health care system in canada essay

Home — Essay Samples — Nursing & Health — Health Care Policy — The Health Care System in Canada

The Health Care System in Canada: Overcrowding in Hospitals

• Categories: Canada Health Care Policy

About this sample

Words: 1515 |

Published: Mar 3, 2020

Words: 1515 | Pages: 3 | 8 min read

Table of contents

Background: essay about health care system, expand primary care, increase ltc beds, recommendation.

• the patient experience and quality of care;
• the caregiver and family member experience;
• the clinicians who may experience burn out, stress or harassment;
• hospital administrators who aim to please the aforementioned stakeholders;
• local health integration networks (LHINs) that govern specific areas;
• home care organizations such as the Community Care Access Centers (CCACs);
• government who is the primary funding source for hospitals.
• organizations which govern healthcare professions, such as the College of Physicians and Surgeons, the Ontario Medical Association, Ontario Nurses Association;
• organizations with a focus on better care, such as Health Quality Ontario; and more.

Cite this Essay

To export a reference to this article please select a referencing style below:

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

• Expert in: Geography & Travel Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 834 words

5 pages / 2447 words

1 pages / 484 words

1 pages / 363 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Health Care Policy

After the recent mass shooting taking place in Toronto, Ontario, the risk of individuals affected by the traumatic event, developing Posttraumatic Stress Disorder(PTSD) became an increased possibility. The traumatic mass [...]

The NHS is the health and care system of the United Kingdom, funded by the government. Everyone who lives in the UK is subject to free health care (although is taxed for the service). The NHS is not one organisation but is many [...]

The healthcare sector substantially has developed over the years thanks to the convenience brought by the current technologies advancements. Nevertheless, there are still many difficulties that the industry has to deal with, [...]

In this case, the most likely diagnosis of the patient has post-hepatic jaundice which might due to the presence of gallstone blocking the bile duct known as extra-hepatic obstruction. Another cause is carcinoma of the head of [...]

Banner Health operates in health care and is located in Arizona, United States. With over 48,000 staff members, Banner Health provides medical services to patients. Outpatient care, emergency and primary care are some services [...]

American Nurse Association (2015) defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

How healthy is the Canadian health-care  system?

Professor of Medicine and Vice-Dean (Clinical), School of Medicine, Queen's University, Ontario

Stauffer-Dunning Chair and Executive Director, Queen's School of Policy Studies, Queen's University, Ontario

Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor at the School of Policy Studies, Queen's University, Ontario

Professor of Health Services and Policy Research, Queen's University, Ontario

Professor of Family Medicine, Queen's University, Ontario

Disclosure statement

Chris Simpson is a past president of the Canadian Medical Association and has served as their spokesperson on numerous health policy issues. He is also a member of the National Speakers' Bureau and speaks on health policy issues at meetings of NGOs, associations, societies, universities, and other organizations.

David M.C. Walker, Don Drummond, Duncan Sinclair, and Ruth Wilson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Queen's University, Ontario provides funding as a founding partner of The Conversation CA.

Queen's University, Ontario provides funding as a member of The Conversation CA-FR.

View all partners

This article is part of our global series about health systems, examining different health care systems all over the world. Read the other articles in the series here .

Canada’s health-care system is a point of Canadian pride. We hold it up as a defining national characteristic and an example of what makes us different from Americans. The system has been supported in its current form, more or less, by parties of all political stripes — for nearly 50 years.

Our team at the Queen’s University School of Policy Studies Health Policy Council is a team of seasoned and accomplished health-care leaders in health economics, clinical practice, education, research and health policy. We study, teach and comment on health policy and the health-care system from multiple perspectives.

While highly regarded, Canada’s health-care system is expensive and faces several challenges. These challenges will only be exacerbated by the changing health landscape in an aging society. Strong leadership is needed to propel the system forward into a sustainable health future.

A national health insurance model

The roots of Canada’s system lie in Saskatchewan, when then-premier Tommy Douglas’s left-leaning Co-operative Commonwealth Federation (CCF) government first established a provincial health insurance program . This covered universal hospital (in 1947) and then doctors’ costs (in 1962). The costs were shared 50/50 with the federal government for hospitals beginning in 1957 and for doctors in 1968.

This new model inspired fierce opposition from physicians and insurance groups but proved extremely popular with the people of Saskatchewan and elsewhere. Throughout the 1960s, successive provincial and territorial governments adopted the “Saskatchewan model” and in 1972 the Yukon Territory was the last sub-national jurisdiction to adopt it.

Read this article in French: Système de santé canadien : un bilan en demi-teinte

In 1968, the National Medical Care Insurance Act was implemented, in which the federal government agreed to contribute 50 per cent toward the cost of provincial insurance plans. In 1984 the Canada Health Act outlawed the direct billing of patients supplementary to insurance payments to physicians.

The five core principles of the Canadian system were now established: universality (all citizens are covered), comprehensiveness (all medically essential hospital and doctors’ services), portability (among all provinces and territories), public administration (of publicly funded insurance) and accessibility.

For the last 50 years, Canada’s health-care system has remained essentially unchanged despite numerous pressures.

Long wait times

The quality of the Canadian health-care system has been called into question, however, for several consecutive years now by the U.S.-based Commonwealth Fund . This is a highly respected, non-partisan organization that annually ranks the health-care systems of 11 nations. Canada has finished either ninth or 10th now for several years running.

One challenge for Canadian health care is access. Most Canadians have timely access to world-class care for urgent and emergent problems like heart attacks, strokes and cancer care. But for many less urgent problems they typically wait as long as many months or even years.

Patients who require hip or knee replacements, shoulder or ankle surgery, cataract surgery or a visit with a specialist for a consultation often wait far longer than is recommended . Many seniors who are not acutely ill also wait in hospitals for assignment to a long-term care facility, for months and, on occasion, years.

And it’s not just accessibility that is the problem. Against measures of effectiveness, safety, coordination, equity, efficiency and patient-centredness, the Canadian system is ranked by the Commonwealth Fund as mediocre at best . We have an expensive system of health care that is clearly under-performing.

A landscape of chronic disease

How is it that Canada has gone from a world leader to a middle- (or maybe even a bottom-) of-the-pack performer?

Canada and Canadians have changed, but our health-care system has not adapted. In the 1960s, health-care needs were largely for the treatment of acute disease and injuries. The hospital and doctor model was well-suited to this reality.

Today, however, the health-care landscape is increasingly one of chronic disease. Diabetes, dementia, heart failure, chronic lung disease and other chronic conditions characterize the health-care profiles of many Canadian seniors.

Hospitals are still needed, to be sure. But increasingly, the population needs community-based solutions. We need to “de-hospitalize” the system to some degree so that we can offer care to Canadians in homes or community venues. Expensive hospitals are no place for seniors with chronic diseases.

Another major challenge for Canadian health care is the narrow scope of services covered by provincial insurance plans. “Comprehensiveness” of coverage, in fact, applies only to physician and hospital services. For many other important services, including dental care, out-of-hospital pharmaceuticals, long-term care, physiotherapy, some homecare services and many others, coverage is provided by a mixture of private and public insurance and out-of-pocket payments beyond the reach of many low-income Canadians.

And this is to say nothing of the social determinants of health , like nutrition security, housing and income. None of these have ever been considered a part of the health-care “system,” even though they are just as important to Canadians’ health as doctors and hospital services are.

Aging population, increasing costs

Canada’s health-care system is subject to numerous pressures.

First of all, successive federal governments have been effectively reducing their cash contributions since the late 1970s when tax points were transferred to the provinces and territories. Many worry that if the federal share continues to decline as projected, it will become increasingly difficult to achieve national standards. The federal government may also lose the moral authority to enforce the Canada Health Act.

A second challenge has been the increasing cost of universal hospital insurance. As economic growth has waxed and waned over time, governments have increased their health budgets at different rates. In 2016, total spending on health amounted to approximately 11.1 per cent of the GDP (gross domestic product); in 1975, it was about 7 per cent of GDP.

Overall, total spending on health care in Canada now amounts to over $6,000 (US$4,790) per citizen. Compared to comparably developed countries, Canada’s health-care system is definitely on the expensive side .

Canada’s aging population will apply additional pressure to the health-care system over the next few years as the Baby Boom generation enters their senior years. In 2014, for the first time in our history, there were more seniors than children in Canada.

The fact that more Canadians are living longer and healthier than ever before is surely a towering achievement for our society, but it presents some economic challenges. On average, it costs more to provide health care for older people.

In addition, some provinces (the Atlantic provinces, Quebec and British Columbia in particular) are aging faster than the others. This means that these provinces, some of which face the prospects of very modest economic growth, will be even more challenged to keep up with increasing health costs in the coming years.

Actions we can take now

The failure of our system to adapt to Canadians’ changing needs has left us with a very expensive health-care system that delivers mediocre results. Canadians should have a health-care system that is truly worthy of their confidence and trust. There are four clear steps that could be taken to achieve this:

1. Integration and innovation

Health-care stakeholders in Canada still function in silos. Hospitals, primary care, social care, home care and long-term care all function as entities unto themselves. There is poor information sharing and a general failure to serve common patients in a coordinated way. Ensuring that the patient is at the centre — regardless of where or by whom they are being served — will lead to better, safer, more effective and less expensive care. Investments in information systems will be key to the success of these efforts.

2. Enhanced accountability

Those who serve Canadians for their health-care needs need to transition to accountability models focused on outcomes rather than outputs. Quality and effectiveness should be rewarded rather than the amount of service provided. Alignment of professional, patient and system goals ensures that everyone is pulling their oars in the same direction.

3. Broaden the definition of comprehensiveness

We know many factors influence the health of Canadians in addition to doctors’ care and hospitals. So why does our “universal” health-care system limit its coverage to doctors’ and hospital services? A plan that seeks health equity would distribute its public investment across a broader range of services. A push for universal pharmacare, for example, is currently under way in Canada. Better integration of health and social services would also serve to address more effectively the social determinants of health.

4. Bold leadership

Bold leadership from both government and the health sector is essential to bridge the gaps and break down the barriers that have entrenched the status quo. Canadians need to accept that seeking improvements and change does not mean sacrificing the noble ideals on which our system was founded. On the contrary, we must change to honour and maintain those ideals. Our leaders should not be afraid to set aspirational goals.

• Chronic diseases
• Health care
• Aging population
• National Health Insurance
• Health-care system
• Canada Health Act
• Canadian health-care system
• Global health systems series

Chief People & Culture Officer

Lecturer / senior lecturer in construction and project management.

Lecturer in Strategy Innovation and Entrepreneurship (Education Focused) (Identified)

Research Fellow in Dynamic Energy and Mass Budget Modelling

Communications Director

• Plagiarism checker Do The Check
• Academic editing Ask For Help
• Samples database View Samples Base

Essay On Health Care System In Canada: College Paper Sample

08 Jul 2019

Canada's social benefit framework is a board of associated medical coverage designs that permits the involvement of every citizen in Canada. It is financed and regulated on commonplace, inside rules set by the regime.

Under the social insurance arrangement, singular nationals are given medical security and self-examination exercise from required consideration doctors and additionally access to doctor's facilities, dental medical procedure, and extra restorative administrations. With a couple of special cases, all residents fit the bill for well-being inclusion paying little heed to medicinal history, individual salary, or way of life.

Canada Health Act

Accessing health care.

Getting to Canada's medicinal benefit framework includes first practice for a commonplace well-being card. The Canada Health Act requires all inhabitants of an area or region to be acknowledged for well-being inclusion. There is a sitting tight period set up for new foreigners that can't surpass three months. When a well-being card is doled out, it is utilized at whatever point visiting a doctor or medicinal services supplier. The well-being card contains an identified proof number, which is utilized in finding a person medical data.

Subsequent to acquiring wellbeing inclusion, one can enroll with an essential consideration doctor. For a routine call to a doctor, one needs just present their wellbeing card. There are daily no structures to be rounded out or singular administration expenses. The accessibility of doctors rely to a big amount on the quantity of specialists and the current interest for restorative administrations. As of now there is around 1 essential consideration specialist for each 1000 Canadians.

Health Care Funding’s in Canada

Social security in Canada is financed at both the common and regime levels. The financing of medicinal duty is given by means of tax collection both from individual and collective pay charges. Extra assets from other money-related sources like deals duty and lottery continues are likewise utilized by some provinces. At an authority level, reserves are apportioned to regions and regions by means of the Canadian Health and Social Transfer (CHST). Exchange installments are made as a blend of duty exchanges and money commitments. The measure of subsidizing areas and domains get is noteworthy and topped $35 billion of every 2002-2003.

Healthcare and Economics in Canada

Portability and provincial resident requirement.

Canada Health Act characterizes safeguarded people as occupants of a region. The Act characterizes an inhabitant as: "a man lawful qualified for be or to stay in Canada who makes his home and is commonly present in the area, however does exclude a traveller, a transient or a guest to the province." When going inside Canada, a Canadian's wellbeing card from his or her home region or region is acknowledged for healing centre and doctor administrations. This movability is actualized through a progression of two-sided corresponding charging understandings between the areas and domains for doctor's facility and doctor services.

Every area has residency and physical nearness prerequisites to meet all demands for human services inclusion. For instance, to meet all requirements for inclusion in Ontario, with specific exemptions, one must be physically present in Ontario for 153 days in some random year time frame. Most territories require 183 days of physical nearness in some random year time frame. Exemptions might be made for portable laborers, if the individual can give documentation from his or her manager confirming that the person's work requires visit travel all through the province. Transients, independently employed nomad specialists (e.g. cultivate laborers) who move from area to region a few times inside a year, and peripatetic resigned or jobless people who move from territory to region (e.g. remaining with different relatives, or living in a recreational vehicle) may get themselves ineligible for wellbeing inclusion in any area or domain, despite the fact that they are Canadian natives or landed outsiders physically present in Canada 365 days a year. "Seasonal residents" (Canadians who winter in warm atmospheres) and different Canadians who are out their home region or domain for a sum of over 183 days in a year time frame lose all inclusion. A three-month holding up period is normally connected before inclusion is restored subsequent to losing coverage. Students going to a college or school outside their home region are for the most part secured by the medical coverage program of their home area, in any case, "Regularly this inclusion (while out-of-territory yet inside Canada) is for doctor and doctor's facility administrations only." The Ontario Ministry of Health and Long-Term Care, for instance, states, "Along these lines, when going outside of Ontario however inside Canada, the service suggests that you get private advantageous health care coverage for non-doctor/non-clinic services."

Such administrations may incorporate physician endorsed medications, or ground and air rescue vehicle benefits that may be shrouded in one's home province.

Was this article helpful?

Thanks for your feedback, readers also enjoyed, work in canada: informative essay example.

Essay Writing Tips 81 likes

Canada vs USA: Compare And Contrast Essay Sample

Essay Writing Tips 89 likes

Essay Sample on Immigration in Canada: Best College Paper Examples From PapersOwl ...

Essay Writing Tips 54 likes

WHY WAIT? PLACE AN ORDER RIGHT NOW!

Just fill out the form, press the button, and have no worries!

Critical Analysis of Health care system in Canada Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Ethnographic Study

Racialization, egalitarianism.

Health care is a basic social necessity that is critical for people to acquire good health status despite their difference in social, political, and economic levels. The health care system in Canada has made significant steps in ensuring that Canadians receive health care services without undue discrimination.

Accessibility, universality, portability, comprehensiveness, and public administration are five principles that guide the health care system of Canada in delivering quality health care services. However, due to societal differences in social, economic, racial, and political backgrounds, discrimination does arise in delivery of health care services.

In Canada, Aboriginal people experience discrimination in health care by virtue of their race since they do not receive equal treatment. According to United Nations Human Development Index, health care of Canada ranks among the top nations, but health care of Aboriginal people ranks 68th in rural reserves and 36th in other parts (Tang, & Bowne, 2008, p.110).

Hence, racism among others factors such as social exclusion, poverty, and discrimination have contributed to inequitable access to health care by the Aboriginal people. Therefore, this critique examines how “race” and racialization process perpetuate inequality in health care system.

The ethnographic study focuses on factors that influence decisions of Aboriginal patients when seeking health care services from Emergency Department in urban hospitals. The study hypothesizes that racialization affects how doctors and nurses deliver their services to Aboriginal people.

