. Prior to 1966, Veterans Affairs Canada

Veterans Affairs Canada

The Department of Veterans Affairs , also referred to as Veterans Affairs Canada , is the department within the government of Canada with responsibility for pensions/benefits and services for war veterans, retired personnel of the Canadian Forces and Royal Canadian Mounted Police, their families,...

had a large health care network, but this was merged into the general system with the creation of Medicare

Medicare (Canada)

. The largest group the federal government is directly responsible for is First Nations

First Nations

. Native peoples are a federal responsibility and the federal government guarantees complete coverage of their health needs. For the last 20 years and despite health care being a guaranteed right for First Nations due to the many treaties the government of Canada signed for access to First Nations lands and resources, the amount of coverage provided by the Federal government has diminished drastically for optometry, dentistry, and medicines. Status First Nations individuals only qualify for a set amount of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye exams, fillings, root canals, etc. For the most part First Nations people use the normal hospitals and the federal government then fully compensates the provincial government for the expense. The federal government also covers any user fees the province charges. The federal government maintains a network of clinics and health centres on Native Reserves. At the provincial level, there are also several much smaller health programs alongside Medicare

Medicare (Canada)

. The largest of these is the health care costs paid by the worker's compensation system. Regardless of federal efforts, healthcare for First Nations

First Nations

has generally not been considered effective.

Despite being a provincial responsibility, the large health costs have long been partially funded by the federal government. The cost sharing agreement created by the HIDS Act and extended by the Medical Care Act was discontinued in 1977 and replaced by Established Programs Financing

Established Programs Financing

The Established Programs Financing is a financing program created by the Trudeau government, in 1977, to finance the provincially-run healthcare, through transfer payments, by cash and tax points....

. This gave a bloc transfer to the provinces, giving them more flexibility but also reducing federal influence on the health system. In 1996, when faced with a large budget shortfall, the Liberal federal government merged the health transfers with the transfers for other social programs into the Canada Health and Social Transfer

Canada Health and Social Transfer

The Canada Health and Social Transfer was a system of block transfer payments from the Canadian government to provincial governments to pay for health care, post-secondary education and welfare, in place from the 1996-97 fiscal year until the 2004-05 fiscal year...

, and overall funding levels were cut. This placed considerable pressure on the provinces, and combined with population aging and the generally high rate of inflation

Inflation

In economics, inflation is a rise in the general level of prices of goods and services in an economy over a period of time.When the general price level rises, each unit of currency buys fewer goods and services. Consequently, inflation also reflects an erosion in the purchasing power of money – a...

in health costs, has caused problems with the system.

Private sector

About 27.6% of Canadians' health care is paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare, such as prescription drug

Prescription drug

A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...

s, dentistry

Dentistry

Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...

and optometry

Optometry

Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...

. Some 75% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. There are also large private entities that can buy priority access to medical services in Canada, such as WCB in BC.

The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service. According to Dr. Albert Schumacher, former president of the Canadian Medical Association

Canadian Medical Association

The Canadian Medical Association , with more than 70,000 members, is the largest association of doctors in Canada and works to represent their interests nationally. It formed in 1867, three months after Confederation...

, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly.

"Frontline practitioners whether they're GPs or specialists by and large are not salaried. They're small hardware stores. Same thing with labs and radiology clinics ...The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. We have sort of a passive privatization."

"Although there are laws prohibiting or curtailing private health care in some provinces, they can be changed", according to a report in the New England Journal of Medicine. In June 2005, the Supreme Court of Canada

Supreme Court of Canada

The Supreme Court of Canada is the highest court of Canada and is the final court of appeals in the Canadian justice system. The court grants permission to between 40 and 75 litigants each year to appeal decisions rendered by provincial, territorial and federal appellate courts, and its decisions...

ruled in Chaoulli v. Quebec (Attorney General)
Chaoulli v. Quebec (Attorney General)
Chaoulli v. Quebec [2005] 1 S.C.R. 791, was a decision by the Supreme Court of Canada where the Court ruled that the Quebec Health Insurance Act and the Hospital Insurance Act prohibiting private medical insurance in the face of long wait times violated the Quebec Charter of Human Rights and...

that Quebec's prohibition against private health insurance for medically necessary services laws violated the Quebec Charter of Human Rights and Freedoms

Quebec Charter of Human Rights and Freedoms

The Charter of Human Rights and Freedoms is a statutory bill of rights and human rights code passed by the National Assembly of Quebec on June 27, 1975...

