Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded single-payer healthcare, informally called Medicare. It is guided by the provisions of the Canada Health Act, adopted during 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country".
Canadian Medicare provides coverage for approximately 70 percent of Canadians' healthcare needs, and the remaining 30 percent is paid for through the private sector. The 30 percent typically relates to services not covered or only partially covered by Medicare, such as prescription drugs, eye care, medical devices, gender care, psychotherapy, physical therapy and dentistry. About 65-75 percent of Canadians have some form of supplementary health insurance related to the aforementioned reasons; many receive it through their employers or use secondary social programs related to extended coverage for families receiving social assistance or vulnerable demographics, such as seniors, minors, and those with disabilities.
According to the Canadian Institute for Health Information (CIHI), by 2019, Canada's aging population represents an increase in healthcare costs of approximately one percent a year, which is a modest increase. In a 2020 Statistics Canada Canadian Perspectives Survey Series (CPSS), 69 percent of Canadians self-reported that they had excellent or very good physical health—an improvement from 60 percent in 2018. In 2019, 80 percent of Canadian adults self-reported having at least one major risk factor for chronic disease: smoking, physical inactivity, unhealthy eating, or excessive alcohol use. Canada has one of the highest rates of adult obesity among Organisation for Economic Co-operation and Development (OECD) countries attributing to approximately 2.7 million cases of diabetes (types 1 and 2 combined). Four chronic diseases—cancer (a leading cause of death), cardiovascular diseases, respiratory diseases and diabetes account for 65 percent of deaths in Canada. There are approximately 8 million individuals aged 15 and older with one or more disabilities in Canada.
In 2021, the Canadian Institute for Health Information reported that healthcare spending reached $308billion, or 12.7 percent of Canada's GDP for that year. In 2022 Canada's per-capita spending on health expenditures ranked 12th among healthcare systems in the OECD. Canada has performed close to the average on the majority of OECD health indicators since the early 2000s, and ranks above average for access to care, but the number of doctors and hospital beds are considerably below the OECD average. The Commonwealth Funds 2021 report comparing the healthcare systems of 11 high-income countries ranked Canada second-to-last. Identified weaknesses of Canada's system were comparatively higher infant mortality rate, the prevalence of chronic conditions, long wait times, poor availability of after-hours care, and a lack of prescription drugs coverage.A Prescription for Canada: Achieving Pharmacare for All (Government of Canada report, retrieved 2023) An increasing problem in Canada's health system is a shortage of healthcare professionals and hospital capacity.
Canadian healthcare policy The primary objective of the Canadian healthcare policy, as set out in the 1984 Canada Health Act (CHA), is to "protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers." The federal government ensures compliance with its requirements that all Canadians have "reasonable access to medically necessary hospital, physician, and surgical-dental services that require a hospital" by providing cash to provinces and territories through the Canada Health Transfer (CHT) based on their fulfilling certain "criteria and conditions related to insured health services and extended health care services."
In his widely cited 1987 book, Malcolm G. Taylor traced the roots of Medicare and federal-provincial negotiations involving "issues of jurisdiction, cost allocations, revenue transfers, and taxing authorities" that resulted in the current system that provides healthcare to "Canadians on the basis of need, irrespective of financial circumstances."
Monitoring and measuring healthcare in Canada Health Canada, under the direction of the Health Minister, is the ministry responsible for overseeing Canada's healthcare, including its public policies and implementations. This includes the maintenance and improvement of the health of the Canadian population, which is "among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system."
Health Canada, a federal department, publishes a series of surveys of the healthcare system in Canada. Although life-threatening cases are dealt with immediately, some services needed are non-urgent and patients are seen at the next-available appointment in their local chosen facility.
In 1996, in response to an interest in renewing its healthcare system, the federal government established the Canadian Health Services Research Foundation (CHRSF) in the 1996 federal budget to conduct research in collaboration with "provincial governments, health institutions, and the private sector" to identify the successes and failures in the health system.