To collect robust data from interview and participant observation, the study sampled 82 participants; 38 were staff, which consisted of physicians, nurses and social workers, and 44 patients from Fast Track, a division of Emergency Department. Out of the 44 patients, 10 were Euro-Canadian patients and 34 were Aboriginal patients.

Tang and Browne (2008) point out that theoretical sample was necessary to expound racialization of “Aboriginality” among Aboriginal patients (p.112). Diversity of samples provided for comparative analysis of results with respect to racialization and accessibility of health care by Aboriginals people.

Ethnographic researchers interviewed and observed Aboriginal patients for about 30 to 60 minutes at the Fast Track division in the Emergency Department. To collect reliable data, the researchers interviewed and observed Aboriginals patients in private places such as clinical examination rooms and meeting rooms.

Interviews and observations of physicians, nurses, and social workers also took places in the same place and did last for about 15 to 30 minutes. Tang and Browne (2008) assert that the study aimed at analyzing process of racialization in a health care environment (p.113). Process of racialization is so complex because it has many confounding factors such as economic, social, and cultural factors.

Effective analysis of racialization process involved the researchers, Emergency Department staff, and collaborators who confirmed that the data collected resonated with daily experiences that they constantly encounter.

Racialization has a significant impact in perception of images attributed to certain people. Ideally, racialization involves conceptualization of “race” as a basic and natural way of categorizing people according to their racial attributes.

Dominant race has racialized perception of Aboriginal people because of their cultural, historical, social, and economic backgrounds, thus negatively affect their accessibility to health care. Tang and Browne (2008) argue that notions of “Aboriginality” emanate historical power relations between non-Aboriginal and Aboriginal populations, thus creating racialized images that negatively depict Aboriginals (p.114).

Hence, perception of Aboriginal people based on racialized Aboriginality explains tough experiences that they encounter as they struggle to access health care. Racialized Aboriginality is a concept that has historical origin, and plays a considerable role in shaping political discourses regarding racialization of Aboriginal people, in the context of health care.

Ethnographic study revealed that most Aboriginal people experience discrimination in health care system due to racialized images that depict them negatively. A case scenario describes how Aboriginal patient went to two different Emergency Departments in search of treatment of his chronic headache.

In the first, the physician assumed him as drunk, hence did not diagnose any medical condition after brain scan. Since the physician gave him pills, but the pain did not relieve, the patient went to second Emergency Department where they did brain scan and realized that the patient requires urgent operation. Such a case scenario of the Aboriginal patient portrays experiences that Aboriginal patients undergo when they seek medical attention from health care system.

In the first Emergency Department, the physician based his diagnosis of severe headache on racialized perception that Aboriginals people are drunkards. Tang and Browne (2008) assert that, racialized images of Aboriginal people have negatively influenced how they obtain medical services from health care system (p.115). Therefore, this confirms that health care providers perceive Aboriginal people based on racialized assumptions that depict them as drunkards, poor, and abusers of substances.

Although the health care system of Canada upholds egalitarian principle, which supports equal treatment of everyone, racialization hinders Aboriginal people from accessing health care services. Egalitarianism has its basis in ethical principles, which ensure that everyone receives equal treatment in spite of differences in social categories that society attaches to people.

According to Tang and Browne (2008), application of egalitarianism in health care assumes that health care providers are sensitive and rational when exercising their roles lest they succumb to racialized perceptions of patients (p.117). Mere rhetoric of “treating everyone equally” does not reflect how Aboriginal people experience discrimination due to racialization.

Therefore, health care providers should avoid racialization of Aboriginal people by upholding ethical principles that guarantee just and fair treatment of everyone, and prevent discrimination in health care practice.

Racial profiling indicates that racialization is a hidden process that Aboriginal people encounter in health care system when they seek medical services. Although racialization is real, non-Aboriginal people always tend to deny it because they assume that everyone accesses health care equally.

Most people presume that social issues of race and racism no longer exist in society because they seem obsolete, thus; they overlook the fact that there is racialization of Aboriginal people in health care system.

Tang and Browne (2008) explain that, racial profiling is a discourse that government and media articulate to rationalize racializing practices among diverse communities (p.118). Hence, racial profiling of Aboriginal people indicates that they experience enormous challenges in their lives as they struggle to reclaim their racialized images that contribute to discrimination in health care system.

The health care system of Canada is advanced because it advocates for egalitarianism, an ideology which ensures that everyone receive equal treatment in health care. However, racialization of Aboriginal people has hindered them from accessing health care services as their counterparts from other communities.

Ethnographic study revealed that racialization is a form of discrimination that relegates Aboriginal people by depicting them as drunkards, poor, and substance abusers. Assumptions and stereotypes that health care providers have relating to Aboriginal people determine the nature of treatment that they receive from health care system. Thus, race and racialization are factors that contribute to discrimination of Aboriginal people by health care providers.

Tang, S. Y., & Browne, A. J. (2008). ‘Race’ matters: Racialization and Egalitarian

Discourses Involving Aboriginal People in the Canadian Health Care Context. Ethnicity & Health, 13 (2), 109-127. doi:10.1080/13557850701830307

• Professional Communication With General Practitioner GP
• Is Universal Healthcare a Human Right?
• British Petroleum: The Oil Industry
• How Muslims and Arabs are Racialized in America
• Racism and Male Dominance in Education
• Health Care Jobs and Credentials
• The Health Care Industry
• Emergency Room Equipments Industry Profitability
• Health Care Provision of the United States
• Implications of Managed Care
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2019, March 29). Critical Analysis of Health care system in Canada. https://ivypanda.com/essays/critical-analysis-of-health-care-system-in-canada/

"Critical Analysis of Health care system in Canada." IvyPanda , 29 Mar. 2019, ivypanda.com/essays/critical-analysis-of-health-care-system-in-canada/.

IvyPanda . (2019) 'Critical Analysis of Health care system in Canada'. 29 March.

IvyPanda . 2019. "Critical Analysis of Health care system in Canada." March 29, 2019. https://ivypanda.com/essays/critical-analysis-of-health-care-system-in-canada/.

1. IvyPanda . "Critical Analysis of Health care system in Canada." March 29, 2019. https://ivypanda.com/essays/critical-analysis-of-health-care-system-in-canada/.

Bibliography

IvyPanda . "Critical Analysis of Health care system in Canada." March 29, 2019. https://ivypanda.com/essays/critical-analysis-of-health-care-system-in-canada/.

IvyPanda uses cookies and similar technologies to enhance your experience, enabling functionalities such as:

• Basic site functions
• Ensuring secure, safe transactions
• Secure account login
• Remembering account, browser, and regional preferences
• Remembering privacy and security settings
• Analyzing site traffic and usage
• Personalized search, content, and recommendations
• Displaying relevant, targeted ads on and off IvyPanda

Please refer to IvyPanda's Cookies Policy and Privacy Policy for detailed information.

Certain technologies we use are essential for critical functions such as security and site integrity, account authentication, security and privacy preferences, internal site usage and maintenance data, and ensuring the site operates correctly for browsing and transactions.

Cookies and similar technologies are used to enhance your experience by:

• Remembering general and regional preferences
• Personalizing content, search, recommendations, and offers

Some functions, such as personalized recommendations, account preferences, or localization, may not work correctly without these technologies. For more details, please refer to IvyPanda's Cookies Policy .

To enable personalized advertising (such as interest-based ads), we may share your data with our marketing and advertising partners using cookies and other technologies. These partners may have their own information collected about you. Turning off the personalized advertising setting won't stop you from seeing IvyPanda ads, but it may make the ads you see less relevant or more repetitive.

Personalized advertising may be considered a "sale" or "sharing" of the information under California and other state privacy laws, and you may have the right to opt out. Turning off personalized advertising allows you to exercise your right to opt out. Learn more in IvyPanda's Cookies Policy and Privacy Policy .

Canadian Health Care System

Healthcare provision is one of the biggest concerns and priorities for all governments. Therefore, many governments spend considerable resources to fund a comprehensive health care system for their citizens. For instance, Canada provides universal healthcare for all its citizens through the Medicare program. The federal government disburses funds to the provincial administrations, who run the health insurance programs. However, the system faces some challenges related to increased waiting time, aging population, and uncomprehensive medical covers. Despite these challenges, the Canadian government has identified ad implemented various solutions to ensure the optimal provision of health care for its citizens.

Canadian Health System

The Canadian health care system mainly relies on universal health care, where all eligible persons receive health insurance from the government. The system relies on the Canada Health Act of 1984 to define what care provision entails and the extent to which citizens are covered (Ridic, Gleason, & Ridic, 2012). The main insurance system, Medicare, provides all funding for care in Canada. Under the Act, the health plans are the provincial administrations’ responsibility who avail comprehensive coverage for all medically necessary services for patients. Apart from a few exceptions, the health coverage plan is available for all Canadian residents with non-existent out-of-pocket charges. However, the package of services differs in different regions. For instance, some provinces cover legal abortions while others do not.

It is unlawful to offer private insurance for covered services, but most Canadians take additional insurance to cover the services not listed in the government insurance plan. The government health plan covers all essential basic care services, eliminating the need to get various plans. However, some elective surgeries do not fall under the essential care coverage (Martin et al., 2018). Thus, patients can pay for these services out of their pockets or take private insurance covers. In some provinces, dental care is not included in the universal cover. These services are usually covered through supplement insurance, which employers provide.

The system facilitates physicians to receive payment through the fee-for-service system, and their claims are submitted directly to the provincial health insurance plan. The health plan ensures that all residents within Canada are served equally. Generally, patients play no role in the payment process since it occurs exclusively between the public insurer and the caregivers (Allin, Marchildon, & Peckham, 2020). No monetary exchange occurs between a health practitioner and a patient in Canada. Each provincial administration has a ministry of health controlling medical costs within the region. The department prepares fixed budgets and determines practitioner fees. Moreover, the ministry approves and completely funds the hospitals’ operating budgets. Budget negotiation between the department and individual hospitals occurs annually.

Normally, the ministry holds periodic negotiations with the provincial associations representing doctors to determine physician fees. The provincial administration increases the negotiated fees in steps, depending on the service increase. Moreover, the ministry closely controls and facilitates hospital financing (Allin et al., 2020). The provinces provide minimal capital funding for hospital development. Most of the capital comes from residual community fundraisers. In contrast, the operating budgets mainly come from the provincial administration. Hospitals formulate budgets in conjunction with the health ministry to approve them and disburse funds to hospitals. The hospitals can also raise money from other services such as accommodation and parking.

Health Care Delivery Systems

Primary care.

Family physicians and general practitioners (GPs) are mainly responsible for providing primary care in Canada. In most cases, these caregivers provide initial contact with the main health care system in the country. The general practitioners and physicians control admission to health units, diagnose diseases, provide prescriptions for ailments, and control access to specialists (Marchildon & Allin, 2021). Most GPs work in the private sector and practice independently or in groups, enjoying high autonomy. However, some practitioners work in hospital outpatient departments and community health units but still enjoy the same degree of independence. The doctors working in the private sector receive payment through the fee-for-service system, and their claims are submitted directly to the regional health insurance system.

Other health caregivers also collaborate with the physicians and GPs in the hospitals. For instance, the hospital sector usually employs nurses who provide support services for primary care. Midwives work as independent professionals, while pharmacists provide prescriptions and prepare drugs (Marchildon & Allin, 2021). The pharmacists also act as sources of knowledge by giving patients and caregivers information about prescribed drugs. Patients may also access primary healthcare through the emergency room. However, the government generally discourages this practice due to the costs related to emergency care.

Secondary and Tertiary Health Care

Specialized physicians provide care to patients on an equal basis as general practitioners. These specialists conduct diagnostic testing, prescribe necessary drugs, and refer patients to other allied specialists (Marchildon & Allin, 2021). Nevertheless, to practice as a specialist, they have to undergo specialized training and get certification for practice. In most instances, these physicians main in the private sector or work as affiliates within a hospital outpatient program.

Typically, Canadian hospitals operate as private non-profit organizations under the leadership of trustees or community boards. Thus, Canadian hospitals are highly independent entities, with the regional government only conducting capital budgeting, funding, and comprehensive healthcare planning (Marchildon & Allin, 2021). Even though there were municipality hospitals, Medicare’s introduction resulted in closing down or mergers with other hospital systems. Today, provincial administrations only operate psychiatric institutions. In contrast, the national government only runs military hospitals, native care centers, and veterans’ hospitals.

Challenges in the System

The Canadian health care system faces various challenges hindering optimal service provision. For instance, Medicare’s health insurance system does not cater to all medical services. The level of health care depends on the province where the patient receives treatment. The federal places various conditions to disburse healthcare funds to a province. The region must comply with the Canadian Healthcare Act, which stipulates that medical insurance covers only necessary medical services. Nevertheless, the concept is undefined, meaning each province interprets it at its discretion (Valle, 2016). Thus, various services may not be available in some provinces. Moreover, other services, including psychology and dental services, which are necessary, are not included in the care plan. Thus, the system fails to cover some important services required by citizens.

Moreover, the aging Canadian population will cause an increase in healthcare expenditure as a proportion of total government spending. At least 14% of Canadians were aged above 65 years in 2011, and the number is expected to rise to 36 percent by 2036 (Valle, 2016). The rise in the aging population means that the government will have to revise its public health policies in the future. Even though the older people only accounted for 145 of the total Canadian population in 2011, 44 percent of the total healthcare expenditure went to this age group. With the increasing number of older people, the cost of healthcare will continue to rise (Valle, 2016). Projections indicate that by 2036, expenditure in the healthcare sector will account for at least 10 percent of the Gross Domestic Product. Moreover, the aging population will increase the demand for services not covered in the Medicare program. Thus, there will be a need to revise policies to tackle this issue.

Another pertinent issue with Canadian health care is the extended waiting time to access services. For instance, a patient requiring surgery or other diagnostic procedures has to wait for an average of 13.3 weeks. Most Canadian physicians agree that the average waiting time for most procedures is a third longer than clinically reasonable durations (Valle, 2016). The situation is even worse in scenarios where a patient requires diagnostic imaging. Some vulnerable categories of the Canadian population are suffering from delays. For instance, the elderly who require fast access to cardiovascular surgery, hip replacement, and cataract surgery do not get timely services. This challenge causes diminishing health outcomes in the Canadian population.

Possible Solutions

There is a need for the federal government to effect universal policies for cover in all provinces. In the current system, the provinces have the discretion to determine what medical services are deemed necessary. This causes an imbalance in healthcare provision across regions in the country. Therefore, a policy standardizing the practices for all provinces will be useful (Dhalla & Tepper, 2018). The Canadian Healthcare Act should be amended to include compliance requirements for provincial admirations to follow the standard policy. Moreover, the government needs to revise its policy on the services included in the medical care plan. Important dental and psychology sessions should be part of necessary medical services.

Moreover, the government can invest further resources into the healthcare system to reduce waiting time in hospitals. For decades, Canadians have widely publicized this issue and demanded that the government address this issue. In response, the government invested billions into alleviating the problem, particularly for some procedures, including cancer treatment and heart procedures. In 2004, the government invested 5.5 billion Canadian dollars in reducing hospital waiting times (Valle, 2016). However, these measures are not enough. The government needs to continue investing in the healthcare system to ensure that this problem does not endure.

The Canadian government also needs to reconsider the ‘single-payer’ system. Currently, all Canadian residents depend on the government healthcare plan to access basic medical services. Even though it is comprehensive, the funds may sometimes not be enough to cater to all patient needs. Thus, they are a need to consider other avenues for patients to access medical coverage (Ridic et al., 2012). For instance, the government could repeal the Act outlawing private insurance use on medically necessary services. Allowing private insurance to provide coverage to willing clients will increase resource allocation into the health sector. Increased funding will translate to better health care for Canadian residents.

Comparison between the United States and Canadian Health Care Systems

In both countries, the private sector plays a significant role in health care provision. For example, in the United States, private entities are the main providers for both health insurance and medical care services. Insurance companies compete for customers by selling their policies directly to customers. The private enterprises also operate private hospitals providing medical services to Americans (St George’s University, 2019). Most of the hospitals in the United States are private-owned. Similarly, Canada’s main system of health provision is through the private sector. All hospitals apart from military and psychiatric institutions are privately owned and operated. Communities, religious organizations, and non-profit institutions operate the hospitals. Practitioners and physicians work independently through private hospitals or health-affiliated institutions. However, the government supports these hospitals by funding their operational budgets.

