Health Care in Canada

Known for her in-depth knowledge and clarity of style, Antonia Maioni wades into the complicated world of health care in Canada and emerges with a concise roadmap of how the different systems work together. Instead of an ideological argument about how things should be, Maioni's unbiased account describes how they actually are. Any Canadian who has ever spent too long in an emergency room or wondered about the costs of new medical technologies will find this both fascinating and essential reading.

Maioni condenses years of research and teaching into accessible accounts of key issues: the political history that led to our current organization; the current division of responsibilities between provinces and the federal government; the financing of health care; and the ways our systems contrast with other comparable Western countries. An overview of Canada's political history in health care is a thought-provoking entry into the development of our system over time. With origins in urbanization, postwar medicine, labour unrest, and early liberalism, health care as we now know it is the result of surprisingly hard-fought political battle whose outcomes, Maioni argues, could not have been predicted. Key figures like Tommy Douglas and Thomas "Duff" Pattullo, Leonard Marsh, and Claude Castonguay played pivotal roles in devising the origins of our insurance system. Canadians are constantly surprised by the different system south of the border; Maioni's chapter on the evolution of Medicare in America from John F. Kennedy to Barack Obama is a compelling account of two countries and two networks that diverged over time. Similarly, a look at the European systems - in particular Britain - shows that while there are similarities like health care delivery free at the point of service, there are also some essential differences such as the capitation process.

Maioni also explores how our systems are organized in Canada around several basic tents. In theory, health care in Canada is characterized by comprehensive benefits, portability, universality, and accessibility. But change is in the air: how, for example, should we organize team-based efforts, outpatient drug therapies, home and care long term care? Should mental health be included? There have been reforms in recent decades, and other reforms will likely be needed in future. Money, of course, is a key issue. Maioni's chapter on funding reveals how money flows through the public purse via governments and their agencies. There are a mix of health care financing modes emerging from a "single payer" system. Maioni usefully breaks down the numbers: for example, we spend roughly 12 per cent of our GDP on health care and about $6000 per individual. Maioni also looks at how spending has changed over time, noting relative increases for example in drug costs and long-term care facilities. As the burden on the public sector increases, governments must develop smart cost control strategies.

Antonia Maioni, Professor, Department of Political Science, McGill University