University of Toronto.
European Observatory on Health Systems and Policies.
Health Syst Transit. 2020 Nov;22(3):1-194.
This analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as "medicare"), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/ territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.
这篇对加拿大卫生系统的分析回顾了组织和治理、卫生筹资、医疗服务提供、卫生改革和卫生系统绩效的近期发展。加拿大的预期寿命较高，但由于阿片类药物危机，其在 2016 年至 2017 年间趋于平稳。健康方面的社会经济不平等现象显著，土著居民与加拿大其他人口在健康结果方面存在的巨大且持续的差距，是卫生系统乃至整个社会面临的主要挑战。加拿大是一个联邦制国家：各省和地区为其居民管理医疗保险系统（称为“医疗保险”），而联邦政府则通过《加拿大卫生法》等制定国家标准，并负责特定人群的医疗保险。卫生服务主要由公共资金提供，大约 70%的卫生支出通过一般税收来筹集。然而，医疗保险存在重大缺口，例如医院外的处方药、长期护理、精神卫生保健、牙科和视力保健等，这解释了雇主私人健康保险和自付费用在其中发挥的重要作用。全国范围内医生和护士的供应分布不均，农村和偏远地区长期短缺。最近的改革包括朝着在省/地区一级将卫生区域合并为更集中的治理结构的方向发展，以及逐步向土著人在卫生保健方面的自治迈进。在引入全国性处方药保险计划（Pharmacare）方面也取得了一些进展，尽管 2020 年的 COVID-19 大流行可能会将重点转移到解决其他主要的卫生系统挑战上，例如长期护理部门的服务质量差和监管监督不力。近年来，通过住院死亡率、癌症存活率和可避免的住院率等指标衡量，加拿大的卫生系统绩效有所提高。然而，在非医疗保险服务的可及性、专科和选择性手术护理的等待时间、以及分散和协调不良的护理方面，仍存在重大挑战，这些问题将继续困扰政府，以追求改善卫生系统绩效。
