JANUARY

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CANADA provides recommendations to governments, providers, and the public on reducing low-value care (Choosing Wisely Canada, 2015). What major innovations and reforms have been introduced? At the annual meeting of Canada’s provincial premiers in July 2015, national health care priorities included pharmaceuticals, appropriateness of care, senior care, and dementia. There has not been a meeting between the first ministers of the federal and provincial governments on health care since 2009. In its 2015 election platform, the Liberal Party committed to a CAD3 billion (USD2.4 billion) investment in home care services and proposed a pan-Canadian collaboration to improve access to prescription medication (Liberal Party of Canada, 2015). In 2015, the Canadian government expanded the National Anti-Drug Strategy to include prescription drug abuse. This strategy focuses on reducing the supply of and demand for illicit drugs (Government of Canada, 2015b). Also introduced in 2015 was the Protecting Canadians from Unsafe Drugs Act (Vanessa’s Law), which strengthens regulation on therapeutic products to promote reporting of adverse reactions by health care institutions (Government of Canada, 2014). Provincial health system governance: Several provinces have reformed or are in the process of reforming their health system governance structures, mostly in an attempt to achieve efficiencies and reduce costs. Quebec is merging 182 Health and Social Centres, which include hospitals, clinics, and long-term care facilities, into just 28 (Assemblée Nationale Québec, 2015). In April 2015, Nova Scotia passed legislation to consolidate 10 district health authorities into two: the Nova Scotia Health Authority and the IWK Health Centre. The two merged authorities will work together to plan and deliver primary care, community health services, and acute care across the province (Government of Nova Scotia, 2015). The 2015 Newfoundland and Labrador provincial budget announced the consolidation of administrative service for the health care system into one shared services organization. The regional health authorities will remain in place, while the shared services organization will provide them with support for human resources, information technology, telecommunications, marketing, communications, finance, and payroll (Government of Newfoundland Labrador, 2015). The government appointed an implementation team in August 2015. The authors would like to acknowledge Diane Watson as a contributing author to earlier versions of this profile. 28 The Commonwealth Fund
References CANADA Assemblee Nationale Quebec (2015). Bill No. 10: “An Act to Modify the Organization and Governance of the Health and Social Services Network, in Particular by Abolishing the Regional Agencies.” http://www.assnat.qc.ca/en/travauxparlementaires/projets-loi/projet-loi-10-41-1.html. Accessed Aug. 24, 2015. Canada Health Infoway (2014). Annual Report, 2013–2014. Ottawa: Canada Health Infoway. https://www.infoway-inforoute. ca/index.php/resources/infoway-corporate/annual-reports. Accessed Oct. 1, 2014. Canada Revenue Agency (2014). “Family Caregiver Amount (FCA).” http://www.cra-arc.gc.ca/familycaregiver/. Accessed Oct. 1, 2014. Canadian Institute for Health Information (2015a). “National Health Expenditure Trends 1975–2015.” Ottawa: Canadian Institute for Health Information. Canadian Institute for Health Information (2015b). “Supply, Distribution and Migration of Canadian Physicians.” Ottawa: Canadian Institute for Health Information. Canadian Institute for Health Information (2015c). “National Physician Database, 2010–2011.” Ottawa: Canadian Institute for Health Information. Canadian Institute for Health Information (2015d). “Trends in Income-Related Health Inequalities in Canada.” Ottawa: Canadian Institute for Health Information. Canadian Life and Health Insurance Association Inc. (2014). “Canadian Life and Health Insurance Facts.” http://clhia.uberflip. com/i/369328-canadian-life-and-health-insurance-facts-2014-edition. Accessed Aug. 27, 2015. Choosing Wisely Canada (2015). “What is CWC?” http://www.choosingwiselycanada.org/about/what-is-cwc/. Accessed Nov 1, 2015. Divisions of Family Practice (2014). “Welcome to the Divisions of Family Practice,” https://www.divisionsbc.ca/provincial/ home. Accessed Sept. 1, 2014. Goering, P., Wasylenki, D., and Durbin, J. (2000). “Canada’s Mental Health System.” International Journal of Law and Psychiatry 23(3–4):345–59. Government of Canada (2014). “Protecting Canadians from Unsafe Drugs Act (Vanessa’s Law): Questions/Answers.” http:// www.hc-sc.gc.ca/dhp-mps/legislation/unsafedrugs-droguesdangereuses-faq-eng.php. Accessed Aug 24, 2015. Government of Canada (2015a). “Federal Support to Provinces and Territories.” Ottawa: Department of Finance. http:// www. fin.gc.ca/fedprov/mtp-eng.asp. Accessed Nov. 1, 2015. Government of Canada (2015b). “National Anti-Drug Strategy.” http://healthycanadians.gc.ca/anti-drug-antidrogue/indexeng.php. Accessed Aug 24, 2015. Government of Ontario (2010) “Excellent Care for All Act, 2010, S.O. 2010, c. 14.” http://www.ontario.ca/laws/ statute/10e14. Accessed Aug. 1, 2015. Government of Ontario (2011). “Open Minds, Healthy Minds. Ontario’s Comprehensive Mental Health and Addictions Strategy.” http://www.health.gov.on.ca/en/common/ministry/publications/reports/mental_health2011/mentalhealth_rep2011. pdf. Accessed Oct. 1, 2014. Government of Ontario (2014). “Health Force Ontario. Family Practice Models.” http://www.healthforceontario.ca/en/Home/ Physicians/Training_%7C_Practising_Outside_Ontario/Physician_Roles/Family_Practice_Models. Accessed Oct. 9, 2014. Government of Ontario (2015) “Ontario Funds Bundled Care Teams to Improve Patient Experience” http://news.ontario.ca/ mohltc/en/2015/09/ontario-funds-bundled-care-teams-to-improve-patient-experience.html. Accessed Sept. 1, 2015 Government of Ontario. (2015a). “Diabetes Education Program.” https://www.ontario.ca/page/diabetes-educationprogram?