Health care system in Canada

Canada's health care system is a group of socialized health insurance plans that provides coverage to all Canadian citizens. It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government. Under the health care system, individual citizens are provided preventative care and medical treatments from primary care physicians as well as access to hospitals, dental surgery and additional medical services. With a few exceptions, all citizens qualify for health coverage regardless of medical history, personal income, or standard of living. Canada's health care system is the subject of much political controversy and debate in the country. Some question the efficiencies of the current system to deliver treatments in a timely fashion, and advocate adopting a private system similar to the United States. Conversely, there are worries that privatization would lead to inequalities in the health system with only the wealthy being able to afford certain treatments. Regardless of the political debate, Canada does boast one of the highest life expectancies (about 80 years) and lowest infant morality rates of industrialized countries, which many attribute to Canada's health care system. Health care in Canada is delivered through a publicly-funded health care 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. 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 three provinces also impose a fixed monthly premium which may be 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 Pharmacies 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. Those suspected of abusing the system by over-frequent or frivolous use can be tracked by the doctor through the ID on their health insurance card and may have to wait longer than those with more urgent needs.

Canada Health Act

The Canada Health Act is federal legislation that puts in place conditions by which individual provinces and territories in Canada may receive funding for health care services. There are five main principles in the Canada Health Act: Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the province or territory, and their records and accounts are subject to audits. Comprehensiveness: All necessary health services, including hospitals, physicians and surgical dentists, must be insured. Universality: All insured residents are entitled to the same level of health care. Portability: A resident that moves to a different province or territory is still entitled to coverage from their home province during a minimum waiting period. This also applies to residents which leave the country. Accessibility: All insured persons have reasonable access to health care facilities. In addition, all physicians, hospitals, etc, must be provided reasonable compensation for the services they provide.

Health Care and the Economy

Canada's health care has a large impact on the Canadian economy. Here are a few facts and figures about the economy and health care: Health care expenditures in Canada topped $100 billion in 2001.Approximately 9.5% of Canada's gross domestic product is spent on health care. Individually, Canadians spend about $3300 per capita on health care. At a provincial level, funding is between one-third and one-half of what provinces spend on social programs.

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 whiles 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, public funding is required to pay for medically necessary care, but only if it is delivered in hospitals or by physicians. 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.

Health Care and Politics

One of the forefronts of debate in Canadian politics is its health care system. There are many factors in the debate, but some key issues are: Federal involvement in health care: Because provinces and territories are responsible for the actual administration and delivery of health care in Canada, friction is apparent whenever policies are set at a federal level. Private health care: While privately funded clinics do provide certain services with shorter wait times than the public system, there are those who object to any privatization of the health system. The arguments are that a "two-tier" health care system will unbalance the system and favor those with higher incomes. 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 (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. By far the largest government health program is Medicare, which is actually ten provincial programs, such as OHIP in Ontario, that are required to meet the general guidelines laid out in the federal Canada Health Act. Almost all government health spending goes through Medicare, but there are several smaller programs. The federal government directly administers health to groups such as the military, and inmates of federal prisons.. The largest group the federal government is directly responsible for is 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 centers on Native Reserves. At the provincial level, there are also several much smaller health programs alongside Medicare. The largest of these is the health care costs paid by the worker's compensation system. Regardless of federal efforts, healthcare for 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. 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, 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 in health costs, has caused problems with the system.

Private Sector
Although, the Health Act was designed to prevent the development of a two-tiered system, nothing is ever that straightforward. Given the preponderance of long waiting times, some analysts have argued that the Act does not apply: surgery performed without waiting is simply not the same treatment as surgery for which one is required to wait months. The distinction has never been tested in the courts, but it has led to a growing private sector in areas once thought to be off-limits. The core requirement of the 1984 Act is that hospital and physician services be 100 per cent publicly financed. But as health care becomes less focused on hospital and physician care (together they comprise less than half of total health care expenditure in Canada) and more focused on community care and drugs (the latter now exceed physician costs), less and less healthcare treatment service is covered by Medicare. Dental insurance, eye-care insurance, insurance for prescription drugs, ambulance services, medical devices, private health insurance covering the upgrading of hospital rooms and out of country insurance are all outside the scope of Medicare. . The public seem ready for an expansion of the private sector. In 2002 the Canadian Medical Association sponsored a poll on user fees. Its results were far from expected; 57 % supported user fees (A further Michael poll in August 2001 found that a clear majority of Canadians support both user fees and a private insurance option. (A first, similar poll in 1991 found only a small percentage of the public accepting such ideas.) The 2005 Health Care in Canada survey by the public opinion research firm POLLARA shows that 49 % of the public said they would be willing to make out-of-pocket payments to purchase faster access to health care. A majority also believe that expanding private insurance would: result in shorter waiting times (68 %), provide better access to healthcare (59 %) and improve quality (60 %). Private Clinics In addition to public health care providers such as primary care doctors and hospitals, many private clinics offering specialized services also operate in Canada. Under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. Regardless of this legal issue, many do offer such services. The advantage of private clinics is that they typically offer services with reduced wait times compared to the public health care system. For example, obtaining an MRI scan in a hospital could require a waiting period of months, whereas it could be obtained much faster in a private clinic. Private clinics are a subject of controversy, as some feel that their existence unbalances the health care system and favors treatments to those with higher incomes. Costs in private clinics are usually covered by private insurance policies, which will typically pay around 80% of the costs. Private Health Insurance While the health care system in Canada covers basic services, including primary care physicians and hospitals, there are many services that are not covered. These include things like dental services, optometrists, and prescription medications. Private health insurance plans are usually offered as part of employee benefit packages in many companies. Incentives usually include vision and dental care. Alternatively, Canadians can purchase insurance packages from private insurance providers. The main reason many choose to purchase private insurance is to supplement primary health coverage. For those requiring services that may not be covered under provincial health insurance such as corrective lenses, medications, or home care, a private insurance plan offsets such medical expenses.

