Macro efficiency concerns the interaction of the health care system within the larger economy with the main focus on labour market issues. Differences between provincial health care systems can inhibit the mobility of labour by creating barriers to move between provinces. There is a clear benefit to the Canadian economy if provincial health care systems offer similar services and since there is no incentive for individual provinces to do so, federal action would be required to address this national concern adequately. More recently, macro efficiency goals are concerned with achieving an acceptable level of health care spending relative to GDP and the impacts of health care financing on industrial costs of production. These are influenced by the health of the workforce, levels of health care spending and medical costs outside the publicly financed system.
Equity is also an important health care goal for national and provincial governments.
Horizontal equity is equal access to medical services to individuals irrespective of factors such as location and age, and vertical equity is equal access irrespective of income or wealth. While equity of access was the early concern, a more equitable distribution of health status has become the important goal. Given the different populations, income distributions, revenue mixes, and potentially different philosophical interpretations of what vertical and horizontal equity are, federal and provincial interpretation of equity goals differ. Based on these rationales, national standards and federal financial resources are required to support the health care system. In summary, federal and provincial interests are likely to coincide on the goal of micro efficiency, but they are likely to differ to varying degrees on macro efficiency, and vertical and horizontal equity.