In Canada, the government provides funding for universal medical coverage for its citizens through the provinces. The only condition is that the provinces have to abide by the requirements of the Canadian Health Act. The funds from the federal government cover Canadian residents on all medically necessary services. In contrast, United States residents cover their medical insurance (St George’s University, 2019). However, there are few exceptions where the government provides insurance for special groups depending on income, disability, age, and occupation. Some government policies include Medicaid, Medicare, and the Veterans Health Administration. Most of the private insurances covering citizens originate from employment. Companies and businesses deduct part of their employees’ salaries to cater to insurance benefits.

Even though the Canadian healthcare system faces some challenges, the government has actively tried to provide good medical care for its citizens. The country’s universal health policy supports the medical care system in Canada. Through Medicare, the government provides insurance for all its residents for medically necessary services. Private entities usually provide medical services through general practitioners and physicians who work autonomously. Specialized physicians also operate similarly. However, the system experiences various problems, including increased waiting time, an aging population, and uncomprehensive medical covers. Possible solutions include changing the insurance policies and additional investment into the healthcare system.

Allin, S., Marchildon, G., & Peckham, A. (2020). International health care system profiles: Canada.  The Commonwealth Fund.  Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/canada.

Dhalla, I. A., & Tepper, J. (2018). Improving the quality of health care in Canada : Canadian Medical Association Journal   190 (39), 1162–1167. DOI: 10.1503/cmaj.171045.

Marchildon, G., & Allin, S. (2021).  Health systems in transition: Canada  (3rd Ed.). University of Toronto Press.

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal healthcare system: achieving its potential.  The Lancet ,  391 (10131), 1718-1735. DOI: 10.1016/S0140-6736(18)30181-8.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada.  Materia Socio-Medica ,  24 (2), 112–120. DOI: 10/5455/MSM/ 2012.24. 112-120.

St George’s University. (2019). Comparing the US and Canadian health care systems: Fouur differences you need to know. Retrieved from https://www.sgu.edu/blog/medical/comparing-us-and-canadian-health-care-systems/.

Valle, V. M. (2016). An assessment of Canada’s healthcare system weighing achievements and challenges.  Norteamérica ,  11 (2), 193-218. DOI: 10.20999/nam.2016/b008.

Cite This Work

To export a reference to this article please select a referencing style below:

Related Essays

The impact of technology on sports performance, ethical theories case study, public health system, asphalt pavements recycling techniques, professional practice statement: nurse practitioner, changes in aging and health, popular essay topics.

• American Dream
• Artificial Intelligence
• Black Lives Matter
• Bullying Essay
• Career Goals Essay
• Causes of the Civil War
• Child Abusing
• Civil Rights Movement
• Community Service
• Cultural Identity
• Cyber Bullying
• Death Penalty
• Depression Essay
• Domestic Violence
• Freedom of Speech
• Global Warming
• Gun Control
• Human Trafficking
• I Believe Essay
• Immigration
• Importance of Education
• Israel and Palestine Conflict
• Leadership Essay
• Legalizing Marijuanas
• Mental Health
• National Honor Society
• Police Brutality
• Pollution Essay
• Racism Essay
• Romeo and Juliet
• Same Sex Marriages
• Social Media
• The Great Gatsby
• The Yellow Wallpaper
• Time Management
• To Kill a Mockingbird
• Violent Video Games
• What Makes You Unique
• Why I Want to Be a Nurse
• Send us an e-mail

• Undergraduate
• High School
• Architecture
• American History
• Asian History
• Antique Literature
• American Literature
• Asian Literature
• Classic English Literature
• World Literature
• Creative Writing
• Linguistics
• Criminal Justice
• Legal Issues
• Anthropology
• Archaeology
• Political Science
• World Affairs
• African-American Studies
• East European Studies
• Latin-American Studies
• Native-American Studies
• West European Studies
• Family and Consumer Science
• Social Issues
• Women and Gender Studies
• Social Work
• Natural Sciences
• Pharmacology
• Earth science
• Agriculture
• Agricultural Studies
• Computer Science
• IT Management
• Mathematics
• Investments
• Engineering and Technology
• Engineering
• Aeronautics
• Medicine and Health
• Alternative Medicine
• Communications and Media
• Advertising
• Communication Strategies
• Public Relations
• Educational Theories
• Teacher's Career
• Chicago/Turabian
• Company Analysis
• Education Theories
• Shakespeare
• Canadian Studies
• Food Safety
• Relation of Global Warming and Extreme Weather Condition
• Movie Review
• Admission Essay
• Annotated Bibliography
• Application Essay
• Article Critique
• Article Review
• Article Writing
• Book Review
• Business Plan
• Business Proposal
• Capstone Project
• Cover Letter
• Creative Essay
• Dissertation
• Dissertation - Abstract
• Dissertation - Conclusion
• Dissertation - Discussion
• Dissertation - Hypothesis
• Dissertation - Introduction
• Dissertation - Literature
• Dissertation - Methodology
• Dissertation - Results
• GCSE Coursework
• Grant Proposal
• Marketing Plan
• Multiple Choice Quiz
• Personal Statement
• Power Point Presentation
• Power Point Presentation With Speaker Notes
• Questionnaire
• Reaction Paper

Research Paper

• Research Proposal
• SWOT analysis
• Thesis Paper
• Online Quiz
• Literature Review
• Movie Analysis
• Statistics problem
• Math Problem
• All papers examples
• How It Works
• Money Back Policy
• Terms of Use
• Privacy Policy
• We Are Hiring

Canadian Health Care, Essay Example

Pages: 5

Words: 1328

Hire a Writer for Custom Essay

Use 10% Off Discount: "custom10" in 1 Click 👇

You are free to use it as an inspiration or a source for your own work.

Waiting Time Policy in Canadian Health Care System

Nowadays, Canada is considered one of the most developed and service-oriented countries in the world; moreover, it is well-praised for its health care system that is free and accessible for everybody. In fact, there are numerous public debates discussing necessary and urgent changes of the health care policy and system in general; it is announced that the system lacks sufficient funding and struggles corporate profiteering and demographic surcharge. Nevertheless, it is known that the government spends billions of dollars on investigating province hospitals, investigating into new technologies, and observing the main principles of Canada Health Act.

The major problem has always been restricting policy to medical treatment access that results in long-term waiting lists. Although the government funds the Medicare system in the country, it is obvious that it is unable to cover all the costs; it is also necessary to take into consideration that the medical science does not stand at the same position, it has been developing steadily with constant appearance of new technologies and drugs that also increase spending. Without public involvement, the government reveals the inability of the state and the health care system to provide and ensure high-quality treatment to everybody.

Though Canada is one of the seven OECD countries providing free medical service, it is considered to occupy the worst place in the world because of its wait lists. Besides general inconvenience and indignation of the public, it often causes severe problems to the well-being of the patients that lack appropriate and timely medical care. These expectations sometimes and lately even more often result in death of patients or their health conditions worsen so much that there is no more need in the professional help.

The system of Canadian health care is based on reasonable and good intentioned principles such as public administration, comprehensiveness, universality, portability, and accessibility (Butler, 2009). Nevertheless, the system expecting to offer a variety of services free to every resident and available anywhere in Canada does not provide the whole set of health care treatments. According to the primary objective of Canadian health care policy (1985), it is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers (p. 5). Nevertheless, Canadian publications have been currently exploding with shocking medical stories.

As the main demand is for hospitable beds and physicians, the government funds these aspects of health care while it is almost impossible to get the services such as drug prescription, dentistry, ophthalmology, optometry, reproductive care, and cosmetic items. Long-term wait lists serve to cut the costs on the above fields through exceptional access to the specialist and procedures. The worst thing here is that government authorities supported by media claim that this is a necessary restriction and is the solution to the problems existing in the current system.

Because of the government attempts to manage the free Medicare system as well as save budget funds at the same time, the health care is supposed to be the most bureaucratic social industry in the country. Treatment and medical attention are required by large groups of population, but the system cannot satisfy all the demands that results in long queues when crowds of patients need the diagnosis or treatment simultaneously. The policy of waiting queues reveals the constant necessity of patients in doctors, nurses, and hospitable beds; the schedule books purposing to solve these problems arouse long-term waiting especially for particular diagnosis procedures when some patients drop the attempts to get the proper treatment and seek it in private clinics or stop their waiting because of recovery or even death.

Avoiding the schedule book system is possible only if there are acquaintances involved in the health care field who may help in skipping the long-months expectation. Apart from inconvenience and indignation, poor medical management has already resulted in some accidents with negative consequences; there are some cases when people may wait for hours in emergency lobbies without seeing a doctor. These situations may arouse conflicts with personnel and even result in aggressive behavior and actions that lead to nothing, but law problems concerning both parties.

The selective approach of the government also covers the sphere of chronic diseases treatment that mostly involves long-term medical care and home care assistance. That is hardly affordable by the system because of the expenses as while struggling with such difficult and usually multiple chronic diseases, the patients usually need various services responding their multiple and changing needs and full-fledged attention of the experienced staff. As a result, chronic-ill patients face long wait list for certain specialists and tests, limited resources provided, and lack of technology required.

There is another aspect of the holding-the-line-on-costs policy pursued by the government; it is to provide a selective effect on patients’ demands that are often inappropriate. This means that some referrals for medical procedures and treatment are unjustified because of their free nature. However, when there is an opportunity to experience a long wait list, such demands stand no longer as there is no sharp need in them (Davies, 1999, p. 1469). Nevertheless, it is only in a specialist’s responsibility to evaluate the necessity in some kinds of treatments and drugs as the symptoms can be interpreted by the patient in a wrong way.

While selecting inappropriate patients’ referral, the government policy also causes serious health consequences for those who really need timely treatment. The longest waiting lists concern such important spheres for patients’ well-being as urology, general surgery, ophthalmology, and otolaryngology. The other spheres suffering from inability to provide sufficient medical help are plastic surgery, gynecology, neurosurgery, orthopedics, cardiology, and internal medicine (Globerman, 1991, p.253)

It is also important to take into consideration the cost of the waiting lists that are supposed to save government costs, but mismanage to help patients. Wrongly supposed as a solution, the waiting policy is a serious problem that causes numerous deaths of patients who spent the rest of their lives waiting for medical help. Apart from death cases, health conditions often worsen that much that it is either too risky to conduct treatment such as surgery or there is no more need in it. It is not stated in system statistic reports that the patients who manage to wait to the doctor’s appointment have to wait again to receive the appropriate treatment.

According to Esmail article (2004), a number of programs have been created at the provincial and local levels to both report surgical waiting times to the public and better organize and manage patients waiting for care (p. 3). Although it is a positive step to build public awareness of the existing problem, the negative side of it is that the problem is considered to be an essential part of the Medicare system. In fact, the government should solve disadvantages of the system through attracting and implementing market mechanisms into the public insurance scheme (Esmail, 2004).

The policy of waiting lists is a burden for the Canadian health care system that prevents it from development and efficiency of provided services. This policy should be eliminated as the main reason of society disease; it is necessary to build a health care system that will be able to provide needed treatment in compliance with appropriate time limits. The government should focus on conducting detailed patients’ data to establish the proper demand for medical services as well as use only expertized and experienced medical staff to translate the findings into sufficient guidelines reflecting the amount and kind of services needed to be provided.

Butler, G.J. (2009). The Health Care Debate in Canada: One Canadian Radiologist’s View. Canadian Association of Radiologists Journal , no. 60, pp. 11-15.

Canada Health Act (1985). Minister of Justice , Retrieved from http://laws-lois.justice.gc.ca

Davies, R.F. (1999). Waiting Lists for Health Care: A Necessary Evil?. CMAJ: Canadian Medical Association Journal , Vol.160, Iss.10, pp. 1469-1470.

Esmail, N. (2004). Fixing Waiting Times. Fraser Forum , p.3.

Globerman, S. (1991). A Policy Analysis of Hospital Waiting Lists. Journal of Policy Analysis & Management , Vol.10, Iss.2, pp. 247-262.

Stuck with your Essay?

Get in touch with one of our experts for instant help!

Development Through the Lifespan, Essay Example

Retention Model for International Students, Research Paper Example

Time is precious

don’t waste it!

Plagiarism-free guarantee

Privacy guarantee

Secure checkout

Money back guarantee

Related Essay Samples & Examples

Relatives, essay example.

Pages: 1

Words: 364

Voting as a Civic Responsibility, Essay Example

Words: 287

Utilitarianism and Its Applications, Essay Example

Words: 356

The Age-Related Changes of the Older Person, Essay Example

Pages: 2

Words: 448

The Problems ESOL Teachers Face, Essay Example

Pages: 8

Words: 2293

Should English Be the Primary Language? Essay Example

Pages: 4

Words: 999

Academic Support for Nursing Students

No notifications.

Disclaimer: This essay has been written by a student and not our expert nursing writers. View professional sample essays here.

View full disclaimer

Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date.

Analysis of Canada's Healthcare System

Info: 2077 words (8 pages) Nursing Essay Published: 11th Feb 2020

Reference this

Tagged: funding

If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help!

Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.

Cite This Work

To export a reference to this article please select a referencing stye below:

Related Services

• Nursing Essay Writing Service

• Nursing Dissertation Service

• Reflective Writing Service

Related Content

Content relating to: "funding"

General taxation supplemented by National Insurance contributions still accounts for around 80% of NHS funding. Other funding is generated by user changes that includes prescriptions, dental treatment and spectacles which were first introduced in the early 1950’s.

Related Articles

Public Health Funding Essay

It is imperative that the Aspen County Public Health Department explore all viable federal grant funding opportunities in order to continue its ability to improve the health of the state’s underserved populations....

Relay for Life - a Cancer Charity

By Michelle Springer My paper will start with the history of Relay for Life and how it started up. Then talk about places that help to fundraiser money for cancer research. Also about how cancer affe...

INTRODUCTION Canada is a developed country located in the northern part of North America. In 1867, it became a self-governing state while retaining its tie with the British crown. When it comes to ec...

DMCA / Removal Request

If you are the original writer of this essay and no longer wish to have your work published on the NursingAnswers.net website then please:

Our academic writing and marking services can help you!

• Marking Service
• Samples of our Work
• Full Service Portfolio

Related Lectures

Study for free with our range of nursing lectures!

• Drug Classification
• Emergency Care
• Health Observation
• Palliative Care
• Professional Values

Write for Us

Do you have a 2:1 degree or higher in nursing or healthcare?

Study Resources

Free resources to assist you with your nursing studies!

• APA Citation Tool
• Example Nursing Essays
• Example Nursing Assignments
• Example Nursing Case Studies
• Reflective Nursing Essays
• Nursing Literature Reviews
• Free Resources
• Reflective Model Guides
• Nursing and Healthcare Pay 2021

Health data collected from Indigenous Peoples in Canada has a dark history. One Indigenous company is turning that around

In the 1980s, Nuu-chah-nulth people on Vancouver Island donated more than 800 vials of blood for research on rheumatic diseases prevalent in their communities. Their hope was to help find a cure.

Decades later, however, they learned the samples they supplied had led nowhere and were instead used for unapproved studies in genetic anthropology.

"Just because we're First Nations doesn't mean you can do whatever you want with us," a donor told Indigenous newspaper Ha-Shilth-Sa in 2004.

But cases like this highlight a dark history of medical researchers doing just that: subjecting children in residential schools to experiments involving intentional malnutrition and patients at Indian hospitals to treatments without their consent .

This week, at a ceremony in Victoria, the Canadian Medical Association (CMA) issued a formal apology for its role, and the role of the medical profession, in harms to Indigenous Peoples – including the unethical collection and misuse of health data that has contributed to ongoing mistrust of the health system and avoidance of care.

The CMA states that the apology is a critical first step towards reconciliation and better Indigenous health outcomes. Another, says Mark Sommerfeld, is enabling Indigenous data sovereignty, ensuring that Indigenous Peoples have control over their own health information, from clinical records to data collected for medical research.

Sommerfeld is the CEO of Mustimuhw Information , named for a Coast Salish word for "all of the people" or "all my relations."

Owned and operated by Cowichan Tribes on Vancouver Island, the software company develops medical records systems that are built on a foundation of Indigenous traditions and values, allowing health providers working in First Nations communities to capture data informed by their cultural practices, ways of communicating and culturally guided care environments.

For example, Sommerfeld says, "A lot of our services in Indigenous communities are offered in a group setting," rather than one-on-one interactions in a doctor's office. The group dynamic demonstrates the value of honouring the collective, working together with humility and supporting others.

