Iwona A. Bielska

The Canadian health care system is a publicly financed system administered by ten provincial and three territorial governments. The purpose of this article is to provide an overview of the universal health care system in Canada, including its history, the health status of Canadians, health care funding and spending, and health research and data collection. Health care spending in Canada amounts to 11.6% of the country’s gross domestic product and is estimated to have been $200.5 billion Canadian dollars in 2011. Hospitals account for the largest source of health care spending (29%), followed by drugs (16%) and physician spending (14%). Of the total health care spending, 70% is paid for by the public system. Due to the Canadian population being covered by the universal health care system, health data are being collected and can be used to monitor the health care system and inform evidence-based medicine.

The public health system in the province of Ontario in Canada is a publicly funded system that is responsible for addressing the health status of the population. Public health involves the combined effort of all levels of government (federal, provincial, municipal) in the country to strengthen the health system and promote the health of Canadians. The federal Canada Health Act guides the delivery of health services, with the administration of the health system a provincial responsibility. There are multiple organizations involved in public health including the Ontario Ministry of Health and Long-Term Care, Local Health Integration Networks, local Boards of Health, Public Health Ontario, and the Ontario Public Health Association. Public health program costs at Ontario’s 36 public health units are shared between municipal and provincial governments. Public health initiatives undertaken by public health units and governmental agencies are aimed at addressing and improving the population’s determinants of health.

Ankle sprains are common soft-tissue injuries that are often treated in emergency departments. These injuries can have significant consequences for the patient, including long-term morbidity and loss of productivity. The objective of this study was to examine the direct and indirect health resource utilization associated with ankle sprains. 296 adult patients with acute ankle sprains participated in the study in Kingston, Ontario, Canada. Data were collected using a one-month productivity questionnaire. Overall, 11% (95% CI, 8-15%) of the participants visited a physician following the initial emergency department visit. Almost all (95%; 95% CI, 92-97%) of the participants used medications or supportive treatments and 55% (95% CI, 50-61%) reported taking time off from work, school, or housework. The use of unpaid assistance was indicated by 56% (95% CI, 50-62%). Findings from this analysis highlight the significant patient-related and health care system burden of acute ankle sprains.

Public health is comprised of services, programs, and policies aimed at promoting health, preventing injury and chronic diseases, and responding to health emergencies. Public health professionals include front line providers, consultants, and specialists from various disciplines and professions, such as medicine, nursing, and epidemiology. Public health in Canada is provided through the collaboration between three levels of government, namely municipal, provincial or territorial, and federal. While public health is a shared responsibility of all levels of government, the volume and direction of allocated resources for related activities varies between the provinces and territories. Canada’s public health history predates its founding in 1867. A turning point in public health in the country occurred following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. The following year, the federal Public Health Agency of Canada (PHAC) was created. Its role is to improve and maintain population health in Canada. The Chief Public Health Officer is the deputy head of the PHAC and is the government’s lead public health professional. The public health landscape in Canada will continue to evolve to meet the growing needs of its population and to address existing health challenges including adverse health events related to chronic diseases and unhealthy lifestyles. Moreover, it will further adapt to respond to new public health threats, such as the emergence of tropical illnesses, the northward spread of infectious agents due to climate change, and disease transmission related to international travel.