The Public-Private Mix in the Delivery of Health-Care Services: Its Relevance for Lower-Income Canadians

This paper reviews and analyzes the implication of the public-private mix of financing and delivery of health care in Canada for lower-income Canadians. Based on the type of government stewardship and the degree of state intervention, the Canadian health system can be separated into three distinct layers: universal hospital and physician services financed and regulated by federal and provincial governments (“Medicare”); mixed services, including prescription drugs and long-term care, subject to some provincial stewardship and subsidy; and privately funded and delivered services such as dental care. Within Medicare financial barriers to access have been removed; however, there is a growing trend toward private sector involvement in the delivery of services, and inequalities by income in the use of physician services are high in Canada relative to other high income countries. Moreover, the exclusion of prescription drugs and long-term care from universal health coverage in Canada, as well as the nearly exclusively private dental market, has created significant access issues for lower-income Canadians. © 2016, Springer International Publishing.