Canada: Health System Review.

Q1 Medicine
Health systems in transition Pub Date : 2020-11-01
Gregory P Marchildon, Sara Allin, Sherry Merkur
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引用次数: 0

Abstract

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.

加拿大:卫生系统审查。
这份对加拿大卫生系统的分析回顾了在组织和治理、卫生筹资、卫生保健提供、卫生改革和卫生系统绩效方面的最新发展。美国人的预期寿命很高,但由于阿片类药物危机,它在2016年至2017年期间趋于平稳。卫生方面的社会经济不平等非常严重,土著人民与其他加拿大人之间在卫生结果方面存在巨大而持久的差距,这是卫生系统乃至整个社会面临的一项重大挑战。加拿大是一个联邦制国家:各省和地区管理其居民的医疗保险系统(称为“医疗保险”),而联邦政府制定国家标准,例如通过《加拿大健康法》,并负责特定亚群体的医疗保险。卫生保健主要由公共资助,大约70%的卫生支出由一般税收收入资助。然而,在医疗保险方面存在重大差距,比如医院外的处方药、长期护理、精神卫生保健、牙科和视力保健,这就解释了以雇主为基础的私人医疗保险和自付费用的重要作用。医生和护士的供应在全国范围内是不平衡的,农村和偏远地区长期短缺。最近的改革包括在省/地区一级将卫生区域整合为更集中的治理结构,并逐步实现土著人民在卫生保健方面的自治。尽管2020年的COVID-19大流行可能会将重点转向解决其他主要卫生系统挑战,如长期护理部门的质量差和监管监督,但在引入国家处方药覆盖规划方面也取得了一些势头。以住院死亡率、癌症存活率和可避免住院率来衡量,近年来卫生系统的表现有所改善。然而,诸如获得非医疗保险服务、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等重大挑战将继续使各国政府在追求改善卫生系统绩效的过程中关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health systems in transition
Health systems in transition Medicine-Medicine (all)
CiteScore
16.00
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0.00%
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