, potentially opening the door to much more private sector participation in the health system. Justices Beverley McLachlin

Beverley McLachlin

Beverley McLachlin, PC is the Chief Justice of Canada, the first woman to hold this position. She also serves as a Deputy of the Governor General of Canada.-Early life:...

, Jack Major, Michel Bastarache

Michel Bastarache

J. E. Michel Bastarache is a Canadian lawyer, businessman, and retired puisne justice on the Supreme Court of Canada....

and Marie Deschamps

Marie Deschamps

Marie Deschamps is a puisne justice on the Supreme Court of Canada.-Education:She studied law at the Université de Montréal, graduating in 1974 and completing a Masters in 1983 at McGill.-Career:...

found for the majority. "Access to a waiting list is not access to health care", wrote Chief Justice Beverly McLachlin.

The Quebec and federal governments asked the high court to suspend its ruling for 18 months. Less than two months after its initial ruling, the court agreed to suspend its decision for 12 months, retroactive to June 9, 2005.

Physicians and medical organization

Canada, like its North American neighbour the United States, has a ratio of practising physicians to population that is below the OECD average but a level of practising nurses that is higher than either the U.S. or the OECD average.

Family physicians in Canada make an average of $202,000 a year (2006, before expenses). Alberta

Alberta

Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...

has the highest average salary of around $230,000, while Quebec

Quebec

has the lowest average annual salary at $165,000, arguably creating interprovincial competition for doctors and contributing to local shortages. In fact, the cost of living in Alberta is considerably higher than the cost of living in Quebec, so absolute income differentials can be massively misleading.

In 1991, the Ontario Medical Association agreed to become a province-wide closed shop

Closed shop

A closed shop is a form of union security agreement under which the employer agrees to hire union members only, and employees must remain members of the union at all times in order to remain employed....

, making the OMA union a monopoly. Critics argue that this measure has restricted the supply of doctors to guarantee its members' incomes.

In September 2008, the Ontario Medical Association

Ontario Medical Association

The Ontario Medical Association is a professional organization for physicians in Ontario, Canada founded in 1880. It represents and, to a certain degree, governs approximately 24,000 physicians in Ontario. The association's main office is located at 150 Bloor St. West in Toronto. The current...

and the Ontarian government agreed to a new four-year contract that will see doctors receive a 12.25% pay raise. The new agreement is expected to cost Ontarians an extra $

Canadian dollar

The Canadian dollar is the currency of Canada. As of 2007, the Canadian dollar is the 7th most traded currency in the world. It is abbreviated with the dollar sign $, or C$ to distinguish it from other dollar-denominated currencies...

1 billion. Referring to the agreement, Ontario premier

Premier of Ontario

The Premier of Ontario is the first Minister of the Crown for the Canadian province of Ontario. The Premier is appointed as the province's head of government by the Lieutenant Governor of Ontario, and presides over the Executive council, or Cabinet. The Executive Council Act The Premier of Ontario...

Dalton McGuinty

Dalton James Patrick McGuinty, Jr., MPP is a Canadian lawyer, politician and, since October 23, 2003, the 24th and current Premier of the Canadian province of Ontario....

said,"One of the things that we've got to do, of course, is ensure that we're competitive ... to attract and keep doctors here in Ontario...".

In December 2008, the Society of Obstetricians and Gynaecologists of Canada

Society of Obstetricians and Gynaecologists of Canada

The Society of Obstetricians and Gynaecologists of Canada is a national medical society in Canada, representing over 3,000 obstetricians/gynecologists, family physicians, nurses, midwives, and allied health professionals in the field of sexual reproductive health...

reported a critical shortage of obstetricians and gynaecologists. The report stated that only 1,370 obstetricians were practicing in Canada and that number is expected to fall by at least one-third within five years. The society is asking the government to increase the number of medical school

Medical school

A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

spots for obstetrics and gynecologists by 30 per cent a year for three years and also recommended rotating placements of doctors into smaller communities to encourage them to take up residence there.