_ga=1.120298504.125010404.1446227826. Accessed Oct. 30, 2015. Government of Manitoba (2015). “QuickCare Clinic.” http://www.gov.mb.ca/health/primarycare/public/access/quickcare. html. Accessed Aug. 25, 2015. Government of Newfoundland Labrador (2015). “Innovative Approaches to Effective Health Care Delivery: Minister Announced Implementation Team for New Health Shared Services Organization.” http://www.releases.gov.nl.ca/ releases/2015/health/0806n02.aspx. Accessed Aug. 24, 2015. Government of Nova Scotia (2015). “Nova Scotia Health Authority.” http://novascotia.ca/dhw/about/nova-scotia-healthauthority.asp. Accessed Dec. 2, 2015. Grignon, M., and N. F. Bernier (2012). Financing Long-Term Care in Canada. Canada: Institute for Research on Public Policy (IRPP). Health Canada (2013a). Canada Health Act Annual Report 2012–2013. Ottawa: Minister of Health of Canada, http://www. hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/2013-cha-lcs-ar-ra/index-eng.php. Accessed Oct. 1, 2014. Health Canada (2013b). “Provincial and Territorial Home Care Programs: A Synthesis for Canada.” http://www.hc-sc.gc.ca/ hcs-sss/pubs/home-domicile/1999-pt-synthes/index-eng.php. Accessed Oct. 9, 2014. International Profiles of Health Care Systems, 2015 29
Page 1 and 2: JANUARY 2016 2015 International Pro
Page 3: 2015 International Profiles of Heal
Page 6 and 7: Table 1. Health Care System Financi
Page 8 and 9: Table 3. Selected Health System Per
Page 11 and 12: The Australian Health Care System,
Page 13 and 14: AUSTRALIA low-income adults, childr
Page 15 and 16: AUSTRALIA In 2013, the federal gove
Page 17 and 18: What is being done to reduce dispar
Page 19: References AUSTRALIA Australian Bur
Page 22 and 23: CANADA What is covered? Services: T
Page 24 and 25: CANADA funding to 145 not-for-profi
Page 26 and 27: CANADA Organization of the Health S
Page 30 and 31: CANADA Health Council of Canada (20
Page 32 and 33: CHINA Private health insurance: Com
Page 34 and 35: CHINA is not substantially more exp
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Page 38 and 39: CHINA References Chen, X. (2014).
Page 40 and 41: DENMARK In addition, nearly 1.5 mil
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Page 44 and 45: DENMARK Quality data for a number o
Page 46 and 47: DENMARK portion is small, it makes
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Page 50 and 51: ENGLAND immunization, and vaccinati
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Page 60 and 61: FRANCE VHI finances 13.8 percent of
Page 62 and 63: FRANCE The average income of primar
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Page 66 and 67: FRANCE inequities in prevention rel
Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
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INDIA Private health insurance: The
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INDIA provide after-hour care, reim
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INDIA are provided by other ministr
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INDIA How are costs contained? Ther
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ISRAEL Together, these two types of
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ISRAEL Primary care physicians are
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ISRAEL Organization of the Health S
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ISRAEL • Using electronic health
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ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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JAPAN incentives for providers to c
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JAPAN Organization of the Health Sy
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JAPAN The author would like to ackn
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THE NETHERLANDS receive faster acce
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THE NETHERLANDS Hospital payment ra
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THE NETHERLANDS Organization of the
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THE NETHERLANDS References Organisa
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NEW ZEALAND provided in GP clinics.
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NEW ZEALAND management (e.g., clean
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NEW ZEALAND including such informat
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NEW ZEALAND largely through efficie
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NORWAY Primary, preventive, and nur
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NORWAY Patients are free to choose
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NORWAY What are the major strategie
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NORWAY The National System for the
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SINGAPORE Medifund is the governmen
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SINGAPORE Public hospital funding i
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SINGAPORE Public consultation: The
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SINGAPORE To keep demand for servic
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SWEDEN What is covered? Services: T
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SWEDEN Hospitals: There are seven u
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SWEDEN Care, which promotes use of
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SWEDEN What major innovations and r
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SWITZERLAND Insurers offer premiums
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SWITZERLAND Hospitals: About 70 per
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SWITZERLAND Organization of the Hea
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SWITZERLAND To control pharmaceutic
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UNITED STATES What is covered? Serv
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UNITED STATES Administrative mechan
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UNITED STATES The Institute of Medi
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UNITED STATES adopted at least a ba
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The COMMONWEALTH FUND Affordable, q
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