Evidence map›Paper›PMID 29483027›Full record

ReviewLancet (London, England)2018

Canada's universal health-care system: achieving its potential.

Danielle Martin, Ashley P Miller, Amélie Quesnel-Vallée, Nadine R Caron, Bilkis Vissandjée, Gregory P Marchildon

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Lancet (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 253 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
253citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

253 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Trial
  10. Trial
  11. Review
  12. Article
  13. Review
  14. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  15. Article
  16. Epidemiology of burn injuries in a Canadian population during the COVID-19 pandemic.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2026
    Article
  17. Article
  18. Article
  19. Challenging norms: the history and future of physicians with disabilities in Canada.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  20. Article

193 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Danielle MartinWomen's College Hospital and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: danielle.martin@wchospital.ca.
Ashley P MillerDivision of General Internal Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Amélie Quesnel-ValléeMcGill Observatory on Health and Social Services Reforms, Department of Epidemiology, Biostatistics and Occupational Health, and Department of Sociology, McGill University, Montréal, QC, Canada.
Nadine R CaronDepartment of Surgery, Northern Medical Program and Centre for Excellence in Indigenous Health, University of British Columbia, Prince George, BC, Canada.
Bilkis VissandjéeSchool of Nursing and Public Health Research Institute, Université de Montréal, SHERPA Research Centre, Montréal, QC, Canada.
Gregory P MarchildonDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.

Indexed as

CanadaHealth Services AccessibilityHumansNational Health ProgramsUniversal Health Insurance

Identifiers

PMID29483027
PMCPMC7138369

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.