Each province regulates its medical profession through a self-governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members.

The national doctors association is called the Canadian Medical Association

Canadian Medical Association

; it describes its mission as "To serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care. " Because health care is deemed to be under provincial/territorial jurisdiction, negotiations on behalf of physicians are conducted by provincial associations such as the Ontario Medical Association

Ontario Medical Association

. The views of Canadian doctors have been mixed, particularly in their support for allowing parallel private financing. The history of Canadian physicians in the development of Medicare has been described by C. David Naylor

David Naylor

Christopher David Naylor, OC, FRCPC, FRSC is a medical researcher and president of the University of Toronto.-Biography:...

. Since the passage of the 1984 Canada Health Act

Canada Health Act

, the CMA itself has been a strong advocate of maintaining a strong publicly-funded system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL).

However, there are internal disputes. In particular, some provincial medical associations have argued for permitting a larger private role. To some extent, this has been a reaction to strong cost control; CIHI estimates that 99% of physician expenditures in Canada come from public sector sources, and physicians—particularly those providing elective procedures who have been squeezed for operating room time—have accordingly looked for alternative revenue sources.

One indication of this internal dispute came when Dr. Brian Day

Brian Day

Brian Day, MRCP , FRCS , FRCS , is a physician in Canada and was the 2007-2008 president of the Canadian Medical Association. He is known as Dr. Profit by opponents and Dr. Prophet by supporters for his advocacy of a role for private health care...

of B.C. was elected CMA president in August 2007. Day is the owner of the largest private hospital in Canada and a vocal supporter of increasing private health care in Canada. The CMA presidency rotates among the provinces, with the provincial association electing a candidate who is customarily ratified by the CMA general meeting. Day's selection was sufficiently controversial that he was challenged—albeit unsuccessfully—by another physician. The newspaper story went on to note that "Day said he has never supported the privatization of health care in Canada, and accused his detractors of deliberately distorting his position."

Wait times

Health Canada

Health Canada is the department of the government of Canada with responsibility for national public health.The current Minister of Health is Leona Aglukkaq, a Conservative Member of Parliament appointed to the position by Prime Minister Stephen Harper.-Branches, regions and agencies:Health Canada...

, a federal department

Structure of the Canadian federal government

The following list outlines the Structure of the Canadian federal government.Cabinet-level Departments, Agencies, Secretariats and Offices are denoted in bold with the corresponding Minister listed alongside.-Crown:* Monarchy of Canada...

, publishes a series of surveys of the health care system in Canada based on Canadians first-hand experience of the health care system.

Although life-threatening cases are dealt with immediately, some services needed are non-urgent and patients are seen at the next-available appointment in their local chosen facility.

The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 90 days.

The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 90 days.

The median wait time for surgery is four weeks with 82.2% waiting less than 90 days.

Another study by the Commonwealth Fund

Commonwealth Fund

The Commonwealth Fund is a private U.S. foundation whose stated purpose is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, especially for society's most vulnerable.-History:...

found that 57% of Canadians reported waiting 30 days (4 weeks) or more to see a specialist, broadly in line with the current official statistics. A quarter (24%) of all Canadians waited 4 hours or more in the emergency room.

Dr. Brian Day was once quoted as saying "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." Day gave no source for his two to three years claim. The Canadian Health Coalition has responded succinctly to Day's claims, pointing out that "access to veterinary care for animals is based on ability to pay. Dogs are put down if their owners can’t pay. Access to care should not be based on ability to pay." Regional administrations of Medicare across Canada publish their own wait time data on the internet. For instance in British Columbia the wait time for a hip replacement is currently a little under ten weeks. The CHC is one of many groups across Canada calling for increased provincial and federal funding for medicare and an end to provincial funding cuts as solutions to unacceptable wait times. In a 2007 episode of ABC News

ABC News

ABC News is the news gathering and broadcasting division of American broadcast television network ABC, a subsidiary of The Walt Disney Company...

