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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 1; 335(7617): 419.
PMCID: PMC1962858

Canada's health system needs overhaul, say nation's doctors

Canada's public health system, created in the 1960s, needs to be modernised to expand access and improve patient care, according to Canada's doctors.

The system primarily funds services provided by hospitals and doctors; it pays for 98.7% of doctors' services but only 45.6% of the cost of prescription drugs, according to the Canadian Medical Association. Canadian residents, or their insurance plans, are responsible for paying for other health services, such as crutches for someone who has broken a leg, an ambulance for someone who has had a heart attack, and even painkillers.

Currently a large but unknown number of poor people have no insurance and cannot afford to pay for these items.

“The needs of Canadians are changing and our system needs to be changed and updated to address the health care challenges of the 21st century,” said the association's outgoing president, Colin McMillan, at the association's annual meeting in Vancouver, British Columbia.

“While the Canadian Medical Association believes that change is required, we stand firm, however, on the basic underlying principle that access to quality health care services in this country will be based on medical needs and not your ability to pay.”

“Our system was built to meet the needs of the underprivileged. It is now failing both them and everyone else because it has not adapted to the times,” said the incoming president, Brian Day. “The greatest deficiencies are in the poorest regions of our nation, especially Aboriginal communities. Our health system has been ranked 30th by the World Health Organization.”

About 250 delegates at the association's meeting examined and passed a series of resolutions to recommend ways to improve care for Canadian patients. For example, delegates called on Canada's governments to provide comprehensive coverage of prescription drugs and immunisation for all children in Canada. They also urged governments to consider the creation of a compulsory social insurance plan, based on contributions, to cover Canadians' long term healthcare needs.

They also resolved that the association should develop a policy framework, and design principles, for access to publicly funded medically necessary services in the home and community settings. The goal is to urge Canada's governments to develop new legislation, a “Canadian extended health services act,” to cover the cost of drugs and long term care and care at home.

Although almost three in four Canadians have private insurance for essential services, at least 30% of Canadians do not have access to high risk insurance to cover their drugs, says the association.

“We tend to forget that it is the people who need it most that lack coverage,” pointed out Dr Day. “I think we're one of the few countries—if not the only country—with universal health care that provides no national drug programme.”

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