"Standard software used by physicians isn't designed for [this]," he says, explaining that Mustimuhw incorporates factors like these into their applications.

The group is key to Indigenous definitions of health, as well, another nuance that can be overlooked by health-care systems or misinterpreted, Sommerfeld says. "When we build our software, we understand that 'health' to First Nations is more than health. It's not only about an individual, but also about wholistically building and supporting a Nation."

To reflect this, Mustimuhw collaborates closely with clients as data systems are developed. Sommerfeld points to a nursing program offered through the Nuu-chah-nulth Tribal Council, a non-profit health service for 14 Nuu-chah-nulth First Nations. The program is rooted in traditional nursing practices and standards developed by the community, and that lens is applied to the digital tools they use.

Sommerfeld notes that First Nations data systems must ultimately work in two worlds, providing standard health information in commonly used formats while also meeting community needs. "It's crucial that the data stored using Mustimuhw allows for interoperability within western medical systems as needed," he says.

But sharing health data effectively does not diminish the strength that comes from Indigenous people stewarding that data. Dr. Ryan Giroux, a Métis general pediatrician in Toronto, sees data sovereignty as "a natural extension of self-determination and self-governance." This autonomy, he says, "shifts the power imbalance Indigenous people have felt within the health-care system."

Giroux references the significant difference even subtle changes in patient-physician communications and interactions can make. "Research has proven that when a physician shifts the approach from a place of knowledge and authority to being a 'curious partner' in someone's health experience, the health care received, and patient experience, is greater and more effective."

Making space for Indigenous data governance, he says, is a tangible step towards the decolonization of health care, for individuals as well as Indigenous communities as a whole.

Dr. Alika Lafontaine, an anesthesiologist in Grande Prairie, Alta., with Métis, Oji-Cree and Pacific Islander ancestry, was the first Indigenous president of the CMA and has been instrumental in the organization's apology. He says data sovereignty also means that the narrative around information that's collected is grounded in lived experience.

"There are nuances to data and the fact that you have data doesn't mean it is always valuable," he says. "Data without context isn't valuable."

In the movement towards Indigenous data sovereignty, the First Nations Information Governance Centre has established a framework for success based on four principles – the ownership, control, access and possession of information, or OCAP.

In stark contrast to the horrific medical experimentation conducted without the consent of Indigenous patients, OCAP puts Indigenous Peoples at the centre of decisions about health data.

"OCAP was first used as a value change in looking at Indigenous health sovereignty," Lafontaine says. "It's about establishing an aligned interest and learning what people want to share."

Information on young Indigenous patients with genetic syndromes, for example, can help with testing, screening and diagnosis, he says.

As the technology used to harness and analyze data continues to advance, Lafontaine says the need for Indigenous leadership, knowledge and innovation will continue to grow. Direct engagement with AI tools, for instance, will be critical to ensure the accuracy of data cited and how it informs health care decision-making.

"For Indigenous data sovereignty, the focus needs to be on the 'why and what,' instead of just 'how,'" he says.

"If First Nations aren't included, then we will become the product."

This piece is part of a partnership between the Canadian Medical Association (CMA) and CTV News. For more information on the CMA, visit www.cma.ca .

CTVNews.ca Top Stories

Recall issued for 38,000 GM vehicles in Canada over software safety glitch

Transport Canada has issued a recall for 38,000 General Motors (GM) vehicles for safety risks related to a software glitch, the agency reported in a notice on Wednesday.

Top Hezbollah commander among 12 killed in Israeli strike on Beirut

Israel killed a top Hezbollah commander and other senior figures in the Lebanese movement in an airstrike on Beirut on Friday, vowing to press on with a new military campaign until it is able to secure the area around the Lebanese border.

11-year-old boy dies after subway surfing in NYC

An 11-year-old boy died Monday after subway surfing in New York City. He's the fourth person to die from subway surfing in the city this year.

Woman nearly shut out of mother's estate sues brother in B.C. Supreme Court – and wins

Since she was a young girl growing up in Vancouver, Ginny Lam says her mom Yat Hei Law made it very clear she favoured her son William, because he was her male heir.

Canadians say they fear they've been scammed out of thousands of dollars by car moving company

An Ontario man says he’s still waiting for a vehicle he purchased on Kijiji to be delivered to his home. But after more than a month, he says he’s losing hope that the car will arrive and believes that he is a victim of a scam.

'We're still pushing hard': Search for missing Manitoba boy continues, RCMP find tracks

The search for a missing six-year-old boy in Shamattawa is continuing Friday as RCMP hope recent tips can help lead to a happy conclusion.

BREAKING | N.B. RCMP looking for 15-year-old with gun in Moncton, Shediac areas

The New Brunswick RCMP has issued an alert as officers search for an armed teenager in the Moncton and Shediac areas.

Ontario man to pay $1,500 surcharge after insurer says his SUV is at higher risk of theft

An Ontario man says it is 'unfair' to pay a $1,500 insurance surcharge because his four-year-old SUV is at a higher risk of being stolen.

DEVELOPING | Here's what we know about Israel's latest strike in Beirut

Israel’s military has struck the southern suburbs of Beirut, Lebanon’s capital, in a dramatic escalation in a year-long period of conflict between Israel and Hezbollah.

'Worst nightmare': Toronto mom pleads for return of son who was allegedly abducted

For the last seven-and-half months, Toronto resident Heather McArthur has been living out what she describes as her 'worst nightmare.' On Feb. 7, her then three-year-old son Jacob along with his father Loc Phu 'Jay' Le departed for what was supposed to be a week-long visit to Vietnam to celebrate the Lunar New Year with family, McArthur says.

BREAKING | Ontario Minister Michael Ford announces leave of absence from cabinet

Michael Ford, Ontario's minister of citizenship and multiculturalism, says he is taking a leave of absence from cabinet to prioritize his health.

Four dead in northern Ontario house fire

Emergency crews in northern Ontario found the bodies of four people inside a home where a fire broke out Thursday night.

Victims, including three Canadians, claim former Harrods boss Al Fayed was a 'monster' who abused young women, lawyers say

Lawyers in Britain representing dozens of alleged victims -- including three Canadians -- of Mohamed Al Fayed, the former boss of Harrods, said Friday their clients assert that he was a "monster" who raped and sexually abused young women.

Mexican president blames the U.S. for bloodshed in Sinaloa as cartel violence surges

Mexican President Andres Manuel Lopez Obrador blamed the United States in part on Thursday for the surge in cartel violence terrorizing the northern state of Sinaloa which has left at least 30 people dead in the past week.

Secret Service report details communication failures preceding July assassination attempt on Trump

Communication breakdowns with local law enforcement hampered the Secret Service's performance ahead of a July assassination attempt on former U.S. president Donald Trump, according to a new report that lays out a litany of missed opportunities to stop a gunman who opened fire from an unsecured roof.

House unanimously votes to boost Trump security as Congress scrambles to ensure candidate safety

Lawmakers are scrambling to ensure that the U.S. Secret Service has enough money and resources to keep the nation's presidential candidates safe amid repeated threats of violence. It's unclear, though, how much they can do with only weeks before the election, or if additional dollars would make an immediate difference.

NDP ask competition watchdog to investigate potential rent-fixing by landlords

The NDP is asking the Competition Bureau to investigate whether Canadian landlords are using the same AI software that sparked an antitrust lawsuit in the United States.

Joly convenes fellow women foreign ministers to talk harassment, equity in politics

Foreign Affairs Minister Melanie Joly is convening female foreign ministers from a dozen countries to talk about women's participation in governance and issues like online harassment.

PM Trudeau names Anita Anand transport minister after Pablo Rodriguez quits cabinet

Prime Minister Justin Trudeau tapped Treasury Board President Anita Anand to take on additional duties as Canada's minister of transport on Thursday.

N.S. woman with painful condition seeks MAID amid battle to fund surgical treatment

A Nova Scotia woman has applied for a medically assisted death, saying after years of battling to receive out-of-country surgery for an illness that causes 'indescribable' pain, she struggles to maintain the will to live.

After years of advocacy by a pediatrician, all Nunavut babies to get RSV immunization

The Nunavut government says it will provide immunization against respiratory syncytial virus to all infants in the territory this fall, a policy change that one pediatric infectious diseases specialist has been advocating for decades.

Ontario minister and ex-CFL player will donate his brain for concussion research

Ontario’s Minister of Sport, Neil Lumsden, will donate his brain to research.

Lebanon bans pagers, walkie-talkies from flights

Lebanese authorities on Thursday banned walkie-talkies and pagers from being taken on flights from Beirut airport, the National News Agency reported, after thousands of such devices exploded during a deadly attack on Hezbollah this week.

Chechen warlord accuses Elon Musk of 'remotely disabling' his Cybertruck

Chechen leader Ramzan Kadyrov has accused Tesla CEO Elon Musk of 'remotely disabling' his Cybertruck, which had been sent to the frontline of Russia's war in Ukraine.

No, these viral purple apples don't exist in Saskatchewan

If something looks too good to be true, it might be. That's the message from Saskatchewan horticulturists after customers have come into their stores hoping to buy purple apple trees this month.

Entertainment

'The last show': Memorial service for Calgary children's entertainer Buck Shot

It will be the last show for longtime children's TV star Ron (Buck Shot) Barge as a memorial is held Friday in Calgary.

What's next in the federal investigation into Sean 'Diddy' Combs and his alleged co-conspirators

Sean "Diddy" Combs, who was arrested this week on charges of racketeering conspiracy and sex trafficking, pleaded not guilty Tuesday and was ordered to remain in custody until his federal trial in New York. CNN spoke to several legal experts to try to understand what lies ahead for Combs and for those in his orbit.

This Canadian city was a category on Jeopardy this week

Viewers of Jeopardy got a chance to test their knowledge of trivia about B.C.'s biggest city Wednesday night.

Bank of Canada trying to figure out how AI might affect inflation, Macklem says

Bank of Canada governor Tiff Macklem says there is a lot of uncertainty around how artificial intelligence could affect the economy moving forward, including the labour market and price growth.

Sask. court orders trial in fraud case after $100K in stolen cash was traded for bitcoin

A case involving stolen funds from a Saskatchewan business being used to purchase cryptocurrency will be heading back to the courts, thanks to a new decision by Saskatchewan's Court of Appeal.

McDonald's touchscreen kiosks were feared as job killers. Instead, something surprising happened

Self-service kiosks at McDonald's and other fast-food chains have loomed as job killers since they were first rolled out 25 years ago. But nobody predicted what actually happened.

Is your kid a picky eater? It's probably not your fault, study shows

A new study found that food fussiness in children is “a largely genetic trait,” while other factors, such as the types of foods eaten at home and where meals are eaten, may only be significant when the child is a toddler.

Huge Australian king penguin chick Pesto grows into social media star

A huge king penguin chick named Pesto, who weighs as much as both his parents combined, has become a social media celebrity and a star attraction at an Australian aquarium.

Heroic dog saved his northern Ont. owner who had a massive heart attack

They say a dog is a man’s best friend. In the case of Darren Cropper, from Bonfield, Ont., his three-year-old Siberian husky and golden retriever mix named Bear literally saved his life.

Ottawa Senators, National Capital Commission agree to build a new arena at LeBreton Flats

Agreement in principle has been reached to build a new NHL arena at LeBreton Flats has been reached between the Ottawa Senators and the National Capital Commission (NCC), the two sides announced Friday.

Off-season departures means opportunity knocks for young players at Jets camp

The Winnipeg Jets have some huge holes to fill on both offence and defence this season.

Shohei Ohtani surpasses 50-50 milestone in spectacular fashion with a 3-homer, 2-steal game

Shohei Ohtani became the first major league player to hit 50 home runs and steal 50 bases in a season, with the Los Angeles Dodgers star going deep twice to reach the half-century mark and swiping two bags to get to 51 against the Miami Marlins on Thursday.

Woman steals Porsche, runs over owner after responding to Mississauga Auto Trader ad

Video of a brazen daylight auto theft which shows a suspect running over a victim in a stolen luxury SUV has been released by police west of Toronto.

Local Spotlight

Brides and vendors claim they were ripped off by Barrie, Ont. photographer

A growing group of brides and wedding photographers from across the province say they have been taken for tens of thousands of dollars by a Barrie, Ont. wedding photographer.

'Trove of extraordinary fossils' discovered in northern B.C., museum says

Paleontologists from the Royal B.C. Museum have uncovered "a trove of extraordinary fossils" high in the mountains of northern B.C., the museum announced Thursday.

Missing 28-year-old donkey found dead, believed to have been killed by cougar

The search for a missing ancient 28-year-old chocolate donkey ended with a tragic discovery Wednesday.

'The gift they gave us was their service': 50 years since first female troop joined the RCMP

The Royal Canadian Mounted Police is celebrating an important milestone in the organization's history: 50 years since the first women joined the force.

Young family from northern Ontario wins $70 million Lotto Max jackpot

It's been a whirlwind of joyful events for a northern Ontario couple who just welcomed a baby into their family and won the $70 million Lotto Max jackpot last month.

'The right thing to do': Good Samaritan builds new bottle cart for Moncton man who had his stolen

A Good Samaritan in New Brunswick has replaced a man's stolen bottle cart so he can continue to collect cans and bottles in his Moncton neighbourhood.

Oppenheimer star David Krumholtz dishes on his time filming in Winnipeg

David Krumholtz, known for roles like Bernard the Elf in The Santa Clause and physicist Isidor Rabi in Oppenheimer, has spent the latter part of his summer filming horror flick Altar in Winnipeg. He says Winnipeg is the most movie-savvy town he's ever been in.

'Craziest thing I've ever seen': Elusive salamanders make surprising mass appearance in Edmonton area

Edmontonians can count themselves lucky to ever see one tiger salamander, let alone the thousands one local woman says recently descended on her childhood home.

Climate protesters to march through downtown Vancouver on Friday

Thousands of protesters are expected to march into downtown Vancouver on Friday, demanding more action from their government to address the growing climate crisis.

Canucks fan group The Larscheiders fighting for spot at Rogers Arena

Members of the only organized support group for the Vancouver Canucks are feeling slighted after losing their usual space at Rogers Arena.

'Adult content' viewers targeted in growing Bitcoin extortion scam, B.C. RCMP say

There have been more reports of a Bitcoin extortion scam seeking to exploit viewers of "adult content" in B.C.'s Lower Mainland, according to the RCMP.

Ford government considering restricting new bike lanes that require the removal of lanes of traffic: source

The Ford government is considering restricting Ontario municipalities from installing new bike lanes that would require the removal of lanes of traffic, a source confirms to CTV News Toronto.

Alberta Health Services declares E. coli outbreak over at central Alberta daycare

Alberta Health Services says an E. coli outbreak at a daycare in Blackfalds has ended.

Murder suspect wrote 'I'm sorry' in blood on cell wall to Banff, Alta., stabbing victim, court hears

Defence counsel for accused murderer John-Christopher Arrizza argues he was in an “altered state of mind” due to days of drug and alcohol use, sleep deprivation and not eating, when he fatally stabbed a man at a Banff nightclub in 2022.

Ottawa driver safely extricated following two-vehicle collision in south end

Ottawa Fire Services says a driver has been safely extricated after being trapped following a two-vehicle collision near a high school in the city’s south end.

Ottawa police arson unit investigating basement fire in Little Italy

The Ottawa Police Service Arson Unit is seeking witnesses to a fire that happened early Friday morning in a two-storey commercial building in Little Italy.

Montreal couple facing deportation to Mexico granted temporary residency

The Montreal couple from Mexico and their three children facing deportation have received a temporary residence permit.

'It's disgusting': Quebec minister reacts after body of boy, 14, found near Hells Angels hideout

The province's public security minister said he was "shocked" Thursday amid reports that a body believed to be that of a 14-year-old boy was found this week near a Hells Angels hideout near Quebec City.

Man wins right to work in French: Quebec tribunal

A man who asserted his right to work in French has won his case before the Tribunal, invoking the new provisions of the province's French-language law (Bill 96) to that effect.

Suspect still at large after police search in Sherwood Park

Mounties say there was an increased police presence in the Emerald Hills area of Sherwood Park on Friday morning as officers searched for a man who is wanted by police.

Man found dead in Edmonton river valley was shot to death: autopsy

Edmonton police say a man who was died in the river valley last weekend was fatally shot.

