Health care delivery system
Primary health care and public health services
General practitioners (GPs) and family physicians provide the majority of primary health care in
Canada. They are usually the initial contact with the formal health care system and control access
to most specialists, many allied providers, admissions to hospitals at which they have admitting
privileges, diagnostic testing and prescription drug therapy.
Most GPs are private practitioners who work in independent or group practices and enjoy a high
degree of autonomy. Some doctors work in community health centres, hospital-based group
practices or work in affiliation with hospital outpatient departments, while still enjoying the same
level of autonomy. Private practitioners are generally paid on a fee-for-service basis and submit
their service claims directly to the provincial insurance plan for payment. Physicians in other
practice settings are also paid on a fee-for-service basis, but are more likely to be salaried or
remunerated through an alternative payment scheme.
Patients are free to choose their own physicians, however, in some cases this choice may be
limited by the supply of physicians in an area. In severe cases of overutilization, some provinces
have sought agreements from patients to see only one physician for their ongoing care.
Another access point for the health care system is through the hospital emergency room
. Despite
the wide availability of primary care physicians, certain subgroups of the population, such as the
homeless, tend to use the emergency room as their primary access point for health care. This
practice is generally discouraged by provincial governments due to the cost of emergency care.
A number of allied health care personnel are also involved in primary health care to a certain
extent. Dentists work independently of the health care system, except where in-hospital dental
surgery is required. While nurses are generally employed in the hospital sector, they also provide
support for primary services, typically in conjunction with private practices. There has been an
increasing trend toward the independent provision of midwifery, and a recent reintroduction of
nurse practitioners who may eventually play a larger role in primary health care and remote care.
Pharmacists dispense prescribed medications and drug preparations and also act as an
independent knowledge source, by providing information on prescribed drugs, or by assisting in
the purchase of nonprescription drugs.
Until recently, general practitioners were free to practice where they preferred. Once they had
been certified for practice they simply applied for a billing number from the provincial insurance
plan, and opened an office or joined an existing practice. This has tended to lead to an oversupply
of physicians in urban areas, and a chronic shortage in rural and northern areas. In response, a
number of provinces have introduced or considered supply restrictions in urban areas, incentive
systems for rural doctors, or a mandatory time period in rural practice for foreign physicians.
24 Health care systems in transition – Canada
Public health services
Public health services in Canada were originally established to control the spread of infectious
diseases, ensure public sanitation and, to some degree, provide basic health education to the
population. Since this early inception, the role of public health services has changed substantially.
For example, as infectious diseases became less prevalent or more treatable, public health
services began to refocus their concern on disease prevention and the needs of certain underserviced segments of the population.
Today’s public health services are typically funded and provided separately from the main
components of health care, and are administered through local or regional health units.
Throughout the evolution of health care in Canada, public health services have managed to create
a useful role for themselves, coordinating and providing services typically overlooked by the rest
of the health care system.
As the focus of health care services has shifted towards a wellness
model, public health services have become a far more important component of the health care
system.
While most services are available to all residents, the design of a number of public health
programmes tends to focus them on the financially and medically disadvantaged. Today, public
health services range from broad immunization programmes, such as the current programme of
providing second-dose measles immunizations, to health programmes that educate identified atrisk groups. For example, public health services across Canada provide child and maternal health
counselling programmes, and have been at the forefront of the effort to control the spread of
AIDS. In addition, most public health services have also taken on a role coordinating or directly
providing personal and home care services such as meals-on-wheels programmes, homemaker
services, or home nursing care. As such, they are an integral part of community health care.
