Cecilia Van Cauwenberghe from Frost & Sullivan’s TechCasting Group, turns the spotlight on healthcare in Canada, focussing on milestones & opportunities triggered by pandemics. The discussion begins with an exemplary model worldwide, Canada Medicare

Canada is one of the most evolved federations worldwide and one of the Organisation for Economic Co-operation and Development (OECD) members. With a strong political power and policy responsibility to govern ten provinces and three territories, including the province of Quebec, with a unique French-speaking linguistic and cultural context. Healthcare in Canada has a system known as Medicare, which is decentralised. Indeed, it comprises a collection of provincial and territorial, taxation-based, publicly funded, universal health insurance plans subject to national standards.

A team of researchers from six different universities in Canada – University of Toronto, Dalhousie University, McGill University, University of British Columbia, Université de Montréal, and University of Regina – have published a paper series on Canada’s health system and global health leadership (Martin et al., 2018; Marchildon et al., 2020; Marchildon and Tuohy, 2021). The researchers have analysed the singular trajectory of this country in providing a high-quality, accessible, affordable, and inclusive healthcare system and the key factors impacting policymakers while advising on its potential to become a world-in-class model.

According to the researchers, Canadian Medicare is based on need instead of the ability to pay. Therefore, it constitutes more than a set of public insurance plans. More than 90% of Canadians agree on the healthcare system as an essential source of collective pride, an implicit social contract between governments, healthcare providers, and the public. The Canadian Institute for Health Information (2021) further states that health expenditures as a percentage of GDP were at 11.5% in 2020 (Ufodike et al., 2021).

On the other hand, Canada faces an ageing population and fiscal constraints in its publicly funded programmes that deserve attention. Its vast geography, high migration rates, and ethnocultural diversity are also factors of note in delivering health and wellness options. Decentralisation comes with some level of fragmentation, inherent to the fact that hospitals and authorities have their own independent boards and separate budgets.

Canada Pharmacare & long-term care: Paradigm shift after COVID-19

Some researchers remark on some inherent issues in the country’s health system (Martin et al., 2018). Whereas Canadians have a life expectancy at birth of 82.14 years – above OECD, U.S., UK and Denmark measures – the average masks variations in vulnerable groups. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system and society more generally (Marchildon et al., 2020).

Healthcare in Canada, conversely, to the major nations, is often slow and incremental in terms of change and flexibility to new times. Furthermore, although urgent medical and surgical care is prompt and of high quality, the timeliness of elective care, such as programmed surgeries, non-urgent advanced imaging and outpatient speciality visits, is problematic.

Finally, Canada is the only developed country with universal health coverage that does not include prescription medications. It is important to highlight, however, that there have been some initiatives towards introducing a national programme of prescription drug coverage, called Pharmacare, though the COVID-19 pandemic that started in 2020 may constitute an inflection point in addressing this issue (Marchildon et al., 2020). According to the researchers, this fact could represent a paradigm shift from whether to add outpatient pharmaceuticals to universal health coverage toward federal standards in long-term care (LTC) and its possible inclusion in universal health coverage (Marchildon and Tuohy, 2021). In their opinion, the best option would be a LTC insurance programme directly linked to Canada’s public pension arrangements.

Researchers working at the McMaster University, have tracked the experience of the physicians’ assistants (PA) introduced by the Ministry of Health and Long[1]Term Care (MOHLTC) into the Ontario healthcare system a decade ago, with present post-pandemic concerns with the goal of helping to increase accessibility, promptness, care continuity, and work interaction (Burrows et al., 2020).

Final remarks

The COVID-19 pandemic has opened a window of opportunity for policy reform in areas previously neglected. In Canada, the first result has been related to an increase in the federal government’s presence beyond Medicare conventional coverage. The current debate is more focused on LTC, leaving Pharmacare deferred once again for further discussions.

Acknowledgements I want to thank all contributors from the industry involved with developing and delivering this article from Frost & Sullivan.

Further reading

  1. Burrows, K.E., Abelson, J., Miller, P.A., Levine, M. and Vanstone, M., 2020. Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada. BMC health services research, 20(1), pp.1-14.
  2. Marchildon, G.P. and Tuohy, C.H., 2021. Expanding health care coverage in Canada: a dramatic shift in the debate. Health Economics, Policy and Law, 16(3), pp.371-377.
  3. Marchildon, G.P., Allin, S. and Merkur, S., 2020. Canada: Health system review. Health Systems in Transition, 22(3).
  4. Martin, D., Miller, A.P., Quesnel-Vallée, A., Caron, N.R., Vissandjée, B. and Marchildon, G.P., 2018. Canada’s universal health-care system: achieving its potential. The Lancet, 391(10131), pp.1718-1735.
  5. Ufodike, A., Okafor, O.N. and Opara, M., 2021. First Nations gatekeepers as a common pool health care institution: Evidence from Canada. Financial Accountability & Management.

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