Gregory Marchildon - Health Systems in Transition: Canada

Published by the WHO Regional Office for Europe acting as host organization for, and secretariat of, the European Observatory on Health Systems and Policies under the title Health Systems in Transition: Canada. 2020. Third Edition

World Health Organization 2020 on behalf of, the European Observatory on Health Systems and Policies

The Regional Office for Europe of the World Health Organization has granted reproduction and electronic publishing rights to University of Toronto Press.

Published in North America by University of Toronto Press, 2021
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The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation country or area appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

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University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council, an agency of the Government of Ontario.

The Health Systems in Transition (HiT) series consists of country-based reviews that provide a detailed description of a health system and of reform and policy initiatives in progress or under development in a specific country. Each review is produced by country experts in collaboration with staff at the North American Observatory on Health Systems and Policies and the European Observatory on Health Systems and Policies. In order to facilitate comparisons between countries, reviews are based on a template prepared by the European Observatory, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a report.

HiTs seek to provide relevant information to support policy-makers and analysts in the development of health systems in Europe and other countries. They are building blocks that can be used to:

learn in detail about different approaches to the organization, financing and delivery of health services, and the role of the main actors in health systems;

describe the institutional framework, process, content and implementation of health care reform programmes;

highlight challenges and areas that require more in-depth analysis;

provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries; and

assist other researchers in more in-depth comparative health policy analysis.

Compiling the reviews poses a number of methodological problems. In many countries, there is relatively little information available on the health system and the impact of reforms. Due to the lack of a uniform data source, quantitative data on health services are based on a number of different sources, including data from national statistical offices, the Organisation for Economic Co-operation and Development (OECD), the International Monetary Fund (IMF), the World Banks World Development Indicators and any other relevant sources considered useful by the authors. Data collection methods and definitions sometimes vary, but typically are consistent within each separate review.

A standardized review has certain disadvantages because the financing and delivery of health care differ across countries. However, it also offers advantages because it raises similar issues and questions. HiTs can be used to inform policy-makers about experiences in other countries that may be relevant to their own national situations. They can also be used to inform comparative analysis of health systems. This series is an ongoing initiative and material is updated at regular intervals.

Comments and suggestions for the further development and improvement of the HiT series are most welcome and can be sent to .

HiTs and HiT summaries are available on the Observatorys website (http://www.healthobservatory.eu).

The Health Systems in Transition (HiT) profile on Canada was co-produced by the European Observatory on Health Systems and Policies and the North American Observatory on Health Systems and Policies (NAO) in Canada, which is a member of the Health Systems and Policy Monitor (HSPM) network. The NAO is a collaborative partnership of interested researchers, governments and health organizations promoting evidence-informed health system decision-making with academic directors in Canada, the United States of America and Mexico. The NAO partnership secretariat is hosted by the Institute of Health Policy, Management & Evaluation at the University of Toronto. The HSPM is an international network that works with the Observatory on Country Monitoring. It is made up of national counterparts that are highly regarded at national and international level and have particular strengths in the areas of health systems, health services, public health and health management research. They draw on their own extensive networks in the health field and their track record of successful collaboration with the Observatory to develop and update the HiT.

This 2020 edition was written by Gregory P Marchildon and Sara Allin (NAO, University of Toronto). It was edited by Sherry Merkur (European Observatory on Health Systems and Policies). The basis for this edition was the previous HiT on Canada, which was published in 2013, written by Gregory P Marchildon and edited by Anna Sagan. The European Observatory on Health Systems and Policies and NAO are grateful to Robert S Bell (former Deputy Minister of Health and Long-Term Care in Ontario), Colleen M Flood (Director, University of Ottawa Centre for Health Law, Policy and Ethics), Kathleen Morris (Vice President, Research and Analysis, Canadian Institute for Health Information) and her colleagues at the Canadian Institute for Health Information, and Anna Maresso (European Observatory on Health Systems and Policies) for reviewing the report. The authors are also grateful to Michael Sherar, University of Toronto, for research assistance, and to Stephen Lucas (Deputy Minister) and his colleagues at Health Canada as well as those at the Public Health Agency of Canada, the Canadian Institutes of Health Research, Employment and Social Development Canada, Global Affairs Canada and Indigenous Services Canada who reviewed specific sections of the HiT. Thanks are also extended to the OECD for their Health Statistics Database and to the World Bank for their World Development Indicators.