Canada's universal health-care system: achieving its potential

Abstract

Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

“…Monitoring access to specialist consultation and elective surgery may help determine whether clinical care is readily available to patients . For patients diagnosed with euthyroid nodules, access to specialist consultation and elective surgery varies widely between the United States and Canada . Patients waiting for thyroid surgery for lengthy periods of time may experience unnecessary stress and anxiety .…”

“…For patients diagnosed with euthyroid nodules, access to specialist consultation and elective surgery varies widely between the United States and Canada. 42 Patients waiting for thyroid surgery for lengthy periods of time may experience unnecessary stress and anxiety. 43 The panel did not make a recommendation about the upper limit of wait times for elective surgery.…”

Canada's global health role: supporting equity and global citizenship as a middle power

“…In Canada, the domestic experience of creating a system of universal health coverage based on the principle of equity has been central to nation building. 3 A key moment in this process occurred in 1974 when the landmark Lalonde Report 24 (named for then-Minister of National Health and Welfare, Marc Lalonde) emphasised the role of both biological and social factors as health determinants. The Lalonde Report is credited with advancing health promotion and public health domestically, and for setting the global stage for adoption of the WHO Alma-Ata Declaration on primary health care in 1978.…”

“…In this second paper of a two-part Series on Canada's health system and global health leadership, 3 we analyse how this ideal of Canada as a work in progress, combined with its international position as a middle power, has shaped its role in global health policy and action. The country has mostly sought to be a socially progressive force, punching above its weight and exerting influence disproportionate to its financial and military resources.…”

“…Canada's publicly funded, but largely privately delivered, health-care system straddles social and private medicine. 3 Abroad, Canada's approach has mainly been to promote global health through multilateral cooperation, alliance building, and collective action (panel 2). The link between Canada's domestic interests and global citizenship is also well recognised; Canada is ranked the tenth most globalised country in the world, based on trade relations, population mobility, and openness.…”