Bear tranquilized in Dartmouth Commons released back to wild: DNRR

A black bear that was tranquilized in a park in Dartmouth, N.S., has been released back into the wild, according to the Nova Scotia Department of Natural Resources and Renewables (DNRR).

Manitoba to encourage renewable energy while acknowledging fossil fuel use

Manitoba's government says it will encourage the development of renewable energy in the province while acknowledging fossil fuels aren't going away any time soon.

Man charged following fire that killed married couple: Winnipeg police

The Winnipeg Police Service (WPS) has made an arrest following a fire that claimed the lives of two people.

Face of Nutrien workforce changing after 65 years of potash production in Sask.

Driving into the tunnels of Nutrien's Rocanville mine, the largest potash mine in the world by production volume, feels like driving down a lonely highway in the middle of the night.

Tornado in southeastern Sask. Wednesday was 3rd latest in province on record: ECCC

A tornado in Langbank, Sask. on Wednesday was the third latest in the province on record, according to Environment and Climate Change Canada (ECCC).

What do people need to know about the upcoming City of Yorkton election?

With the municipal election fast approaching, Yorkton’s city returning officer shared details on what people need to know before voting, and what to know if they are interested in running for city council.

Hydrogen sulfide leak at Brantford high school

Levels of hydrogen sulfide gas are being monitored at Brantford Collegiate Institute after a leak in their geothermal system.

Remembering Susan Bard, who died at 79 in hit-and-run

Guelph resident, Susan Bard, is being remembered as a vibrant community advocate and volunteer who died doing what she loved – cycling.

'Nothing but complete empathy': Thomas Hamp's father addresses Sanche family at murder trial

The second-degree murder trial of Thomas Hamp is being adjourned until December so an expert witness central to the trial can testify.

One dead and 3 hospitalized after truck and SUV collide on Sask. highway

A 69-year-old woman from Outlook, Saskatchewan is dead and three people are injured after a truck and SUV collided on Highway 15 on Thursday.

Sask. mother says gym teacher at private Christian school hit her 7-year-old in the head with a relay baton

A gym teacher at a private Christian school in Saskatoon has been charged. Terra MacEwan, 44, is charged with assault with a weapon. A Saskatoon mother who spoke with CTV News says her autistic son was MacEwan's victim.

Northern Ontario

No injuries after plane does a hard landing on Lake Temiskaming, Ont.

Two people emerged unhurt after a float plane had a hard landing late Friday morning on Lake Temiskaming.

3 1/2 hour drive to the doctor: Could a new type of clinic in Elgin County end her commute?

The Elgin Community Health Hub, operated by the Thames Valley Family Health Team, is accepting new patients to a model where doctors are rarely seen.

Police keep close eye on protest and counter protest in Victoria Park

Members of the 2SLGBTQ+ community and supportetrs greatly outnumbered the people attending a '1 Million March 4 Children' event along Central Avenue.

Paramedic celebrates half a century on the job

Today, the 71 year old is marking 50 years a paramedic. He said he never aspired to move into management or a desk job, he enjoys being on the road, helping patients too much.

Suspect image released in connection with 'senseless destruction' of flower displays

Provincial police are investigating vandalism in Huntsville after the "senseless destruction" of flower displays along Main Street East.

Two Barrie men charged in connection with double homicide at Keswick park

Two men from Barrie have been charged after a deadly shooting at a park in Keswick on Wednesday.

Truck driver from Orillia celebrates $1 million lottery win

A truck driver from Orillia is proof that saying yes to Encore can pay off in a big way.

Windsor mom charged in drowning death of her 5-year-old child

Windsor police say a 25-year-old mother has been charged with the drowning death of her 5-year-old child in the family’s backyard pool.

Windsor fire on scene at McDougall Street

Windsor fire is on scene at an incident on McDougall Street.

Windsor police looking to identify suspect in break-and-enter

The Windsor Police Service is asking for help from the public following a break-and-enter at a home.

Vancouver Island

'Seems very political': Greater Victoria teachers surprised by ministerial order on student safety

In a rare move, the Greater Victoria School District Board of Education has been slapped with a ministerial order from the province requiring it to update a student safety plan – drawing concern around political posturing leading up to an election.

B.C. First Nations declare state of emergency over opioid crisis and mental health

Getting a bed at one of British Columbia's drug detoxification facilities is like winning the lottery, the vice-president on the Nuu-chah-nulth Tribal Council says.

UBCM calls for province to pay for free transit for teenagers

The Union of B.C. Municipalities is asking the provincial government to make transit free for teenagers.

'Don't know where the animals came from': Runaway pigs rounded up in West Kelowna, B.C.

A pair of runaway pigs are in the custody of an animal sanctuary in the Okanagan after evading police and volunteers for hours earlier this week.

Video shows historic bridge in Kamloops, B.C., collapsing after fire

The Red Bridge, a historic landmark in Kamloops, B.C., was completely destroyed by fire early Thursday morning.

Pregnant pit bull with 10 puppies rescued from rat-infested B.C. home

Animal protection officers in British Columbia have rescued three pit bulls – including one that gave birth to 10 puppies – from a rat-infested home in Kelowna.

Second-degree murder charge laid after woman found dead in Oyen, Alta.

A Vulcan, Alta., man has been charged with a Lethbridge woman's murder after her body was found in the Oyen area.

Lethbridge couple has car stolen while waiting for an appointment

A Lethbridge couple got a good reminder as to why you should keep your vehicle doors locked at all times.

Lethbridge police to hold low-light shooting training exercise Wednesday and Thursday evening

Lethbridge residents who live near the police range can expect to hear plenty of shots fired Wednesday and Thursday.

Sault Ste. Marie

Police seize handgun, drugs worth $300K in traffic stop near Espanola, Ont.

Ontario Provincial Police say three suspects from southern Ontario have been charged and drugs worth $300,000 have been seized following a traffic stop Sept. 16.

Northern police find more than $100K in SUV suspected in Hwy. 17 shooting

A Brampton driver, 27, was charged this week when northern Ontario police stopped the SUV he was driving on Highway 17 after a reported shooting and found more than $100,000 in cash.

Health data show higher rates of some forms of cancer in Algoma district

A new community health profile in the Algoma District shows the area is significantly below provincial averages in a number of health metrics.

Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

Newfoundland and Labrador's chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dispute over unrecognized Inuit group halts major conference for Canadian North

A 16-year-old biennial event aimed at fostering business in the country's eastern Arctic and northern regions has been cancelled indefinitely as a dispute unfolds between Inuit in Canada and a Labrador group claiming to share their heritage.

Cow cuddling: Why a Newfoundland farm is offering quality time with these 'gentle creatures'

Jim Lester’s farm hopped on the cow-cuddling trend in early August, and his time slots have been pretty well sold out ever since.

Shopping Trends

The Shopping Trends team is independent of the journalists at CTV News. We may earn a commission when you use our links to shop.  Read about us.

Editor's Picks

19 things that are currently on our fall fashion wish list, 16 products that reviewers with anxiety swear by, little luxuries are important, so let me introduce you to a few hand creams that smell amazing, 25 car accessories from amazon canada that you’ll use every day, 19 essential tools and accessories everyone should have in their kitchen, 15 cleaning products from amazon canada that'll leave every inch of your home sparkling, 16 excellent, wish list-worthy gifts that cost less than $50, 15 of the best birthday gifts to give this month, 18 top-notch presents and gift add-ons that anyone would love to receive, 17 skincare products that reviewers swear improved their skin texture, the best gels, pomades, and waxes that'll keep your hair in place, canadians, ready your carts: amazon prime big deal days are on the way (and 20+ discounts you can snag already), from wayfair to walmart: here are the best deals you'll find online this weekend, from anthropologie to amazon: here are the best deals you'll find online this weekend, stay connected.

AI tool cuts unexpected deaths in hospital by 26%, Canadian study finds

Researchers say early warning system, launched in 2020 at st. michael's hospital, is 'saving lives'.

Social Sharing

Inside a bustling unit at St. Michael's Hospital in downtown Toronto, one of Shirley Bell's patients was suffering from a cat bite and a fever, but otherwise appeared fine — until an alert from an AI-based early warning system showed he was sicker than he seemed.

While the nursing team usually checked blood work around noon, the technology flagged incoming results several hours beforehand. That warning showed the patient's white blood cell count was "really, really high," recalled Bell, the clinical nurse educator for the hospital's general medicine program.

The cause turned out to be cellulitis, a bacterial skin infection. Without prompt treatment, it can lead to extensive tissue damage, amputations and even death. Bell said the patient was given antibiotics quickly to avoid those worst-case scenarios, in large part thanks to the team's in-house AI technology, dubbed Chartwatch.

"There's lots and lots of other scenarios where patients' conditions are flagged earlier, and the nurse is alerted earlier, and interventions are put in earlier," she said. "It's not replacing the nurse at the bedside; it's actually enhancing your nursing care."

A year-and-a-half-long study on Chartwatch, published Monday in the Canadian Medical Association Journal, found that use of the AI system led to a striking 26 per cent drop in the number of unexpected deaths among hospitalized patients.

"We're glad to see that we're saving lives," said co-author Dr. Muhammad Mamdani, vice-president of data science and advanced analytics at Unity Health Toronto and director of the University of Toronto Temerty Faculty of Medicine Centre for AI Research and Education in Medicine. 

'A promising sign'

The research team looked at more than 13,000 admissions to St. Michael's general internal medicine ward — an 84-bed unit caring for some of the hospital's most complex patients — to compare the impact of the tool among that patient population to thousands of admissions into other subspecialty units. 

• This northern Ontario company is using AI to reduce paperwork at doctors' offices

"At the same time period in the other units in our hospital that were not using Chartwatch, we did not see a change in these unexpected deaths," said lead author Dr. Amol Verma, a clinician-scientist at St. Michael's, one of three Unity Health Toronto hospital network sites, and Temerty professor of AI research and education in medicine at University of Toronto. 

"That was a promising sign."

• AI will be critical for the future of rural health care in Canada, experts say

The Unity Health AI team started developing Chartwatch back in 2017, based on suggestions from staff that predicting deaths or serious illness could be key areas where machine learning could make a positive difference.

The technology underwent several years of rigorous development and testing before it was deployed in October 2020, Verma said.

"Chartwatch measures about 100 inputs from [a patient's] medical record that are currently routinely gathered in the process of delivering care," he explained. "So a patient's vital signs, their heart rate, their blood pressure … all of the lab test results that are done every day."

Working in the background alongside clinical teams, the tool monitors any changes in someone's medical record "and makes a dynamic prediction every hour about whether that patient is likely to deteriorate in the future," Verma told CBC News.

• AI shows major promise in breast cancer detection, new studies suggest

That could mean someone getting sicker, or requiring intensive care, or even being on the brink of death, giving doctors and nurses a chance to intervene. 

In some cases, those interventions involve escalating someone's level of treatment to save their life, or providing early palliative care in situations where patients can't be rescued. 

In either case, the researchers said, Chartwatch appears to complement clinicians' own judgment and leads to better outcomes for fragile patients, helping to avoid more sudden and potentially preventable deaths.

AI on the rise in health care

Beyond its uses in medicine, artificial intelligence is getting plenty of buzz — and blowback — in recent years. 

From controversy around the use of machine learning software to crank out academic essays, to concerns over AI's capacity to create realistic audio and video content mimicking real celebrities, politicians, or average citizens, there have been plenty of reasons to be cautious about this emerging technology.

• Canadian researchers use AI to find a possible treatment for bacteria superbug

Verma himself said he's long been wary. But in health care, he stressed, these tools have immense potential to combat the staff shortages plaguing Canada's health-care system by supplementing traditional bedside care.

How AI could change the future of our health care

It's still the early days for many of those efforts. Various research teams, including private companies, are exploring ways to use AI for earlier cancer detection. Some studies suggest it has potential for flagging hypertension just by listening to someone's voice; others show it could scan brain patterns to detect signs of a concussion .

• From virtual care apps to AI algorithms: the trouble with data collection in healthcare

Chartwatch is notable, Verma stressed, because of its success in keeping actual patients alive.

"Very few AI technologies have actually been implemented into clinical settings yet. This is, to our knowledge, one of the first in Canada that has actually been implemented to help us care for patients every day in our hospital," he said.

'Real world' look at AI's health-care impact

The St. Michael's-based research does have limitations. The study took place during the COVID-19 pandemic, at a time when the health-care system faced an unusual set of challenges. The urban hospital's patient population is also distinct, the team acknowledged, given its high level of complex patients, including individuals facing homelessness, addiction and overlapping health issues.

"Our study was not a randomized controlled trial across multiple hospitals. It was within one organization, within one unit," Verma said. "So before we say that this tool can be used widely everywhere, I think we do need to do research on its use in multiple contexts."

• Opinion Regulating artificial intelligence: Things are about to get a lot more interesting

Dr. John-Jose Nunez, a psychiatrist and researcher with the University of British Columbia — who wasn't involved in the study — agreed the research needs to be replicated elsewhere to get a better sense of how well Chartwatch might work in other facilities. There also needs to be considerations around patient privacy, he added, with the use of any emerging AI technologies.

Still, he praised the study team for providing a "real-world" example of how machine learning can improve patient care.

"I really think of AI tools as becoming one more team member on the clinical care team," he said.

The Unity Health team is hopeful their technology will roll out more widely in the future, within their own Toronto-based hospital network and beyond.

Much of that work is happening through GEMINI , Canada's largest hospital data-sharing network for research and analytics, said Mamdani, Unity Health's vice-president of data science.

• Researchers give a robot hand the power of touch, designing a human-like fingertip

More than 30 hospitals across Ontario are working together, he said, offering opportunities to test Chartwatch and other AI tools in various clinical settings and hospitals. 

"It just sets the groundwork now to be able to deploy these things well beyond our four walls," Mamdani said.

ABOUT THE AUTHOR

Senior Health & Medical Reporter

Lauren Pelley covers the global spread of infectious diseases, pandemic preparedness and the crucial intersection between health and climate change. She's a two-time RNAO Media Award winner for in-depth health reporting in 2020 and 2022, a silver medallist for best editorial newsletter at the 2024 Digital Publishing Awards, and a 2024 Covering Climate Now award winner in the health category. Contact her at: [email protected].

• @LaurenPelley

Related Stories

• Ontario's police watchdog investigating after man dies in Thunder Bay hospital days following arrest
• Learn how to transform your health with AI at an upcoming webinar
• Nova Scotia forms partnership with Google Cloud to improve digital health care
• Recent bot campaign backing Poilievre shows AI easily accessible for political messaging: report
• Lawsuit alleges woman's death caused by overdose of antidote at Manitoba hospital

Add some “good” to your morning and evening.

A vital dose of the week's news in health and medicine, from CBC Health. Delivered to your inbox every Saturday morning.

This site is protected by reCAPTCHA and the Google Privacy Policy and Google Terms of Service apply.

A century of ‘feminization’ has made medicine better for all Canadians, but it could be better still

Women, once excluded from practicing as physicians, have spent decades improving our health-care culture. More must be done to remove the obstacles of pay equity, maternity leave and burnout that many still face

When Dr. Shelley Ross graduated from medical school at the University of Alberta in 1974, there were only 20 women in the class of 120.

Back then, there was still a quota. Not affirmative action, but the opposite – a cap meant to limit the number of women entering the profession. The assumption was that training women would largely be a waste of time and money because they would soon get pregnant and quit, whereas men would have a long career.

Fifty years later, Dr. Ross is still a practising family physician in Burnaby, B.C. “Guess they got their money’s worth out of me,” she says with a laugh. And, yes, she had children – two.

Shelley Ross, a former president of B.C.'s medical association, still practises today. Jeff Vinnick/the Globe and Mail

The way women have been treated in medicine, however, is no laughing matter. For centuries, they have been shut out and marginalized: paid less than their male counterparts, passed over for leadership roles, steered toward less prestigious specialties, treated as nurses, denied maternity leave and more.

As one male medical professor said in 1873: The end result of medical education for women was “monstrous brains and puny bodies.”

Systems of education, training, clinical practice, academia and research were all designed by men, for men.

Those systems are evolving. The macho 100-hour work weeks, the teaching-by-bullying, the paternalistic approach to patient care, the old boys’ networks and more, are disappearing. The culture of medicine is changing. Slowly.

