The Canadian healthcare system does not have such a rich history as the European one, but it is considered one of the most developed around the world. Dhalla and Tepper (1) state that ‘Canadians are healthier than ever before, and in many respects, the quality of health care provided to Canadians is also better than ever’ (p. 1). An important indicator of the successful development of the healthcare system are indicators of the health of the population, and in Canada, these indicators remain relatively high.
Before the formation of the Canadian Confederation in 1867, private doctors provided medical care to the population. Patients paid for rather expensive services of specialists themselves, thus not everyone had the opportunity to seek help. The solution for this situation was the provision of medical care by church parishes and religious charitable organizations, among which the famous Salvation Army stood out. At the same time, such assistance was local in nature: the remote northern regions, which were predominantly inhabited by the indigenous population, remained without medical care until the 20s of the last century.
In the period of 1920-1960s, with the onset of the era of industrialization, cities in Canada began to grow and develop rapidly. Study (2) reveals that it was the necessity of a population needs-based healthcare system that had been driving the changes. As a result, the role of the state in organizing health care and social security increased. This approach helped to overcome the Great Depression, but until the end of the 1940s, the system of private medicine still prevailed.
In 1947, with the introduction of public health insurance in the province of Saskatchewan, a health insurance system gradually began to take shape. According to Soril et al. (3), ‘Medicare became the national, publicly funded health insurance program that provides first-dollar coverage for medically necessary physician and hospital services’ (p. 43). Since 1956, health insurance has been introduced in all provinces and territories of Canada, which later also affected the field of out-of-hospital medical services.
The specifics of the medical industry in Canada lie in the significant decentralization of the health care system: the provinces and districts themselves plan, finance, and evaluate medical care at all levels. The government determines the general direction of healthcare system development and resolves medical issues of a national order. Recent reports (4) add that the state have decided to reform this system for the first time in over half a century due to the COVID-19 pandemic. However, as early as 1972, public insurance systems began to cover the costs of basic medical services, including emergency and hospital treatment.
In 1984, the Canadian Health Care Act formulated the basic principles for the provision of medical care, in particular insurance. The first was the universality: any citizen of the state has the right to health insurance on uniform terms. It is also stated (5) that values of equity, solidarity, and fairness are key to the CHA. Availability proclaimed that medical services are provided on a general basis, without payment, in addition to the policy. Canadians are not assigned to doctors and can go to the medical facilities of their choice, especially in case of an emergency that requires paramedical help.
Comprehensiveness ensured that coverage included hospital stays, care, diagnostics, use of medications, operating room, and other equipment, as well as home care and outpatient drug provision. However, it must be noted that the volume of services provided is not the same in different provinces. For the benefit of portability, health insurance in Canada is not tied to where the person works or lives. Finally, public administration is carried out through government-registered non-profit organizations established in each province to process all health insurance payments.
Thus, health management in Canada is carried out in the following way: federal government to territorial government to regional health departments. The main task of the latter is to directly control the provision of medical services to the population by public and private organizations. According to Rasku et al. (6), ‘the delivery of healthcare needs new models to reduce the costs, patient’s readmission and increase their possibilities to stay at home’ (p. 508). The state has created a nationwide health insurance system that uses non-profit public organizations as the most important element of communication between state authorities and the population. This is another Canadian specificity: numerous public organizations are actively involved in the implementation of health policy at the local level, providing medical care, social support, promoting healthy lifestyles, and solving environmental problems.
Additionally, there is the branch of community paramedicine – a specific kind of medical help that is focused on local and rural areas. As van Vuuren et al. (7) report, ‘community paramedicine is a novel approach to preventative and rehabilitative health’ (p. 1). Community paramedics specialize on caring for patients in non-life-threatening conditions at home or in a community center. Cameron and Carter (8) add that ‘there are local issues such as poorly serviced urban areas, residential aged care, under insurance, and drug and alcohol programs’ (p. 691). Often, people require additional medical help that is not absolutely needed but would improve their quality of life significantly.
Elderly people are the main population category that requires such services, as it can be incredibly difficult for them to leave the house. Studies (9) show that the rural elderly age groups are increasing in size, and they often require affordable and convenient at-home palliative care. Moreover, the patients might not have access to a hospital or family doctors immediately due to their remote location. In this case, community paramedicine becomes their main and most relevant option.
This system allows to reduce the burden of necessary care from clinicians and hospitals by permitting the community paramedics to offer primary care services to the population. Collaborative teams of specialists with multiple working areas work together to ensure that the community is getting the medical attention it needs. The researchers (10) add that nowadays, paramedics are becoming more recognized as professionals that can offer sustainable and high-quality care to vulnerable populations. Overall, such approach allowed the state to diversify and expand its healthcare system in order to fit the population needs better, as well as offer better options for remote areas of the country.
In general, it can be said that Canadian healthcare system is rather well-developed and serves its goal relatively efficiently. For example, introduction of community paramedicine has been one of the more successful programs that helped reach more vulnerable populations. Still, provision of timely and quality medical services is one of the most important tasks the state is given, and it requires constant development and improvement. Future directions of improving healthcare should focus on providing more services to vulnerable populations, especially in the light of pandemic, as well as reducing the cost of emergency care.
References
Dhalla IA, Tepper J. Improving the quality of health care in Canada. Canadian Medical Association Journal. 2018;190(39). Web.
Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada’s Universal Health-care system: Achieving its potential. The Lancet. 2018;391(10131):1718–35. Web.
Soril L, Adams T, Phipps-Taylor M, Winblad U, Clement F. Is Canadian healthcare affordable? A comparative analysis of the Canadian Healthcare System from 2004 to 2014. Healthcare Policy | Politiques de Santé. 2017;13(1):43–58. Web.
Marchildon GP, Tuohy CH. Expanding Health Care Coverage in Canada: A dramatic shift in the debate. Health Economics, Policy and Law. 2021;16(3):371–7. Web.
Lanoix M. No longer home alone? Home care and the Canada Health Act. Health Care Analysis. 2016;25(2):168–89. Web.
Rasku T, Kaunonen M, Thyer E, Paavilainen E, Joronen K. The core components of Community Paramedicine – Integrated Care in Primary Care Setting: A scoping review. Scandinavian Journal of Caring Sciences. 2019;33(3):508–21. Web.
van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O’Meara P, et al. Reshaping healthcare delivery for elderly patients: The Role of Community Paramedicine; A systematic review. BMC Health Services Research. 2021;21(1). Web.
Cameron P, Carter A. Community Paramedicine: A patch, or a real system improvement? CJEM. 2019;21(6):691–3. Web.
Pugh A, Castleden H, Giesbrecht M, Davison C, Crooks V. Awareness as a dimension of Health Care Access: Exploring the case of rural palliative care provision in Canada. Journal of Health Services Research & Policy. 2019;24(2):108–15. Web.
Nolan MJ, Nolan KE, Sinha SK. Community Paramedicine is growing in impact and potential. Canadian Medical Association Journal. 2018;190(21). Web.
