Canada's Health Care System
This article describes how Canada’s system works; the roles government and the private sector play in the system; and the advantages and disadvantages Canadians experience with it.
- Major Indicators of Health in Canada
- How Health Care Is Organized in Canada
- Health Care Insurance in Canada
- Who Is Eligible for a “Free” Health Care in Canada?
- What Is Covered under Canada’s Public Health Insurance?
- How Is Health Care Paid for in Canada?
- How Do I Use My Health Card to Access Services?
- Drawbacks of the Canada’s Health Care System
- Canada’s Role in Medical Research
Canadians compare very favorably with other developed nations in several major indicators of good health:
- Life expectancy: A child born in Canada can expect to live to age 80 for men and 84 for women on average, about 2 years higher than the average in the 38-country Organisation for Economic Co-operation and Development (OECD), according to the OECD Better Life Index.
- Infant mortality in Canada (deaths of children under 1 year) is just 4.4 per 1,000 births, compared with 5.7 for the United States.
- Canadians stay healthy and productive much longer in their life. Among Canadians who reach age 65 (the standard age of retirement in Canada) women can look forward to living another 22 years on average, and men more than 19 years.
- When asked, "How is your health in general?" more than 88% of Canadians surveyed said they were in good health, one of the highest scores among the OECD countries.
Universal health care, which allows every resident to access doctors and hospital care without paying at the point of service, is often cited as a major reason for Canada’s healthy population. Extensive childhood immunizations, free provision of influenza vaccines, and other proactive measures mean that infectious diseases play a lesser role in Canadians’ health than they do in many parts of the world. Canada’s robust and nimble response to the recent COVID-19 pandemic, has been a success, resulting in a mortality rate almost three times lower than its neighbor, the United States.
Under Canada’s constitution, delivery of health care is generally the responsibility of the ten provinces and three territories, with the federal government setting general principles and criteria as well as providing additional funding.
Each province runs its own hospitals, regulates health care professionals, pays fees for service to independent providers, negotiates prescription drug prices and operates a tax-funded health insurance system that pays for medically necessary services for every legal resident.
The federal government pays for the health services of certain groups: members of the Armed Forces, Inuit and First Nations people living on reserves, and refugees who are waiting to have their claim for asylum heard. The federal government is also responsible for regulations concerning the production of public health items (for example, pharmaceuticals, food, and medical devices), consumer safety, and disease surveillance and prevention. It also supports health promotion and medical research.
Canada’s tax system provides residents with tax credits for medical expenses, disability, caregivers and infirm dependants, and deductions for private extended health insurance premiums for people who are self-employed.
Health care is a major part of the budget in every province. In Ontario, for example, the province with the largest population, more than 38% of every taxpayer dollar is spent on health care. Therefore, assistance from the federal government in covering these costs is vital. Total health spending in Canada is expected to reach CAN $308 billion in 2021, or $8,019 per Canadian.
In practice, the Canada Health Act, the main health care law, ensures that Canada has a single-payer system for basic health care.
Public health insurance in Canada covers all “medically necessary” services. This includes doctor and specialist visits (including virtual or telephone appointments), most medical tests, obstetrics, surgery, and hospital care, as well as drugs provided in the hospital. No one in Canada goes without care or faces financial hardship because they can’t pay the bills when they get cancer, suffer a car accident, have a heart attack, or develop a brain tumor. In most of these cases, they will never even see a bill. Most doctors in Canada operate independent practices, but the province negotiates with medical organizations to determine the standard fees that will be paid for various services, and the doctor bills the provincial health agency directly.
It’s generally illegal to charge patients extra fees, deductibles or “copays” for services that are covered by the provincial health care plan, or to offer expedited services (such as faster elective surgery) to patients willing to pay the cost themselves. This ensures that everyone receives equal treatment and no one is able to “cut the line” by paying more.
For items and services not covered by the province, private or company insurance often steps in to fill the gap. About 87% of employees in Canada are offered some kind of “extended health care plan” through their employers, which will cover them and their dependents for many of these services up to certain limits. People who are self-employed, do “gig work,” or work at a low-wage or part-time job may not have access to this type of coverage but they can buy such coverage on their own.
About 73% of employers who offer such a plan pay the full premium, while others will ask employees to pay a modest portion. Self-employed people can also buy extended health care plans for themselves.