While private insurance can benefit those with certain needs, many Canadians choose to rely exclusively on the public health system. About 30% 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 drugs, dentistry and optometry. Some 65% 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, 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 ruled in Chaoulli v. Quebec (Attorney General) that Quebec's prohibition against private health insurance for medically necessary services laws violated the Quebec Charter of Human Rights and Freedoms, potentially opening the door to much more private sector participation in the health system. Justices Beverley McLachlan, Jack Major, Michel Bastarache and Marie Deschamps found for the majority. "Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlan. 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. This means that, for the interim, there would be no change to the status quo.

Provincial Health Insurance

Health insurance in Canada is handled by individual provinces and territories. New residents to a particular province must apply for health coverage. Upon being granted health coverage, a health card is issued which provides coverage in that particular province or territory. For new residents, there are typically waiting periods before health coverage will be granted. This can vary, but cannot exceed three months as part of the Canada Health Act. Certain provinces (British Columbia, Alberta, and Ontario) require health care premiums for services. Under the Canada Health Act, however, health services cannot be denied due to financial inability to pay premiums. In addition to standard health coverage as described in the Canada Health Act, provinces typically provide additional services. These can include physiotherapy, dental coverage, and prescription medicines. Provinces are not obligated to provide services not listed in the Canada Health Act, and such services can be affected by changing government policies.

Accessing Health Care

Accessing Canada's health care system involves first applying for a provincial health card. Excluding inmates, the Canadian Armed Forces and certain members of the RCMP, the Canada Health Act requires all residents of a province or territory to be accepted for health coverage. There is a waiting period in place for new immigrants that cannot exceed three months. Once a health card is assigned, it is used whenever visiting a physician or health care provider. The health card contains an identification number, which is used to access a person's medical information. After obtaining health coverage, one can register with a primary care physician. For routine visits to a physician, one needs only present their health card. There are typically no forms to be filled out or individual service fees. The availability of physicians depends largely on the number of doctors and the current demand for medical services. Currently there is about 1 primary care doctor for every 1000 Canadians.

Health Care Funding

Health care in Canada is funded at both the provincial and federal levels. The financing of health care is provided via taxation both from personal and corporate income taxes. Additional funds from other financial sources like sales tax and lottery proceeds are also used by some provinces. Alberta, British Columbia, and Ontario also charge health premiums to supplement health funding, but such premiums are not required for health coverage as per the Canada Health Act. At a federal level, funds are allocated to provinces and territories via the Canadian Health and Social Transfer (CHST). Transfer payments are made as a combination of tax transfers and cash contributions. The amount of funding provinces and territories receive is significant, and topped $35 billion in 2002-2003.In 2000, the new budget injected an additional $23 billion of investment into the health care system. About threequarters of all funding come from public sources, with the remainder from private sources such as businesses and private insurance.

Public Health Care Providers

Under the Canada Health Act, primary care doctors, specialists, hospitals and dental surgery are all covered by provincial insurance policies. Primary care physicians are the forefront of Canadian health care. There are currently about 30000 primary care doctors in Canada, and they account for just over half of all physicians. They provide basic medical treatments and preventative care. Specialists are provided for services outside the scope of primary care physicians. Typically, an individual's physician will refer them to specialists as needed. There are currently about 28000 specialist doctors working in Canada. Hospitals operate both with referrals from physicians as well as on an emergency basis. Ambulatory services are provided for those unable to transport themselves to a hospital in the event of an emergency.