's 20/20 titled "Sick in America", host John Stossel

John Stossel

John F. Stossel is an American consumer reporter, investigative journalist, author and libertarian columnist. In October 2009 Stossel left his long time home on ABC News to join the Fox Business Channel and Fox News Channel, both owned and operated by News Corp...

cited numerous examples of Canadians who did not get the health care that they needed. The Fraser Institute

Fraser Institute

The Fraser Institute is a Canadian think tank. It has been described as politically conservative and right-wing libertarian and espouses free market principles...

, a conservative think tank, claims to do its own research and found that treatment time from initial referral by a GP through consultation with a specialist to final treatment, across all specialties and all procedures (emergency, non-urgent, and elective), averaged 17.7 weeks in 2005. However, the report of the Fraser Institute

Fraser Institute

The Fraser Institute is a Canadian think tank. It has been described as politically conservative and right-wing libertarian and espouses free market principles...

is greatly at odds with the Canadian government's own 2007 report.

Criticisms have been laid during the administration of H1N1 shots in 2009, in parts of Canada, including Hamilton and Toronto. "Wait times for flu shots continued to be hours long yesterday [October 29] as Hamiltonians lined up for the only protection from H1N1 that public health can offer. Waits were about five hours at the clinic on the West Mountain, with 1,000 people in line. The Dundas clinic wasn't much better, with 700 waiting for a shot." "Hundreds of people who lined up in Toronto today were given slips of paper with a time on it so they could return for their vaccination without standing around for hours on end."

Since 2002, the Canadian government has invested $5.5 billion to decrease wait times. In April 2007, Canadian Prime Minister Stephen Harper

Stephen Harper

Stephen Joseph Harper is the 22nd and current Prime Minister of Canada and leader of the Conservative Party. Harper became prime minister when his party formed a minority government after the 2006 federal election...

announced that all ten provinces and three territories would establish patient wait times guarantees by 2010. Canadians will be guaranteed timely access to health care in at least one of the following priority areas, prioritized by each province: cancer care, hip and knee replacement, cardiac care, diagnostic imaging, cataract surgeries or primary care.

Counter-criticism: some longer wait times can benefit patients

It has been observed and found in data that the complete elimination of all waiting times is not ideal. When waiting lists arise through a prioritization process based on physician-determined medical urgency and the procedure's risk, (in contrast to patient's ability to pay or profitability for the physician), waiting lists can possibly help patients. It's been postulated that a system of immediate care can be detrimental for optimal patient outcomes due to avoidance of unnecessary or unproven surgery. An example is the Canadian province of British Columbia

British Columbia

British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...

, where, according to surgeon Dr. Lawrence Burr, 15 heart patients died in 1990 while on a waiting list for heart surgery. According to Robin Hutchinson, senior medical consultant to the Health Ministry's heart program, had the waiting list not existed and all patients given instant access to the surgery, the expected number of fatalities would have been 22 due to the operation mortality rate at that time. Hutchison noted that the BC Medical Association's media campaign did not make reference to these comparative statistics and only focused on deaths during waiting for surgery.

Since, ideally, waiting lists prioritize higher-risk patients to receive surgery ahead of those with lower risks, this helps reduce overall patient mortality. Consequently, a wealthy or highly-insured patient in a system based on profit or
ability to pay (as in the U.S.) may be pushed into surgery or other procedures more quickly, with a result in higher morbidity or mortality risk. This is in addition to the better-understood phenomenon in which lower-income, uninsured, or under-insured patients have their care denied or delayed, also resulting in worse health care.

Restrictions on privately funded health care

The Canada Health Act

Canada Health Act

, which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government, does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. This does not constitute a ban on privately funded care; indeed, about 30% of Canadian health expenditures come from private sources, both insurance and out-of-pocket payments. The Canada Health Act does not address delivery. Private clinics are therefore permitted, albeit subject to provincial/territorial regulations, but they cannot charge above the agreed-upon fee schedule unless they are treating non-insured persons (which may include those eligible under automobile insurance or worker's compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding.