This shift is often referred to as the “feminization” of medicine. It’s a loaded term, one with often negative connotations and stereotypical beliefs, such as female doctors work slower and work less. In particular, the influx of women into medicine is often blamed the decline in access to care – everything from the inability to find a family doctor to longer waits for surgery.

But the data don’t really bear that out. According to a study published earlier this year in the Canadian Medical Association Journal, the median average weekly hours worked by physicians in this country has steadily declined for decades; the average physician works about seven fewer hours weekly today as in 1987. That decline is most pronounced for men, whose weekly hours have dropped to 47.7 hours from 55.2 hours. In the same period, the average workweek of female physicians has declined only slightly, to 43.7 hours from 44.7 hours.

What doctors do during their working hours has also changed markedly over the years, and so too have the needs of patients and priorities of health systems. Patients are sicker and more complex, and waiting lists ever-growing so the work is more intense. The amount of paperwork has become stifling, even in the digital age. Those are much larger factors in determining access than the gender of practitioners.

There are those who find the term “feminization” distasteful, saying it implies that a “masculine” system is the norm, and that women taking their rightful place in the hallways of medicine is an anomaly.

Male domination is cemented into medicine’s very foundations. What female physicians have long been seeking is gender equity.

In this country, the fight for equity started in earnest a century ago, in 1924, with the founding of the Federation of Medical Women of Canada. (That was five years before women were recognized as persons under Canadian law.)

When Dr. Maude Abbott, the FMWC’s founding president, rallied her colleagues, medical schools were reluctant to accept women. There were about 8,000 doctors in Canada, and only 187 were women (2 per cent), and many of them had been trained in the U.S. or Europe.

By 1954, that number had crept up to 4 per cent.

Half a century after the founding of the FMWC, when Dr. Ross graduated, only 12 per cent of physicians in Canada were women.

In generations past, women in Canadian medicine were restricted to nursing, but over the decades, the cohort of licensed doctors has come closer to gender parity. Justin Tang/The Canadian Press

Today, 43,209 of Canada’s 96,020 licensed medical doctors are women – 45 per cent of the total. And gender parity is near because between 50 and 60 per cent of students in Canada’s 17 (and soon to be 20) medical schools are women.

But overall numbers don’t tell the whole story.

“Is medicine equitable now? Absolutely not,” says Dr. Ivy Bourgeault, a professor of sociological and anthropological studies at the University of Ottawa, where she serves as the University Research Chair in Gender, Diversity and the Professions. “Gender still permeates all experiences in medicine: applying for med school, studying, residency, practice and promotion.”

Dr. Bourgeault says the biggest problem is the still a paucity of women in leadership positions in health care institutions, academia, research enterprises and physician associations. The glass ceiling may be starting to show cracks, but it hasn’t yet been shattered.

Male to female ratios vary a lot by specialty: It’s 50-50 in family medicine, 58-42 in medical specialties, and 66-34 in surgical specialties, according to data from the Canadian Institute for Health Information. Female physicians gravitate – or are pushed – toward family medicine, pediatrics and public health, not more prestigious and higher paid specialties.

“The reality is that women get the most complex patients, those that require a lot of time, and those cases are remunerated the least,” says Dr. Shirley Schipper, a family physician who is the vice-dean of education in the faculty of medicine at the University of Alberta.

Questions of pay equity, work-life balance and burnout in health care grew more urgent during the pandemic, as in Quebec's strikes last year. Ryan Remiorz/The Canadian Press

Physicians are well-paid generally. But equal pay for work of equal value is far from the norm in medicine.

What is clear is that female physicians make practical choices. They are drawn to jobs with more flexibility, because they are torn between personal and professional responsibilities, particularly in their child-bearing years. Research also shows that female doctors tend to be more empathetic. They take more time with patients, do more follow-up and prefer working in teams, which is more time-consuming.

“Women strive to practice in ways that make sense,” Dr. Schipper says. “They work in a collaborative fashion and try to balance work with their lives.”

But that’s not how doctors are trained and it’s not how the health system is designed to function. It rewards individualism and volume. Not results.

But there is a growing body of evidence that female physicians must be doing something right because they get better results.

A large study that examined data from 770,000 records of U.S. Medicare patients who were hospitalized, published recently in the Annals of Internal Medicine, found that patients (both male and female) whose care was led by a female doctor were less likely to die and had lower readmission rates 30 days after leaving hospital. Female patients benefited significantly more from being seen by a female doctor than male patients did, as well. A 2018 study examining the records of 580,000 cardiac patients admitted to Florida ERs also found death rates for men and women were lower when they were seen by a female doctor; women who were treated by male doctors fared the worst. Another research paper , published last year in JAMA Surgery, analyzed the outcomes of more than one million surgical patients, and found that patients treated by female surgeons were less likely to suffer adverse outcomes at 90 days and one year after surgery. A 2021 Canadian study found that women operated on by a female surgeon were 25 per cent less likely to die, and the same was true for 13 per cent of men.

Recent research suggests that female surgeons can have higher success rates than their male colleagues, thanks to differences in their styles of communication. Chris Young/The Canadian Press

The differences in outcomes are certainly not due exclusively the presence or absence of a Y chromosome in the treating physicians. Rather, researchers believe that better results are explained principally by differences in communication styles seen between male and female doctors. In short, female physicians spend more time with patients, and they spend that time in conversation – on average two minutes more in each encounter – than male doctors. While two minutes of conversation doesn’t seem like something that would lower death rates, consider that, on average, a physician listens to a patient for 11 seconds before interrupting . Again, female doctors listen a lot longer than men before interjecting.

Are women better doctors than men? That question, which has found its way into many a provocative headline, is difficult to answer because “better” depends on the patient being treated and the outcome being measured.

What is clear though is that many patients prefer to be treated by a female physician. That is especially true for women, particularly for gynecological and sexual-health issues.

Throughout history, female physicians have been at the forefront of advocating for better women’s health, especially reproductive rights, notably access to contraception and abortion. One of the founders of the FMWC, Dr. Elizabeth Bagshaw, established Canada’s first birth control clinic in 1932 in Hamilton. That was decades before birth control was legalized in 1969. Dr. Bagshaw also continued to work as a physician until her retirement at the age of 95.

In recent years, that advocacy has extended to areas such as cardiovascular health and chronic pain. Heart disease and stroke are the No. 1 killer of women , but they are still viewed largely a men’s issues.

Child care and caring for aging family members remain largely the burden of women, even those with well-paying and powerful positions. That sexist societal reality has clearly affected female physicians and how they practice.

A study conducted in the U.S. during the height of the COVID-19 pandemic – when many daycares and schools were closed, and remote learning was the norm – drove this point home. It found that female physicians were 30 times more likely to be solely responsible for child care and schooling of children compared with their male counterparts – 24.6 per cent of women versus 0.8 per cent men. Another study found that female clinicians spend, on average, 100.2 minutes a day more on household activities and child care than their male counterparts.

The closing of daycares during the pandemic helped illustrate how women in medicine, as in other professions, bear a disproportionate share of child-care responsibilities. Melissa Tait/The Globe and Mail

In medicine, time is money. In Canada, most physician income ( 72 per cent ) is paid on a fee-for-service basis. Doctors are essentially small businesses doing piece work. Very few are salaried. That can make taking time off for child-rearing costly. For a long time, it was near-impossible.

Dr. Noni MacDonald, a professor emeritus of pediatrics at Dalhousie University, recalls that, when she had her first child in 1976, while working as a medical resident at the Children’s Hospital of Eastern Ontario, she could only take four weeks off – her entire allotment of holidays.

“If I had taken one more day, I would have lost my whole year. It was brutal,” Dr. MacDonald said. Her first day back at work, she had a 48-hour shift.

To add insult to injury, when Dr. MacDonald got her first clinical job, she was paid half as much as a man in a similar position – because he had four children and a wife, while she had a husband and two kids.

Parental leave programs are relatively new in medicine, but now commonplace. But taking time off to have a baby can still be an impediment to career advancement.

In the early years of a career, physicians have a lot of time and energy and can do demanding work such as surgery, overnight shifts, obstetrics and palliative care. When children come along, they should be able to step back a bit, work part-time, or predictable hours, then, as their children grow up, return to more demanding leadership roles. In short, says Dr. Schipper, medicine needs to do a better job of adapting to the realities of modern family life.

“I graduated 25 years ago, and the system is exactly the same today as it was then. It hasn’t adapted,” she says.

The result is that physicians (mostly women) leave the profession, or never work to their full potential. The combination of a rigid system and a “leaky pipeline” is one reason there are so few women in positions of power.

But there is a distinct lack of research and interest in how women’s careers progress and why they struggle to get into positions of power in medicine, says Dr. Bourgeault of the University of Ottawa. “If we’re going to fix problems, first we have to recognize there are problems,” she says.

Joss Reimer, the former medical lead for Manitoba's COVID-19 vaccine group, is now president of the Canadian Medical Association, one of a dozen women to hold that office. John Woods/The Canadian Press

There are some data on equity (or lack thereof) in academic medicine, but virtually none in clinical medicine.

The data we do have are telling.

The Canadian Medical Association , founded in 1867, has had 152 presidents in its history. Only 12 have been women, and nine of those in the past 20 years.

The Canadian Medical Hall of Fame has 161 laureates, only 25 of them women.

There have only been 11 female deans of faculties of medicine in the 200 years since Canada’s first medical school opened in 1824.

Dr. MacDonald was the first female dean of medicine, appointed to the position at Dalhousie University in 1999. But, after one term, she returned to clinical practice.

“People don’t understand that women don’t always want to be king of the castle,” she says. It can be exhausting to be a trailblazer. (She was also inducted in the Hall of Fame.)

Noni MacDonald is a professor emeritus in pediatrics at Dalhousie University, where she was once the dean of medicine. Darren Calabrese/The Globe and Mail

The most positive impact of “feminization,” Dr. MacDonald says, is that there is a lot less bullying and abusive behaviour. The military boot camp approach to teaching, rife with humiliation, is no longer tolerated.

Women in medicine, however, still experience a lot of sexual harassment and violence, from both staff and patients. The profession is ripe for its #MeToo moment.

“There’s a new world coming,” says Dr. Ramneek Dosanjh, a family physician in Surrey, B.C. and president-elect of the Federation of Medical Women of Canada, which will mark its 100th anniversary at a conference in Ottawa on Sept. 27 to 28. The progress women have made in medicine in the past century is inspiring, she says, but a lot remains to be done. “Nearly half of physicians are women. Now we need to look beyond the numbers and embolden the push for equity.”

Dr. Dosanjh says medicine needs to look like society, and that means promoting racial equity in addition to gender equity. The solution is largely about fixing archaic systems, and the starting point has be making them more equitable.

“When I see the young women coming into medicine today, I want to give them hope and optimism that the future is theirs.”

Women in medicine through the ages

Women have practised healing since antiquity, but often on the margins, limited to treating the “diseases of women,” namely pregnancy and childbirth. Here are some milestones.

Suffragist Emily Stowe was the first female physician to practise in Canada. Herbert E. Simpson

Jennie Smillie Robertson was Canada's first female surgeon and performed the country's first major gynecological surgery.

• Circa 2700 BCE: Merit-Ptah is often described as the first female physician; she served the pharaoh in dynastic Egypt;
• 4th century BCE: Agnodice, the first female physician in ancient Greece, disguised herself as a man;
• 11th century: Trota of Salerno wrote an influential medical text, “On The Treatments of Women”;
• 12th century: Hilgard of Bingen, a nun and healer became a legendary figure in Germany;
• 1754: Dorothea Erxleben was the first female doctor in Germany and the first woman worldwide to be granted an MD by a university;
• 1850s: Dr. James Miranda Barry was the first female to practise Western medicine in Canada, but the British surgeon’s gender was only revealed after death;
• 1867: Dr. Emily Stowe was the first openly female physician in Canada. Trained in the U.S., she practised in Toronto;
• 1883: Augusta Stowe-Gullen, Dr. Stowe’s daughter, graduated from the University of Toronto in 1883, the first woman to obtain a medical degree in Canada. (U of T would not admit another woman for 25 years.)
• 1883: Dr. Emily Stowe founded Women’s College Hospital in Toronto because no other hospital would take women as medical residents;
• 1885: Dr. Helen Elizabeth Reynolds Ryan was the first woman granted membership in the Canadian Medical Association, which was founded in 1867;
• 1911: Dr. Jennie Smillie Robertson was the first woman to perform major surgery in Canada; however, she was not allowed to register as a surgeon because of her gender;
• 1924: The Federation of Medical Women of Canada was founded to fight for the rights of women physicians;
• 1929: The Supreme Court of Canada ruled that women were persons under the law;
• 1932: Dr. Elizabeth Bagshaw founded the first birth control clinic in Canada, in Hamilton; she also started Planned Parenthood;
• 1939: Dr. Jessie Gray became the first registered female surgeon in Canada;
• 1941: Dr. Jean Flatt Davey became the first woman to serve in the medical corps of the Canadian armed forces; prior to that, women could only serve as nurses;
• 1952: Dr. Jessie Boyd Scriver became the first female president of the Canadian Paediatric Society, founded in 1922;
• 1974: Dr. Bette Stephenson was elected the first female president of the Canadian Medical Association, 107 years after it was founded;
• 1987: Dr. Joan Bain became the first female president of the College of Family Physicians of Canada. It was established in 1954;
• 1999: Dr. Noni MacDonald (Dalhousie) and Dr. Carol Herbert (Western) became the first female deans of medicine in Canada. Canada’s first medical school opened in 1824;
• 2003: Dr. Louise Samson became the first female president of the Royal College of Physicians and Surgeons of Canada. It was founded in 1929;
• 2015: Dr. Jane Philpott becomes the first physician (male or female) to serve as federal Minister of Health.

Source: Federation of Medical Women of Canada

Follow related authors and topics

• André Picard
• Discrimination and Inequality

Authors and topics you follow will be added to your personal news feed in Following .

Interact with The Globe

Who dares to bring bad news to the men who run ci financial, raymond chun’s appointment as td bank’s next ceo takes bay street by surprise, trump media shares slides as lock-up expires, overtime pay for federal civil servants swells even as head counts rise, toronto to tackle traffic with increased fines for drivers and higher fees for builders, the lebanon explosions raise a question: deep into the smartphone era, who is still using pagers, the massive trucks flooding our city streets should be subject to different parking rules, un peacekeepers in lebanon urge de-escalation after heavy airstrikes.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

The PMC website is updating on October 15, 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Healthc Policy
• v.17(2); 2021 Nov

Confronting Barriers to Improving Healthcare Performance in Canada

Jason m. sutherland.

Editor-in-Chief

Is substantive transformation of healthcare delivery in canada a fool's paradise? Since this idiom refers to a state of happiness unconnected to underlying truths, it may be an apt descriptor given the many problems with the provinces' and territories' delivery of healthcare. Some of these problems cause harm, such as hospital-acquired infections, while others are simply wasteful, such as unnecessary tests or imaging. Moreover, meaningful transformation of healthcare delivery has been elusive and divisive in provinces and territories for decades ( Martin et al. 2018 ; McIntosh et al. 2010 ; Ontario Ministry of Finance 2012 ).

Many healthcare organizations in Canada and other parts of the world frame their health system's performance with the “quadruple aim” ( Berwick et al. 2008 ; Bodenheimer and Sinsky 2014 ). As many readers will know, the quadruple aim is a standardized framework for improving health system performance; it serves to guide healthcare organizations' policies, activities and behaviours in the direction of improving health system performance. The quadruple aim is used across clinical settings and health systems ( Brown-Johnson et al. 2018 ; D'Alleva et al. 2019 ; Rathert et al. 2018 ), most commonly among integrated delivery systems, such as Kaiser Permanente ( Gin and Courneya 2020 ) and the US Department of Veterans Affairs ( Shekelle and Begashaw 2021 ).

The quadruple aim includes four dimensions: patient experience, health outcomes, costs and provider experience. Improvement in these dimensions will, according to the framework, result in better health system performance. Currently, the Province of Ontario ( Government of Ontario 2019 ), Alberta Health Services (2018) and British Columbia ( Fraser Health Authority 2020 ) use the quadruple aim as a guiding principle in official policy documents.

In spite of provinces' and regions' practice of using the quadruple aim framework to guide policy development and their strategies – to my knowledge – there are no Canadian exemplars to follow. None of our provinces and territories consistently collect or act on measures from all four dimensions.

