Canada stretches from the Atlantic Ocean in the east to the Pacific Ocean in the west, occupying an area just under 10 million square kilometers. In mid-1991, the population reached 27 million persons. Canada is a federal state, and its vast geographic area is divided into ten provinces and two territories, each of which has its own government. Both health and education come under the jurisdiction of provincial governments.
Each of Canada's provinces and territories administers its own health care system. To obtain partial financial support from the federal government, provincial health plans must meet the following five criteria. (1) Universality: all residents of a province must be covered under the same conditions. Waiting periods for coverage for new residents of a province or territory cannot exceed three months. (2) Portability: residents of a province cannot lose coverage while they are temporarily absent from their province of residence. (3) Comprehensiveness: all medically necessary hospital and physician expenses must be covered. Services not deemed medically necessary may be covered on an optional basis. (4) Accessibility: the provincial health care plan must provide all residents with reasonable access to care without financial barriers--very important in a country the size of Canada. (5) Public administration: the health care plan must be operated and administered by a public nonprofit body. Although physician services are publicly funded, most physicians in Canada are self- employed and are paid on a fee-for-service basis. Only 25 percent of health care expenditures are not paid through the public health care plans.
The chief problem facing Canada's largely publicly funded health care systems today is rapidly escalating costs. The health care policy agenda is