In 2006, the Government of British Columbia threatened to shut down one private clinic because it was planning to start accepting private payments from patients.

Governments have responded through wait time strategies, discussed above, which attempt to ensure that patients will receive high-quality, necessary services in a timely manner. Nonetheless, the debate continues.

Cross-border health care

The border between Canada and the United States represents a boundary line for medical tourism

Medical tourism

Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of travelling across international borders to obtain health care...

, in which a country's residents travel elsewhere to seek health care that is more available or affordable.

Canadians visiting the US to receive health care

Some residents of Canada travel to the United States because it provides the nearest facility for their needs. Some do so on quality grounds or because of easier access. A study by Barer, et al., indicates that the majority of Canadians who seek health care in the U.S. are already there for other reasons, including business travel or vacations. A smaller proportion seek care in the U.S. for reasons of confidentiality, including abortions, mental illness, substance abuse, and other problems that they may not wish to divulge to their local physician, family, or employer.

Canadians offered free care in the US paid by the Canadian government have sometimes declined it. In 1990 the British Columbia Medical Association ran radio ads asking, "What's the longest you'd wait in line at a bank before getting really annoyed? Five minutes? Ten minutes? What if you needed a heart operation?" Following this, the government responded, as summarized by Robin Hutchinson, senior medical consultant for the health ministry's heart program. Despite the medically questionable nature of heart bypass for milder cases of chest pain and follow-up studies showing heart bypass recipients were only 25-40% more likely to be relieved of chest pain than people who stay on heart medicine, the "public outcry" following the ads led the government to take action:

"'We did a deal with the University of Washington at Seattle' said Hutchinton.. to take 50 bypass cases at $18,000 per head, almost $3,000 higher than the cost in Vancouver, with all the money [paid by] the province..In theory, the Seattle operations promised to take the heat off the Ministry of Health until a fourth heart surgery unit opened in the Vancouver suburb of New Westminster. If the first batch of Seattle bypasses went smoothly..then the government planned to buy three or four more 50-head blocks. But four weeks after announcing the plan, health administrators had to admit they were stumped. 'As of now..we've have nine people sign up. The opposition party, the press, everybody's making a big stink about our waiting lists. And we've got [only] nine people signed up! The surgeons ask their patients and they say, "I'd rather wait", We thought we could get maybe two hundred and fifty done down in Seattle..but if nobody wants to go to Seattle, we're stuck,'".

In a Canadian National Population Health Survey of 17,276 Canadian residents, it was reported that only 0.5% sought medical care in the US in the previous year. Of these, less than a quarter had traveled to the U.S. expressly to get that care.
A 2002 study by Katz, Cardiff, et al., reported the number of Canadians using U.S. services to be "barely detectible relative to the use of care by Canadians at home" and that the results "do not support the widespread perception that Canadian residents seek care extensively in the United States."
According to a September 14, 2007, article from CTV News
CTV News
CTV News is the news division of the CTV Television Network in Canada. The name CTV News is also applied as the title of local and regional newscasts on the network's owned-and-operated stations , which are closely tied to the national news division...

, Canadian Liberal MP Belinda Stronach
Belinda Stronach
Belinda Caroline Stronach, PC is a Canadian businessperson, philanthropist and former politician. She was a Member of Parliament in the Canadian House of Commons from 2004 to 2008. Originally elected as a Conservative, she later crossed the floor to join the Liberals...

went to the United States for breast cancer surgery in June 2007. Stronach's spokesperson Greg MacEachern was quoted in the article saying that the US was the best place to have this type of surgery done. Stronach paid for the surgery out of her own pocket. Prior to this incident, Stronach had stated in an interview that she was against two-tier health care
Two-tier health care
Two-tier health care is a term used to describe a situation that arises when there is a basic health care system financed by government providing medically necessary but perhaps quite basic health care services, and a secondary tier of care for those with access to more funds who can purchase...