Yet there are clear Canadian examples that emphasize the need for more data and analytics in the domains of the quadruple aim. At a provincial level, the experiences of patients, families and caregivers with healthcare are not measured in a standardized approach, nor is the information regarding their experiences linked or analyzed across patients' sectors of care or with individual provider-based encounters ( Kuluski and Guilcher 2019 ).

Elsewhere, the cost of healthcare is poorly measured by provinces and territories. In some provinces, such as New Brunswick and British Columbia, the costs of expensive hospitalizations are not measured. These provinces make inferences and policy decisions based on cost information from Ontario, where processes of care and drivers of cost may be significantly different. It is even more challenging to measure healthcare costs that are privately paid or employer-insured. Not borne by the government, costs for privately paid health services, such as psychotherapy or occupational therapy, are not factored into decisions regarding the value of healthcare because they are not reported or linked with publicly provided healthcare.

There is years' worth of strong evidence that the effectiveness of Canada's healthcare ranks very poorly in relation to its peers ( Davis et al. 2014 ; Schneider et al. 2021 ). Provinces' and territories' lack of qualitative and quantitative information in domains of the quadruple aim makes it nearly impossible to judge whether their health systems are improving. This is not a new phenomenon; these gaps have been well understood for over a decade ( European Observatory on Health Systems and Policies et al. 2020 ; Martin et al. 2018 ). This begs the question of whether Canadians should be happy with the healthcare they have now. Given that we are not deficient in spending, there should be significant gains in access, efficiency and equity to be attained.

What Needs to Happen

There are three key imperatives for improving the performance of Canadian health systems in the context of the quadruple aim. First, there is a need to convince provincial and territorial senior health policy makers of the value of standardizing and collecting measures in all four dimensions of the quadruple aim. For instance, population-based collection of patient- and caregiver-reported experience and outcome information has long been identified as overdue ( Gutacker and Street 2018 ; Kuluski and Guilcher 2019 ; Wong et al. 2017 , 2019 ).

Second, there is a need for provinces to be “nimbler,” and more responsive, in order to match public resources with their residents' health needs identified through the quadruple aim. This may mean allocating more funding to long-term care as compared to hospital-based care. Action on nimbleness will be difficult as provinces and territories have organized healthcare delivery by sectors, the activities of which are not well-integrated. For instance, in Alberta, physician remuneration is not integrated with the single health region tasked with organizing acute and residential care.

Third, provinces and territories need to integrate physician services more closely with other healthcare services and communities' health needs. In many settings, physicians' high level of autonomy is out of sync with integrated models of care and contributes to fragmentation of services. New models of clinical and financial partnership between the governments with primary and secondary care providers are needed.

The public expects that healthcare delivery will meaningfully improve as we exit the perilous period of the COVID-19 pandemic. To achieve their expectations and improve health systems' performance, drastic action on archaic policies, delivery structures and processes is needed.

A number of things have been tried. National and provincial blue-ribbon panels and expert advice have not been effective at moving the needle and another independent review is unlikely to result in meaningful inroads ( Forest and Martin 2018 ; Ontario Ministry of Finance 2012 ; Romanow 2002 ). There are options open to political leaders and senior policy makers. These options range from benign strategies, such as linking funding with data collection consistent with the quadruple aim, to more controversial directions, such as the establishment of an independent council for providing recommendations to improve health system performance that would redirect some of the political risk away from governments.

No matter how one analyzes the problem of provinces' and territories' quite dismal health system performance and proposes solutions, substantial sums of money will have to be spent (hint: federal). The allocation of new funds will be an opportunity to redefine relationships among the sectors, settings, providers and technologies vying for a slice of the money. Strong support by government healthcare leaders and new visions for senior policy makers will be needed to guide provinces and territories from their state of immobility to meaningful healthcare policy reform.

If provinces and territories get serious about improving health system performance, the framework of the quadruple aim will be leaned upon heavily. However, the quadruple aim is a tool and not a promise. Maybe a more accurate idiom would be “A journey of a thousand miles begins with a single step.”

In This Issue

Consistent with the need for more comprehensive health system performance measurement, this issue's first research paper features a multi-province study developing regional primary care performance measures. This research by Wong et al. (2021) addresses a significant gap in evaluating primary care performance – a key tenet of provinces' health delivery networks – a sector where provinces conduct very little performance measurement. Drawing on quantitative data from primary care practices and qualitative data from clinicians, this research found that measuring primary care performance is indeed possible and may be imperative to improving health system performance. The study also found significant regional differences in aspects of primary care delivery, meaning that primary care in Ontario is not the same as primary care in British Columbia or Nova Scotia.

An Alberta-based qualitative research paper by Leslie et al. (2021a) focused on the impact of the COVID-19 pandemic on the integration of primary care with other sectors of care. This study found that the pandemic had the effect of more closely integrating primary care with the provincial government and Alberta Health Services, the province's centralized healthcare system. Key drivers of the integration between sectors included access to personal protective equipment, development of new billing codes and new channels of communication.

The next research paper, also written by Leslie et al. (2021b) , used documentation analyses and qualitative methods to explore the resiliency of primary care in Alberta during the COVID-19 pandemic. This paper describes how the structure of primary care delivery management was integrated in the pandemic's response. An important finding was that while there was a provincially focused response to the pandemic, respondents articulated that primary care's presence was under-represented in efforts to maintain continuity of operations and delivery of care to those not able to access virtual-based alternatives.

The next research paper measured the continuity of primary care delivery during the COVID-19 pandemic among Family Health Teams, a model of team-based primary care used in Ontario. Ashcroft et al. (2021) used a cross-sectional design and survey-based methods for collecting data from Family Health Team executives. The research found that there was a very rapid uptake of virtual care among the Family Health Teams, although the policy analysis points out that there are pressing needs for developing clinicians' competencies to lead virtual team-based care and the establishment of best practices for mixed virtual and in-person care.

The research paper by Lee et al. (2021) provides an analysis of the conundrum facing provinces' governments: an increasing number of physicians and continuing struggles for residents to access primary and specialty care. Based on analyses of retrospective administrative datasets, the study found that the number of physicians has been increasing over the past five years even though the volume of services physicians has been providing to their patients has been declining. Emphasizing that the number of hours worked has been eroding over time among primary care and specialist physicians, the authors posit that work–life balance and indirect (unremunerated) patient care activities were, at least partially, responsible for the decline in the number of hours worked. The authors call for policy responses from the government.

In this issue's final research paper, Ethier and Carrier (2021) explore factors associated with the establishment of, and access to, local health and social services. Defined as being local or neighbourhood-based, local health and social services provide primary care and access to community services, social services and home health. One of the key objectives of this delivery model is to provide older adults support to age in place. Based on a scoping study, the authors found regulatory and policy inflexibility by provinces, lack of resources or expertise, conflicts of roles and non-governmental partnerships to be barriers to improving access to local health and social services.

• Alberta Health Services. 2018. The 2017–2020 Health Plan and Business Plan. Year 2 of 3-Year Plan 2018/2019 . Retreived October 20, 2021. < https://www.albertahealthservices.ca/assets/about/org/ahs-org-hpbp-2017-2020.pdf >.
• Ashcroft R., Donnelly C., Gill S., Dancey M., Lam S., Grill A.K. et al. 2021. The Delivery of Patient Care in Ontario's Family Health Teams during the First Wave of the COVID-19 Pandemic . Healthcare Policy 17 ( 2 ): 72–89. doi:10.12927/hcpol.2021.26656. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berwick D.M., Nolan T.W., Whittington J.. 2008. The Triple Aim: Care, Health, and Cost . Health Affairs 27 : 759–69. doi:10.1377/hlthaff.27.3.759. [ PubMed ] [ Google Scholar ]
• Bodenheimer T., Sinsky C.. 2014. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider . Annals of Family Medicine 12 ( 6 ): 573–76. doi:10.1370/afm.1713. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Brown-Johnson C.G., Chan G.K., Winget M., Shaw J.G., Patton K., Hussain R. et al. 2018. Primary Care 2.0: Design of a Transformational Team-Based Practice Model to Meet the Quadruple Aim . American Journal of Medical Quality 34 : 339–47. doi:10.1177/1062860618802365. [ PubMed ] [ Google Scholar ]
• D'Alleva A., Leigheb F., Rinaldi C., Di Stanislao F., Vanhaecht K., De Ridder D. et al. 2019. Achieving Quadruple Aim Goals through Clinical Networks: A Systematic Review . Journal of Healthcare Quality Research 34 ( 1 ): 29–39. doi:10.1016/j.jhqr.2018.10.010. [ PubMed ] [ Google Scholar ]
• Davis K., Stremikis K., Squires D., Schoen C.. 2014, June . Mirror, Mirror on The Wall: How the Performance of the U.S. Health Care System Compares Internationally . The Commonwealth Fund . Retrieved October 19, 2021. < https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2014_jun_1755_davis_mirror_mirror_2014.pdf >.
• Ethier A., Carrier A.. 2021. A Scoping Review of the Implementation of Local Health and Social Services for Older Adults . Healthcare Policy 17 ( 2 ): 105–18. doi:10.12927/hcpol.2021.26654. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• European Observatory on Health Systems and Policies, Marchildon G.P., Allin S., Merkur S.. 2020. Canada: Health System Review . Health Systems in Transition 22 ( 3 ). World Health Organization. [ PubMed ] [ Google Scholar ]
• Forest P.-G., Martin D.. 2018. Summary Report: Fit for Purpose: Finding and Recommendations of the External Review of the Pan-Canadian Health Organizations . Retrieved October 19, 2021. Government of Canada. < https://www.canada.ca/content/dam/hc-sc/documents/services/health-care-system/reports-publications/health-care-system/findings-recommendations-external-review-pan-canadian-health-organization/findings-recommendations-external-review-pan-canadian-health-organization.pdf >. [ Google Scholar ]
• Fraser Health Authority. 2020, August . 2020/21–2022/23 Service Plan . Retrieved October 19, 2021. < https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/About-Us/Accountability/Service-Plans/Fraser-2020-21-2022-23-Service-Plan-Final-for-Posting.pdf?rev=19cfbaa88add4a33ab186ebb1e140a05 >.
• Gin N., Courneya P.. 2020. Working to Achieve the Quadruple Aim – Abstracts from the Kaiser Permanente 2020 National Quality Conference . The Permanente Journal 24 : 20.046. doi: 10.7812/TPP/20.046. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Government of Ontario. 2019, June . A Healthy Ontario: Building a Sustainable Health Care System: 2nd Report from the Premier's Council on Improving Healthcare and Ending Hallway Medicine . Retrieved October 19, 2021. < https://files.ontario.ca/moh-healthy-ontario-building-sustainable-health-care-en-2019-06-25.pdf >.
• Gutacker N., Street A.. 2018. Calls for Routine Collection of Patient-Reported Outcome Measures are Getting Louder . Journal of Health Services Research and Policy 24 ( 1 ): 1–2. doi:10.1177/1355819618812239. [ PubMed ] [ Google Scholar ]
• Kuluski K., Guilcher S.J.T.. 2019. Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers . Healthcare Papers 18 : 36–46. doi:10.12927/hcpap.2019.26030. [ PubMed ] [ Google Scholar ]
• Lee S.K., Mahl S.K., Rowe B.H.. 2021. The Induced Productivity Decline Hypothesis: More Physicians, Higher Compensation and Fewer Services . Healthcare Policy 17 ( 2 ): 90–104. doi:10.12927/hcpol.2021.26655. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leslie M., Fadaak R., Pinto N., Davies J., Green L., Seidel J. et al. 2021a. A “Shock Test” to Primary Care Integration: COVID-19 Lessons from Alberta . Healthcare Policy 17 ( 2 ): 38–53. doi:10.12927/hcpol.2021.26658. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leslie M., Fadaak R., Pinto N., Davies J., Green L., Seidel J. et al. 2021b. Achieving Resilience in Primary Care during the COVID-19 Pandemic: Competing Visions and Lessons from Alberta . Healthcare Policy 17 ( 2 ): 54–71. doi:10.12927/hcpol.2021.26657. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Martin D., Miller A.P., Quesnel-Vallée A., Caron N.R., Vissandjée B., Marchildon G.P.. 2018. Canada's Universal Health-Care System: Achieving its Potential . The Lancet 391 ( 10131 ): 1718–35. doi:10.1016/S0140-6736(18)30181-8. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• McIntosh T., Ducie M., Burka-Charles M., Church J., Lavis J., Pomey M.-P. et al. 2010. Population Health and Health System Reform: Needs-Based Funding for Health Services in Five Provinces . Canadian Political Science Review 4 : 42–61. [ Google Scholar ]
• Ontario Ministry of Finance. 2012, February 15. Commission on the Reform of Ontario's Public Services . Retrieved October 19, 2021. < https://www.fin.gov.on.ca/en/reformcommission/ >.
• Rathert C., Williams E.S., Linhart H.. 2018. Evidence for the Quadruple Aim . Medical Care 56 ( 12 ): 976–84. doi:10.1097/MLR.0000000000000999. [ PubMed ] [ Google Scholar ]
• Romanow R.J. 2002, November . Final Report: Building on Values: The Future of Health Care in Canada. Commission on the Future of Health Care in Canada . Retrieved October 19, 2021. < https://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf >.
• Schneider E.C., Shah A., Doty M.M., Tikkanen R., Fields K., Williams II R.D.. 2021, August . Mirror, Mirror 2021: Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries . The Commonwealth Fund . Retrieved October 19, 2021. < https://www.commonwealthfund.org/sites/default/files/2021-08/Schneider_Mirror_Mirror_2021.pdf >.
• Shekelle P.G., Begashaw M.. 2021, February . What Are the Effects of Different Team-Based Primary Care Structures on the Quadruple Aim of Care? A Rapid Review . Department of Veterans Affairs . Retrieved October 19, 2021. < https://www.hsrd.research.va.gov/publications/esp/teambased-primarycare-EXEC.pdf >. [ PubMed ]
• Wong S.T., Johnston S., Burge F., McGrail K., Hogg W.. 2017. Measuring Patient Experiences: Is It Meaningful and Actionable? Healthcare Papers 17 ( 2 ): 22–29. doi:10.12927/hcpap.2017.25414. [ PubMed ] [ Google Scholar ]
• Wong S.T., Johnston S., Burge F., McGrail K.. 2019. Value in Primary Healthcare – Measuring What Matters? Healthcare Papers 18 ( 4 ): 58–67. doi:10.12927/hcpap.2019.26028. [ PubMed ] [ Google Scholar ]
• Wong S.T., Johnston S., Burge F., Ammi M., Campbell J., Katz A. et al. 2021. Comparing the Attainment of the Patient's Medical Home Model across Regions in Three Canadian Provinces: A Cross-Sectional Study . Healthcare Policy 17 ( 2 ): 19–37. doi:10.12927/hcpol.2021.26659. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Healthc Policy. 2021 Nov; 17(2): 6–18.

Faire face aux obstacles à l'amélioration du rendement des soins de santé au Canada

Rédactrice en chef

La transformation substantielle de la prestation des soins de santé au Canada est-elle un paradis pour les béats? Puisque ce mot fait référence à un état d'heureux bien-être sans égard aux vérités sous-jacentes, il est sans doute approprié étant donné les nombreux problèmes liés à la prestation des services de santé dans les provinces et les territoires. Certains de ces problèmes causent des dommages, tels que les infections nosocomiales, tandis que d'autres constituent tout simplement une perte de temps, tels que les tests ou imageries non nécessaires. De plus, pendant des décennies, toute transformation significative de la prestation des soins de santé a été problématique et conflictuelle dans les provinces et les territoires ( Martin et al. 2018 ; McIntosh et al. 2010 ; ministère des Finances de l'Ontario 2012 ).

Bon nombre d'organismes de santé au Canada ou ailleurs dans le monde définissent le rendement du système de santé au moyen de « quatre objectifs » ( Berwick et al. 2008 ; Bodenheimer et Sinsky 2014 ). Comme plusieurs lecteurs le savent, les quatre objectifs forment un cadre standardisé pour améliorer le rendement du système de santé; ils servent à orienter les politiques, activités et comportements des organisations de santé en vue d'une amélioration du rendement du système de santé. Les quatre objectifs sont utilisés dans les milieux cliniques et dans les systèmes de santé ( Brown-Johnson et al. 2018 ; D'Alleva et al. 2019 ; Rathert et al. 2018 ), le plus souvent dans les systèmes de prestation intégrés, tels que le consortium Kaiser Permanente ( Gin et Courneya 2020 ) ou le département américain des Anciens combattants ( Shekelle et Begashaw 2021 ).