For newcomers to Canada, it is a good idea to find a job that offers the extra health care benefits, as the cost of dental care and so on can become a burden to families.
In addition to the public health insurance plan, each province has an independent workers' compensation agency, funded by employers, that pays for care and rehabilitation services for workers injured on the job.
To receive routine health care services in Canada, you will need to obtain a health insurance card issued by the provincial health agency in the province where you live. These cards usually bear your photo and a unique identifier number. There is no cost to get the card. You will need to present the card each time you visit a doctor’s office, clinic, testing site or hospital.
Each province sets its own requirements, but generally you are eligible to get a card if you:
- Are Canadian citizen or permanent resident (or confirmed PR applicant who is still awaiting a decision),
- Hold a Temporary Work Permit and are working full-time,
- Are a UN Convention refugee or other protected person, or
- Are an Indigenous person.
Certain temporary residents such as international students may also be eligible.
Tourists and visitors are not eligible for health cards and may have to pay out of pocket or through travel insurance if they incur medical expenses while visiting Canada. You cannot use your health card to pay the medical costs of a visiting relative, for example.
Check the website of your provincial health insurance agency to learn about its particular requirements. In some provinces, you may have to wait up to three months before you can receive benefits if you are coming from abroad, so apply as soon as you arrive in Canada; make sure you have temporary insurance coverage while you wait. It is often possible to start the application process online or a member of our team can help you with it. You will need to show documents to prove that you are legally entitled to be in Canada and to prove that you are a resident of the province.
You will have to fulfill certain residency requirements to obtain and retain your access to health care. In most cases, the requirement is that you must be physically present in the province for at least five or six months out of 12. In certain situations (for instance, students studying out of province) you may be able to apply for an extended absence so that you will not lose your health insurance benefits.
The Canada Health Act doesn’t define what is “medically necessary,” so it’s up to each provincial health insurance plan to determine what will be covered; this is done in consultation with physician groups. There are frequent adjustments as new treatments and drugs become available and costs change. So the provinces vary in exactly what they will cover outside of a hospital or physician’s office. For example, in sparsely populated northern regions of the country, the insurance plan subsidizes the cost of travel to larger centres for treatment. You can learn more about what each province covers.
Things considered non-essential are not covered. Cosmetic surgery isn’t covered. Nor is dental care, except for dental surgeries that are performed in a hospital. Childhood immunizations are covered but adult ones, or shots required for travel, may not be. Coverage for mental health services varies. Provincial plans may or may not cover the cost of paramedical services such as chiropractors, physiotherapists, osteopaths and podiatrists, or the cost of equipment used outside a hospital such as wheelchairs, orthotics and hearing aids.
Each province decides which new drugs to approve and pay for. Prescription drugs used outside a hospital can be expensive if you do not have extended health insurance provided through your employer, although as a result of the government's bargaining with pharmaceutical companies they are typically much less costly in Canada than in the US. One of Canada’s major political parties is currently advocating for a national “pharmacare” plan to pay for all prescriptions regardless of age or circumstances.
Provinces may offer extended coverage for some equipment, prescriptions and services to specific groups with special needs, including people with disabilities or on social assistance, children, and seniors over 65.
Private or employee insurance often covers the cost of items the province doesn’t pay for, such as hearing aids, prescription eyeglasses or contact lenses, and the extra cost for a private hospital room.
For immigrants, it is especially important to note that, in case of an emergency, you should purchase travel health insurance for times when you travel outside Canada, unless your company insurance specifically offers travel benefits. Some provinces will reimburse part of your cost for emergency care outside Canada, but only at the same rates that they would pay in the province — which can be far less than what a hospital in the US, for example, would charge. You cannot go back to your home country, visit your old doctor, and expect the provincial plan to pay the bill.
Of course, health care is not really “free.” Canadians pay for their health care through a progressive tax system, so that wealthier individuals pay a bigger share of the load than people who are not as well off, while everyone receives the same standard of care.
Health is the largest expense of provincial and territorial governments, with expenses per capita in 2019 ranging from CAN $4,440 in Ontario to $6,449 in Newfoundland & Labrador, according to Statistics Canada.
Generally this cost is hidden in the federal and provincial taxes Canadians pay, but some provinces may charge an extra health care premium, which is also progressive. In Ontario, for example, people pay a premium of CAN $0 to $900, depending on income, when they complete their annual income tax return.