.
When Robert Bourassa
Robert Bourassa
Jean-Robert Bourassa, was a politician in Quebec, Canada. He served as the 22nd Premier of Quebec in two different mandates, first from May 12, 1970, to November 25, 1976, and then from December 12, 1985, to January 11, 1994, serving a total of just under 15 years as Provincial Premier.-Early...

, the premier of Quebec, needed cancer treatment, he went to the US to get it.
In 2007, it was reported that Canada sent scores of pregnant women to the US to give birth. In 2007 a woman from Calgary
Calgary
Calgary is a city in the Province of Alberta, Canada. It is located in the south of the province, in an area of foothills and prairie, approximately east of the front ranges of the Canadian Rockies...

who was pregnant with quadruplets was sent to Great Falls, Montana
Great Falls, Montana
Great Falls is a city in and the county seat of Cascade County, Montana, United States. The population was 58,505 at the 2010 census. It is the principal city of the Great Falls, Montana Metropolitan Statistical Area, which encompasses all of Cascade County...

to give birth. An article on this incident states there were no Canadian hospitals with enough neo-natal intensive beds to accommodate the extremely rare quadruple birth.
A January 19, 2008, article in The Globe and Mail
The Globe and Mail
The Globe and Mail is a nationally distributed Canadian newspaper, based in Toronto and printed in six cities across the country. With a weekly readership of approximately 1 million, it is Canada's largest-circulation national newspaper and second-largest daily newspaper after the Toronto Star...

states, "More than 150 critically ill Canadians – many with life-threatening cerebral hemorrhages – have been rushed to the United States since the spring of 2006 because they could not obtain intensive-care beds here. Before patients with bleeding in or outside the brain have been whisked through U.S. operating-room doors, some have languished for as long as eight hours in Canadian emergency wards while health-care workers scrambled to locate care."
In 2010, Newfoundland and Labrador Premier Danny Williams
Danny Williams (politician)
Daniel E. "Danny" Williams, QC, MHA is a Canadian politician, businessman and lawyer who served as the ninth Premier of Newfoundland and Labrador between November 6, 2003, and December 3, 2010. Williams was born and raised in St. John's, Newfoundland and Labrador...

traveled to the US for heart surgery.

In 2005 Shona Holmes of Waterdown, Ontario

Waterdown, Ontario

Waterdown is a town in Canada which since 2001 has been a community of Hamilton, Ontario.On January 1, 2001 the new city of Hamilton was formed from the amalgamation of the Regional Municipality of Hamilton-Wentworth and its six municipalities: Hamilton, Ancaster, Dundas, Flamborough, Glanbrook,...

, traveled to the Mayo Clinic

Mayo Clinic

Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...

after deciding she couldn't afford to wait for appointments with specialists through the Ontario health care system. She has characterized her condition as an emergency, said she was losing her sight, and portrayed her condition as life-threatening brain cancer. OHIP did not reimburse her for her medical expenses. In 2007 she joined a lawsuit to force the Ontario government to reimburse patients who feel they had to travel outside of Canada for timely, life-saving medical treatment. In July 2009 Holmes agreed to appear in television ads broadcast in the United States warning Americans of the dangers of adopting a Canadian style health care system. After her ad appeared critics pointed out discrepancies in her story, including that Rathke's cleft cyst

Rathke's cleft cyst

A Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the anterior pituitary gland...

, the condition she was treated for, was not a form of cancer, and was not life-threatening. In fact, the mortality rate for patients with a Rathke's cleft cyst is zero percent.

US citizens visiting Canada to receive health care

On the other hand, some US citizens travel to Canada for health-care related reasons:

Many US citizens purchase prescription drugs from Canada, either over the Internet or by traveling there to buy them in person, because prescription drug prices in Canada are substantially lower than prescription drug prices in the United States
Prescription drug prices in the United States
Prescription drug prices in the United States are the highest in the world. "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most...

; this cross-border purchasing has been estimated at $1 billion annually.
Because medical marijuana is legal in Canada but illegal in most of the US, many US citizens suffering from cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

, AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...