Les quatre objectifs portent sur quatre volets : l'expérience du patient, les résultats pour la santé, les coûts et l'expérience des prestataires de soins. L'amélioration de ces aspects se traduira, selon le cadre de travail, par un meilleur rendement du système de santé. Actuellement, la province de l'Ontario ( gouvernement de l'Ontario 2019 ), l'organisme Alberta Health Services (2018) et la Colombie-Britannique ( Fraser Health Authority 2020 ) ont recours aux quatre objectifs comme principe directeur dans la documentation officielle.

Malgré le recours aux quatre objectifs par les provinces et les régions pour guider l'élaboration des politiques et des stratégies, il n'y a pas – à ma connaissance – d'exemple à suivre au Canada. Aucune province ou territoire ne recueille ou n'agit systématiquement sur la mesure des quatre volets.

Pourtant, il existe des exemples canadiens clairs qui soulignent le besoin de plus de données et d'analyses pour les quatre volets. Au niveau provincial, l'expérience des patients, des familles et des aidants en matière de soins de santé n'est pas mesurée selon une méthode standardisée, pas plus que les informations concernant leur expérience ne sont liées (ou analysées) entre les divers secteurs de soins ou dans le contexte des rencontres avec les prestataires de services ( Kuluski et Guilcher 2019 ).

Ailleurs, le coût des soins de santé est mal mesuré par les provinces et les territoires. Dans certaines provinces, comme au Nouveau-Brunswick et en Colombie-Britannique, le coût des hospitalisations onéreuses n'est pas mesuré. Ces provinces font des déductions et prennent des décisions stratégiques en fonction d'informations provenant de l'Ontario, où les processus de soins et les facteurs de coûts peuvent être très différents. Il est encore plus difficile de mesurer les coûts des soins de santé payés par le secteur privé ou assurés par l'employeur. N'étant pas pris en charge par le gouvernement, les coûts des services de santé payés par le secteur privé, tels que la psychothérapie ou l'ergothérapie, ne sont pas considérés dans les décisions concernant la valeur des soins de santé car ils ne sont pas déclarés ou liés aux coûts des services de santé publics.

Il y a un cumul de preuves solides qui démontrent que l'efficacité des soins de santé au Canada se classe très mal par rapport à ses pairs ( Davis et al. 2014 ; Schneider et al. 2021 ). Le manque d'informations qualitatives et quantitatives concernant les quatre objectifs dans les provinces et territoires rend presque impossible l'appréciation d'une amélioration, ou non, des systèmes de santé. Ce n'est pas un phénomène nouveau; ces lacunes sont bien comprises depuis plus d'une décennie ( Observatoire européen des systèmes et des politiques de santé et al. 2020 ; Martin et al. 2018 ). Cela soulève la question à savoir si les Canadiens sont satisfaits ou non des soins de santé dont ils bénéficient actuellement. Les dépenses étant là, il devrait y avoir des gains importants en matière d'accès, d'efficacité et d'équité à atteindre.

Voilà ce qu'il faut

Il existe trois impératifs clés pour améliorer le rendement des systèmes de santé canadiens dans le contexte des quatre objectifs. Premièrement, il faut convaincre les principaux décideurs provinciaux et territoriaux de la valeur d'une normalisation et d'une collecte de mesures dans tous les volets des quatre objectifs. Par exemple, la collecte d'informations sur l'expérience et les résultats déclarées par les patients et les soignants dans la population est depuis longtemps considérée comme déficitaire ( Gutacker et Street 2018 ; Kuluski et Guilcher 2019 ; Wong et al. 2017 , 2019 ).

Deuxièmement, il est nécessaire que les provinces soient plus agiles et plus réactives afin de faire correspondre les ressources publiques aux besoins des résidents identifiés par le biais des quatre objectifs. Cela peut signifier allouer plus de fonds aux soins de longue durée par rapport aux soins hospitaliers. Il sera difficile d'agir sur l'agilité, car les provinces et les territoires ont organisé la prestation des services selon des secteurs dont les activités ne sont pas bien intégrées entre elles. Par exemple, en Alberta, la rémunération des médecins n'est pas intégrée à la seule région sanitaire chargée d'organiser les soins de courte durée et à domicile.

Troisièmement, les provinces et les territoires doivent intégrer plus étroitement les services des médecins aux autres services de santé et aux besoins des communautés. Dans de nombreux milieux, le niveau élevé d'autonomie des médecins n'est pas en phase avec les modèles de soins intégrés et contribue à la fragmentation des services. De nouveaux modèles de partenariat clinique et financier entre les gouvernements et les prestataires de soins primaires et secondaires sont donc nécessaires.

La population s'attend à ce que la prestation des services de santé s'améliore de manière significative après la pandémie de COVID-19. Pour répondre à leurs attentes et améliorer le rendement du système de santé, il faudra exercer une action rigoureuse sur les politiques, les structures de prestation et les processus archaïques.

On a essayé un certain nombre de choses. Les groupes d'experts nationaux et provinciaux et les conseils d'experts n'ont pas réussi à faire avancer le dossier et il est peu probable qu'un autre examen indépendant aboutisse à des avancées significatives ( Forest et Martin 2018 ; ministère des Finances de l'Ontario 2012 ; Romanow 2002 ). Des options s'offrent pourtant aux dirigeants politiques et aux décideurs de haut niveau. Elles vont de stratégies inoffensives, telles que l'association du financement à la collecte de données conformément au quatre objectifs, à des orientations plus controversées, telles que la création d'un conseil indépendant chargé de formuler des recommandations visant à améliorer le rendement du système de santé, lesquelles détourneraient une partie du risque politique loin des gouvernements.

Peu importe comment on analyse le problème du rendement plutôt lamentable des systèmes de santé des provinces et territoires, et en dépit des solutions proposées, des sommes importantes devront être dépensées (un indice ici : fédéral). L'allocation de nouveaux fonds permettra de redéfinir les relations entre les secteurs, les établissements, les fournisseurs et les technologies en lice pour obtenir une part de l'argent. Un soutien solide de la part des dirigeants gouvernementaux et de nouvelles visions pour les principaux décideurs seront nécessaires pour guider les provinces et les territoires de leur état d'inertie vers une réforme significative des politiques de santé.

Si les provinces et les territoires prennent au sérieux l'amélioration du rendement du système de santé, le cadre des quatre objectifs sera fortement appuyé. Cependant, les quatre objectifs sont un outil et non une promesse. Il convient peut-être ici de penser au proverbe « un voyage de mille lieues commence toujours par un premier pas ».

Dans ce numéro

Conformément au besoin d'une mesure plus complète du rendement du système de santé, le premier rapport de recherche de ce numéro présente une étude multiprovinciale qui développe des mesures régionales du rendement des soins de santé primaires. Cette recherche de Wong et al. (2021) comble une lacune importante dans l'évaluation du rendement des soins primaires – un principe clé des réseaux de prestation de services de santé. Les soins primaires représentent un secteur où les provinces effectuent très peu de mesures du rendement. S'appuyant sur des données quantitatives provenant des cliniques de soins primaires et sur des données qualitatives provenant des cliniciens, cette recherche révèle que la mesure du rendement des soins primaires est effectivement possible et est sans doute nécessaire pour améliorer le rendement du système de santé. L'étude a également révélé des différences régionales importantes dans certains aspects de la prestation des soins primaires, ce qui veut dire que les soins primaires en Ontario ne sont pas les mêmes que ceux en Colombie-Britannique ou en Nouvelle-Écosse.

Un document de recherche qualitative basé en Alberta, et rédigé par Leslie et al. (2021a) , porte sur l'impact de la pandémie de COVID-19 sur l'intégration des soins primaires avec d'autres secteurs de soins. Cette étude révèle que la pandémie a eu pour effet d'intégrer plus étroitement les soins primaires avec le gouvernement provincial et Alberta Health Services, le système de santé centralisé de la province. Les principaux moteurs de l'intégration entre les secteurs comprenaient l'accès aux équipements de protection individuelle, le développement de nouveaux codes de facturation et de nouveaux canaux de communication.

L'article suivant, également rédigé par Leslie et al. (2021b) , a recours à l'analyse documentaire et à des méthodes qualitatives pour explorer la résilience des soins primaires en Alberta pendant la pandémie de COVID-19. Cet article décrit comment la structure de gestion de la prestation des soins primaires a été intégrée dans la réponse à la pandémie. Une conclusion importante est que, bien qu'il y ait eu une réponse à la pandémie dans la province, les répondants ont indiqué que les soins primaires était sous-représentés dans les efforts visant à maintenir la continuité des activités et la prestation des services à ceux qui n'ont pas accès aux modes virtuelles.

L'article suivant mesure la continuité de la prestation des soins primaires pendant la pandémie de COVID-19 parmi les équipes Santé familiale, un modèle ontarien de soins primaires en équipe. Ashcroft et al. (2021) ont utilisé une conception transversale et des méthodes d'enquête pour recueillir des données auprès des cadres des équipes Santé familiale. La recherche révèle qu'il y a eu une adoption très rapide des soins virtuels dans les équipes Santé familiale, bien que l'analyse des politiques souligne qu'il y a un besoin urgent de développer les compétences des cliniciens pour diriger les soins virtuels en équipe, de même qu'un besoin d'établir des pratiques exemplaires pour les soins virtuels et en personne.

L'article de Lee et al. (2021) fournit une analyse de l'énigme à laquelle sont confrontés les gouvernements provinciaux: un nombre croissant de médecins, certes, mais pourtant les efforts continuent sans cesse pour que les résidents aient accès aux soins primaires et spécialisés. Sur la base d'analyses d'ensembles de données administratives rétrospectives, l'étude révèle que le nombre de médecins a augmenté au cours des cinq dernières années, même si le volume de services fournis par les médecins à leurs patients a diminué. Soulignant que le nombre d'heures travaillées s'est érodé au fil du temps chez les médecins de première ligne et les médecins spécialistes, les auteurs postulent que l'équilibre travail–vie personnelle et les activités indirectes (non rémunérées) de soins aux patients sont, au moins en partie, responsables de la baisse du nombre d'heures travaillées. Les auteurs demandent des réponses politiques de la part du gouvernement.

Dans le dernier rapport de recherche du numéro, Ethier et Carrier (2021) explorent les facteurs associés à la mise en œuvre et à l'accès aux services de santé et sociaux locaux. Définis comme étant locaux ou de quartier, les services de santé et sociaux locaux fournissent des soins primaires et un accès aux services communautaires, aux services sociaux et aux soins à domicile. L'un des principaux objectifs de ce modèle de prestation est de fournir aux personnes âgées un soutien pour vieillir chez elles. Sur la base d'une étude de la portée, les auteurs constatent que l'inflexibilité des provinces en matière de réglementation et de politique, le manque de ressources ou d'expertise, les conflits de rôles et les partenariats non gouvernementaux sont autant d'obstacles à l'amélioration de l'accès aux services de santé et sociaux locaux.

Références

• Alberta Health Services. 2018. The 2017–2020 Health Plan and Business Plan. Year 2 of 3-Year Plan 2018/2019 . Consulté le 20 octobre 2021. < https://www.albertahealthservices.ca/assets/about/org/ahs-org-hpbp-2017-2020.pdf >.
• Ashcroft R., Donnelly C., Gill S., Dancey M., Lam S., Grill A.K. et al. 2021. La prestation des soins aux patients dans les équipes Santé familiale de l'Ontario pendant la première vague de la pandémie de COVID-19 . Politiques de Santé 17 ( 2 ): 72–89. doi:10.12927/hcpol.2021.26656. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Davis K., Stremikis K., Squires D., Schoen C.. Juin 2014. Mirror, Mirror on The Wall: How the Performance of the U.S. Health Care System Compares Internationally . The Commonwealth Fund. Consulté le 19 octobre 2021. < https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2014_jun_1755_davis_mirror_mirror_2014.pdf >. [ Google Scholar ]
• Ethier A., Carrier A.. 2021. Examen de la portée de la mise en œuvre des services de santé et sociaux locaux pour les aînés . Politiques de Santé 17 ( 2 ): 105–18. doi:10.12927/hcpol.2021.26654. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Forest P.-G., Martin D.. 2018. Rapport de synthèse: Ajustées à l'objectif: Observations et recommandations de l'examen externe des organisations pancanadiennes de santé . Consulté le 19 octobre 2021. Gouvernement du Canada. < https://www.canada.ca/fr/sante-canada/services/systeme-soins-sante/rapports-publications/regime-soins-sante/observations-recommandations-examen-externe-organisations-pancanadiennes-sante.html >. [ Google Scholar ]
• Fraser Health Authority. Août 2020. 2020/21–2022/23 Service Plan . Consulté le 19 octobre 2021. < https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/About-Us/Accountability/Service-Plans/Fraser-2020-21-2022-23-Service-Plan-Final-for-Posting.pdf?rev=19cfbaa88add4a33ab186ebb1e140a05 >.
• Gouvernement de l'Ontario. Juin 2019. Pour un Ontario en santé: Création d'un système de soins de santé durable: 2e rapport du Conseil du premier ministre pour l'amélioration des soins de santé et l'élimination de la médecine de couloir . Consulté le 19 octobre 2021. < https://files.ontario.ca/moh-pour-un-ontario-en-sante-2019-06-25.pdf >.
• Lee S.K., Mahl S.K., Rowe B.H.. 2021. L'hypothèse du déclin induit de la productivité: plus de médecins, une rémunération plus élevée et moins de services . Politiques de Santé 17 ( 2 ): 90–104 doi:10.12927/hcpol.2021.26655. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leslie M., Fadaak R., Pinto N., Davies J., Green L., Seidel J. et al. 2021a. Un « test de choc » pour l'intégration des soins de santé primaires: leçons relatives à la COVID-19 en Alberta . Politiques de Santé 17 ( 2 ): 38–53. doi:10.12927/hcpol.2021.26658. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Leslie M., Fadaak R., Pinto N., Davies J., Green L., Seidel J. et al. 2021b. Atteindre la résilience dans les soins primaires pendant la pandémie de COVID-19: visions et leçons concurrentes en Alberta . Politiques de Santé 17 ( 2 ): 54–71. doi:10.12927/hcpol.2021.26657. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ministère des Finances de l'Ontario. 15 février 2012. Commission de la réforme des services publics de l'Ontario . Consulté le 19 octobre 2021. < https://www.fin.gov.on.ca/fr/reformcommission/index.html >.
• Observatoire européen des systèmes et des politiques de santé, Marchildon G.P., Allin S., Merkur S.. 2020. Canada: Health System Review . Health Systems in Transition 22 ( 3 ). Organisation mondiale de la Santé. [ PubMed ] [ Google Scholar ]
• Romanow R.J. Novembre 2002. Rapport final: Guidé par nos valeurs: l'avenir des soins de santé au Canada. Commission sur l'avenir des soins de santé au Canada . Consulté le 19 octobre 2021. < https://publications.gc.ca/collections/Collection/CP32-85-2002F.pdf >.
• Schneider E.C., Shah A., Doty M.M., Tikkanen R., Fields K., Williams II R.D.. Août 2021. Mirror, Mirror 2021: Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries . The Commonwealth Fund. Consulté le 19 octobre 2021. < https://www.commonwealthfund.org/sites/default/files/2021-08/Schneider_Mirror_Mirror_2021.pdf >. [ Google Scholar ]
• Shekelle P.G., Begashaw M.. Février 2021. What Are the Effects of Different Team-Based Primary Care Structures on the Quadruple Aim of Care? A Rapid Review . Department of Veterans Affairs. Consulté le 19 octobre 2021. < https://www.hsrd.research.va.gov/publications/esp/teambased-primarycare-EXEC.pdf >. [ PubMed ] [ Google Scholar ]
• Wong S.T., Johnston S., Burge F., Ammi M., Campbell J., Katz A. et al. 2021. Comparaison de la mise en œuvre du modèle des centres de médecine de famille dans trois provinces canadiennes: une étude transversale . Politiques de Santé 17 ( 2 ): 19–37. doi:10.12927/hcpol.2021.26659. [ Google Scholar ]