Physicians, nurses and medical organization

Canada, like its North American neighbor the United States, has a level of practicing physicians that is below the OECD average but a level of practicing 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 has the highest average salary of around $230,000, while Quebec has the lowest average annual salary at $165,000, creating interprovincial competition for doctors and contributing to local shortages. In 1991, the Ontario Medical Association agreed to become a province-wide closed shop, 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 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 $1 billion. Referring to the agreement, Ontario premier Dalton McGuinty 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 Gynecologists of Canada reported a critical shortage of obstetricians and gynecologists. 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 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; 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 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. Since the passage of the 1984 Canada Health Act, the CMA itself has been a strong advocate of maintaining a strong publiclyfunded system, including lobbying the federal government to increase funding, and being a founding member of 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 that have been squeezed for operating room time are accordingly looked for alternative revenue sources. Dr. 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.

Criticisms
Health Canada, a federal department, 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 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. 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 cant 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. The Fraser Institute, 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, an organization advocating a "prosperous world through. Markets" is greatly at odds with the Canadian government's own 2007 report. Canadian psychiatrist Dr David Gratzer, who is also employed by the libertarian Cato Institute, was once asked by U.S. congressman Dennis Kucinich if he knew what the wait time for diagnostic imaging procedures such as CT scans and MRIs was across Canada. Gratzer began his reply "I can tell you what the Ontario government said it was for cancer " when Kucinich cut him short and gave him the true figure of 3 weeks, just as Gratzer was uttering the answer of "six months" to his preferred question. 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 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.

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, 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 betterunderstood 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, 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, a Canadian court 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.

US citizens visiting Canada to receive health care

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; 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, AIDS, multiple sclerosis, and glaucoma have traveled to Canada for medical treatment. One of those is Steve Kubby, the Libertarian Party's 1998 candidate for governor of California, 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 she and her family once used the Canadian health-care system.

Comparison of Canadian and American health care systems

The Canadian health care system is often compared 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 in 2000, while Canada's health system was ranked 30th. The relatively low Canadian WHO ranking has been criticized by some for its choosing 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. Direct comparisons of health statistics across nations are complex. The Commonwealth Fund, compares the performance of the health care systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently underperforms compared to the other countries. A major difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health care. The OECD also collects comparative statistics, and has published brief country profiles.
Infant Physicians Life mortality per 1000 expectancy rate people Nurses per 1000 people Per capita expenditure on health (USD) Healthcare % of % of health costs as a government costs paid by percent of revenue spent government GDP on health

Country Australia Canada France Germany Japan Norway Sweden UK USA

81.4 80.7 81.0 79.8 82.6 80.0 81.0 79.1 78.1

4.2 5.0 4.0 3.8 2.6 3.0 2.5 4.8 6.7

2.8 2.2 3.4 3.5 2.1 3.8 3.6 2.5 2.4

9.7 9.0 7.7 9.9 9.4 16.2 10.8 10.0 10.6

3,137 3,895 3,601 3,588 2,581 5,910 3,323 2,992 7,290

8.7 10.1 11.0 10.4 8.1 9.0 9.2 8.4 16.0

17.7 16.7 14.2 17.6 16.8 17.9 13.6 15.8 18.5

67.7 69.8 79.0 76.9 81.3 83.6 81.7 81.7 45.4

Healthcare Expenditure
The Canadian healthcare system is funded primarily by tax dollars. The federal government makes cash transfers to the provinces, but the provinces may levy their own taxes to help defray the costs. Alberta and British Columbia require a health insurance premium, and other provinces have instituted employer payroll taxes.In2004, $91.1 billion or 70% of total health spending was by the public sector. Private sector spending totaled $39.2 billion in 2004, or 30%. In 2004, total health expenditure was estimated at $130 billion, about 10 per cent of GDP (Ibid). This is estimated to be around $4,078 per person. Latest OECD figures on spending per person is for year 2002, when it reports Canada spent $2,931 per person using purchasing power parities (PPPs), up from $2587 as used in report. This was the third highest, below the USA and Switzerland. Federal governments contributions have decreased significantly in 1998; federal payments make up only slightly more than 20 percent of provincial medical care costs (Kraker, 2002). Provincial government share of total health spending was up to 63.8 per cent in 2002. Other public sector expenditure (which includes federal spending, social security funds and municipal government) totals 5.9 per cent. Private sector spending accounted for 30.3 per cent of total spending in 2002. Private expenditure, which goes towards the cost of services (such as clinics for eye laser surgery or in-vitro fertilization) not covered by provincial health insurance programmes, is divided between out-of-pocket expenditure and insurance.

Bibliography:
en.wikipedia.org/wiki/Health_care_in_Canada www.hc-sc.gc.ca/hcs-sss/index-eng.php www.canadian-healthcare.org/ www.civitas.org.uk/pdf/Canada.pdf