, and glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...

have traveled to Canada for medical treatment. One of those is Steve Kubby
Steve Kubby
Steven "Steve" Wynn Kubby is a Libertarian Party activist who played a key role in the drafting and passage of California Proposition 215. The proposition was a ballot initiative to legalize medical marijuana which was approved by voters in 1996. Kubby himself is well-known as a cancer patient who...

, the Libertarian Party
Libertarian Party (United States)
The Libertarian Party is the third largest and fastest growing political party in the United States. The political platform of the Libertarian Party reflects its brand of libertarianism, favoring minimally regulated, laissez-faire markets, strong civil liberties, minimally regulated migration...

's 1998 candidate for governor of California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...

, who is suffering from adrenal cancer. Recent legal changes such as Proposition 215 may decrease this type of medical tourism from California only.
Sarah Palin, in an appearance in Calgary, told her audience that her family once used the Canadian health-care system, before the Canada Health Act
Canada Health Act
The Canada Health Act is a piece of Canadian federal legislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under the Canada Health Transfer...

although she says it was in the 60s, when the Canadian healthcare system was beginning to reform.

Comparison to other countries

The Canadian health care system is often compared

Canadian and American health care systems compared

Comparison of the health care systems in Canada and the United States are often made by government, public health and public policy analysts. The two countries had similar health care systems before Canada reformed its system in the 1960s and 1970s. The United States spends much more money on...

to the US system. The US system spends the most in the world per capita, and was ranked 37th in the world by the World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

in 2000, while Canada's health system was ranked 30th. The relatively low Canadian WHO ranking has been criticized by some for its choice of ranking criteria and statistical methods, and the WHO is currently revising its methodology and withholding new rankings until the issues are addressed.

Canada spent approximately 10.0% of GDP on health care in 2006, more than one percentage point higher than the average of 8.9% in OECD countries. According to the Canadian Institute for Health Information, spending is expected to reach $160 billion, or 10.6% of GDP, in 2007. This translates to $4,867 per person.

Most health statistics in Canada are at or above the G8 average. Direct comparisons of health statistics across nations is complex. The OECD collects comparative statistics, and has published brief country profiles.

Country	Life expectancy Life expectancy Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...	Infant mortality Infant mortality Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying... rate	Physician Physician A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments... s per 1000 people	Nurses per 1000 people	Per capita expenditure on health (USD)	Healthcare costs as a percent of GDP Gross domestic product Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....	% of government revenue spent on health	% of health costs paid by government
Australia Health care in Australia Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently Nicola Roxon, administers national health policy...	81.4	4.2	2.8	9.7	3,137	8.7	17.7	67.7
Canada	81.3	4.5	2.2	9.0	3,895	10.1	16.7	69.8
France Health care in France The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world...	81.0	4.0	3.4	7.7	3,601	11.0	14.2	79.0
Germany	79.8	3.8	3.5	9.9	3,588	10.4	17.6	76.9
Japan Health care in Japan The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%...	82.6	2.6	2.1	9.4	2,581	8.1	16.8	81.3
Sweden	81.0	2.5	3.6	10.8	3,323	9.1	13.6	81.7
UK	79.1	4.8	2.5	10.0	2,992	8.4	15.8	81.7
US Health care in the United States Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector...	78.1	6.9	2.4	10.6	7,290	16.0	18.5	45.4

External links

Canadian Federalism and Public Health Care: The Evolution of Federal-Provincial Relations | Mapleleafweb.com
CBC Digital Archives — The Birth of Medicare
Canadian Health Services Research Foundation
Data from the Canadian Institute for Health Information

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Public opinion

Economics

18th century

19th century

20th century

The beginning of coverage

Medical Care Act

Government involvement

Private sector

Physicians and medical organization

Wait times

Counter-criticism: some longer wait times can benefit patients

Restrictions on privately funded health care

Cross-border health care

Canadians visiting the US to receive health care

US citizens visiting Canada to receive health care

Comparison to other countries

See also

External links