Critical care in Canada. The North American difference.

Critical care medicine in Canada has evolved into a multidisciplinary service, teaching, and research activity. Pressure on existing funding models for the delivery of health care in Canada is leading to substantial change in the hospital sector. Although not explicitly targeted for change, pre-existing models of critical care delivery will be caught in the acute care services, redesign (that results from the health care restructuring because of the substantial impact that delivering critical care services has on overall hospital budgets). Although starting from different perspectives, the Canadian and American health care systems seem to be converging in their health care redesign principles, with themes such as integration, regionalization, physician payment reform, health care worker redesign, and global budgeting common through the multiplicity of plans being articulated. What critical care will look like in its major domains (service, education, and research) in the year 2001 is difficult to foresee at this time. In this context, therefore, change occurring in Canada's critical care system will be no less challenging than what will occur in the United States or other health care systems. For the resources we have developed for the critically ill patient population to survive health care redesign, we must improve our way of working together internationally, to understand and benchmark best practices and to share ideas for the most effective critical care systems.