Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPA

WPA 2013 Bucharest CongressApril 12, 2013

Health Systems’ Performance Roundtable:

CANADA

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3WPA Health Systems’ Performance Roundtable

Vincenzo Di Nicola, MPhil, MD, PhD, FRCPC, FAPA

Chef du Service de pédopsychiatrie

Chief of Child & Adolescent Psychiatry

Hôpital Maisonneuve-Rosemont

Professeur titulaire de psychiatrie

Professor of Psychiatry

Université de Montréal

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Health Systems’ Performance Roundtable

Co-chairpersons:

• Dr. Michelle Riba, USA

• Dr. Edgard Belfort, Venezuela

• Dr. Anita Everett, USA

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Pedagogical Objective

To present an overview of the Canadian health system

using the SWOT analysis framework –

• Strengths• Weaknesses• Opportunities• Threats

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CANADA HEALTH SYSTEM

DATA

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STRENGTHS

• Canadians consider access to health care benefits part of citizens’ rights.

• Universal health insurance covers everyone including immigrants and refugees.

• It covers all of the population with access to medical services and hospitalization.

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STRENGTHS• The 1984 Canada Health Act defines the principles of health care

delivery:

Public administration of health insurance by an accountable nonprofit agency: This has kept costs far below those of the United States.

Comprehensiveness: All insured services must be covered.

Universality: All citizens living within a province are covered.

Portability: Insurance is portable across Canada.

Accessibility: Access time to necessary services should be reasonable.

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STRENGTHS

• Health care is financed through income taxes.

• Major investment in public health care since the mid-1990s, including capital infrastructure.

• Health care costs have been maintained at sustainable levels (except for pharmaceuticals).

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STRENGTHS

• The Federal government has focused on improving the timeliness, quality and safety of health care.

• Lower costs and time spent in administrative tasks,

not having to select patients or justify treatment planning.

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STRENGTHS

• Psychiatric care is largely based in hospital and other institutions

and group practices and emphasizes an interdisciplinary,

team-based approach.

• Mental health services begin with primary care which is increasingly responsible for first response and follow-through care.

• Growing emphasis on outpatient and community care.

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STRENGTHS

• The Canadian health care system provides similar services

as the US model with significantly lower costs.

• Strong planning relationships among medical and other

professional faculties, provincial government health agencies,

and medical, psychiatric and other professionals orders and

colleges.

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STRENGTHS

• Telemedicine for long-distance learning and medical consultations is increasing.

• Growing acceptance of best practices and evidence-based medicine.

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WEAKNESSES

• The Federal government covers only 26% of health care costs

which means that although it defines and monitors principles,

the major financing and all of the delivery of health care services

is the responsibility of the 10 provinces and 3 northern territories,

which it cannot easily ensure.

• The Federal government has not established clear national standards

for health care delivery.

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WEAKNESSES

• Services such as dentistry, optometry and medications are not covered for outpatients who must pay personally or through employee benefit plans.

• Pharmaceutical costs have increased disproportionately

compared to other health care costs.

• There is a lack of a national “pharmacare” strategy to reduce costs.

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WEAKNESSES

• Workloads increase with the burden to respond to all needs.

• Private-practice psychiatry and as a result psychodynamic

psychotherapy are waning.

• Waiting lists for care versus quality of care.

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WEAKNESSES

• Inpatient services are subject to increasing pressure due to

the aging population and greater emphasis on outpatient

and community care.

• Use of IT services, digital charts and telemedicine is not

being optimized.

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WEAKNESSES

• Pharmaceutical costs have increased disproportionately

compared to other health care costs.

• There is a lack of a national “pharmacare” strategy to reduce costs.

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Après la Coupe mondiale - 2006 Photo : V Di Nicola

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OPPORTUNITIES

• The shift to primary care means a re-visioning of health care services

with a growing emphasis on shared care between primary care

providers and specialists.

• Telemedicine and IT services can bring improved outreach and

knowledge transfer through the multiplier effect.

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THREATS

• Rising pharmaceutical costs.

• Increasing private practice clinics with surcharges for uninsured

services to ensure privileged access to care are a threat to

universality of access.

• The lack of political will to define and enforce national standards.

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REFERENCES

1. Jeste, Dilip (2013). Canadian Psychiatry and Health Care System. Psychiatric News, January 4, 2013, 48(1): 6.

2. Marchildon, Gregory P. (2013). Canada: Health Systems Review 2013. Health Systems in Transition, 15(1):1-179.

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