The Canadian Institute for Health Information (CIHI) is a not-for-profit, independent organization established by the provincial, territorial, and federal government to make healthcare information publicly available. The CIHI was established in 1994 to serve as a national "coordinating council and an independent institute for health information" in response to the 1991 report, "Health Information for Canada" produced by the National Task Force on Health Information. In 1994, the CIHI merged the Hospital Medical Records Institute (HMRI) and The Management Information Systems (MIS) Group.
Reports include topics such as the evaluating and suggested improvements for the efficiency of healthcare services. Regions that were similar in factors such as education levels and immigration numbers were found to have different efficiency levels in health care provision. The study concluded if increased efficiency of the current system was set as a goal, the death rate could be decreased by 18%-35%. The study notes that supporting physician leadership and facilitating engagement of the care providers could reap great gains in efficiency. Additionally, the study suggested facilitating the exchange of information and interaction between health providers and government figures as well as flexible funding would also contribute to the improvement and solve the problem of differences in regional care by allowing regions to determine the needs of their general populace and meet those needs more efficiently by allowing target-specific allocation of funds.
For 24 years, the CIHI has produced an annual detailed report updating "National Health Expenditure Trends" which includes data tables with the most recent report published in January 2021. Other CIHI research topics include hospital care, organ and joint replacements, health system performance, seniors and aging, health workforce, health inequality, quality and safety, mental health and addictions, pharmaceuticals, international comparisons, emergency care, patient experience, residential care, population health, community care, patient outcomes, access and wait times, children and youth, and First Nations, Inuit and Métis.
In 2003, at the First Ministers' Accord on Health Care Renewal, the Health Council of Canada (HCC)—an independent national agency—was established to monitor and report on Canada's healthcare system. For over a decade, until 2014, the HCC produced 60 reports on access and wait times, health promotion, seniors healthcare, aboriginal healthcare, home and community care, pharmaceuticals management, and primary health care.
Demographics
By February 2024, the median age in Canada was 40.6 years in 2023 compared to 39.5 in 2006.
By July 2020, there were 6,835,866 individuals who were 65 years old and older and 11,517 centenarians. The same data reported that by July 2020, 16% of Canadians were 14-years-old or under, 66.5% were between the ages of 15 and 65, and 17.5% were 65 years and older.
Canada's population is aging, like that of many other countries. By 2016, there were about six million seniors in Canada, which then had a population of approximately 34 million. This significantly influences Canada's healthcare services; by 2019, Canada's aging population represented a modest increase in healthcare costs of about 1% a year.
Since the 2010s, Statistics Canada health research on aging has focused on "chronic diseases," "social isolation" and senior's mental health needs, and "transitions to institutional care" including long-term care. The eight chronic conditions that are prevalent in one out of ten seniors include high blood pressure, arthritis, back problems, eye problems, heart disease, osteoporosis, diabetes and urinary incontinence, with many seniors having multiple chronic conditions. Those with chronic conditions are "associated with higher use of home-care services and need for formal-care providers."
Ninety percent of Canadians agree that Canada should have a "national seniors strategy to address needs along the full continuum of care."
Current status The government guarantees the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. In 2005, Private health expenditure accounts for 30% of health care financing.
The Canada Health Act does not cover prescription drugs, home care, or long-term care or dental care. Provinces provide partial coverage for children, those living in poverty, and seniors. Programs vary by province. In Ontario, for example, most prescriptions for youths under the age of 24 are covered by the Ontario health insurance plan if no private insurance plan is available.
As of 2024, Canada introduced the Canadian Dental Care Plan (CDCP), aimed at expanding access to dental services for eligible citizens. The plan is being rolled out in phases, beginning with seniors, children under 18, and people with disabilities who lack private dental insurance and have a household income under $90,000. This federal initiative marks a significant shift in addressing dental care affordability and access, complementing the varying levels of provincial support already in place.
Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. Costs are paid through funding from federal and provincial general tax revenues, which include income taxes, sales taxes, and corporate taxes. In British Columbia, taxation-based funding was (until January 1, 2020) supplemented by a fixed monthly premium that was waived or reduced for those on low incomes. In Ontario, there is an income tax identified as a health premium on taxable income above $20,000.