Costs are rising for medical care everywhere, particularly in countries that have an aging demographic profile, like Canada, where a smaller number of working adults have to care for a growing older population. However, a single-payer system keeps costs lower by regulating what doctors and hospitals are allowed to charge for services, eliminating for-profit basic health care, and by organizing the use of medical equipment, hospital beds, etc., rationally.
Overall, according to the Canadian Institute for Health Information, Canada spent CAN $6,666 per person on health care in 2019, compared with CAN $13,590 in the US, CAN $8,091 in Germany, and CAN $5,586 in the UK.
One reason Canada spends much less on health care than its neighbor to the south, despite having better outcomes statistically, is that it is organized with a focus on primary-care. That means that, outside of urgent situations, you generally have to visit a general practitioner (GP, or “family doctor”) before you can see a specialist. About half of all doctors in Canada are GPs. Because of the need for a referral, Canadians may wait a little longer to see a surgeon or specialist or to get non-urgent procedures such as knee replacements and cornea transplants.
For routine care, you make an appointment with a GP and present your health card when you arrive. You will not be charged any fees for your visit, except perhaps for non-medical services such as writing an absence letter to an employer. Many cities have walk-in clinics and urgent-care centres that treat people who have immediate needs or don’t have a regular physician. In an emergency, you can call 911 to ask for an ambulance, or present yourself at a hospital emergency room with your card. Many provinces now provide a telehealth service that allows you to speak with a nurse on the phone to get advice; the nurse can then direct you to a physician, urgent care centre or hospital.
Your doctor will refer you to a specialist if your condition requires such care, or recommend specialized services such as mental health care.
It is common and encouraged in Canada for doctors to ask you questions about your mental health as part of understanding your health issues. For example, your doctor may ask whether you feel anxious or depressed, or are struggling with family conflict — all common experiences among immigrants. There is a growing understanding that your physical and mental health are deeply connected, and there is no shame in sharing this information with your doctor. Your doctor may be able to write a prescription or refer you to a counsellor or social agency that can help you. Don’t worry: in Canada, anything you tell your doctor is regarded as strictly confidential, unless it needs to be shared with other people on your medical team. The doctor may not tell your relatives anything you don’t want them to know.
Your doctor or surgeon has an obligation to warn you about any particular risks that may come with a procedure, as well as the benefits. You, or a designated family member, will usually need to sign a release form indicating that you understand and accept those risks. You can ask for help from an interpreter or a friend, in person or over the telephone, if you have difficulty communicating with your doctor.
While it’s difficult to fairly compare health care from country to country, Canada’s system is generally considered among the best in the world, with more than 1,200 hospitals, a substantial investment in research, and high standards of training and qualification for physicians. But there are a few challenges within the system, such as:
- Doctor numbers: Canada has only about 2.8 doctors per 1,000 residents, around the average among the OECD countries, but much fewer than some other countries, such as Australia (3.7) and Norway (4.7). As a result, it is sometimes difficult to find a GP who is accepting new patients nearby, especially in smaller communities, where the shortage of doctors is more acute.
- Distance: Canada’s vastness, particularly in the north and in the western provinces, means that people may have to travel long distances to get to a larger centre where specialized care is available; this makes it difficult for family members to accompany a patient on hospital stays. In some large cities, there are charity-run accommodations that allow out-of-town families to stay close to the hospital at a reduced cost.
- Social barriers: People who are somewhat marginalized in society, such as those who struggle with homelessness and poverty, “visible minorities,” Indigenous people, and refugees and other newcomers to Canada, may face social barriers in getting the care they need, provided in a culturally sensitive way. People with mental health and addiction problems likewise often have to wait to get into appropriate programs and inpatient care.
- Rationing: People with a true emergency always take priority and will get timely care. But because the system allocates the use of expensive equipment and services, non-emergency needs may take longer. Getting an MRI to diagnose a chronic shoulder problem, for example, may mean going to a middle-of-the-night appointment several weeks and some distance away. But if you are diagnosed with a life-threatening brain tumor, you may get surgery within 24 hours. If you are rushed to an emergency room suffering a heart attack, you will get treated before the girl who has been waiting for two hours with a broken bone.
- Long wait times: Complaints about crowded emergency rooms and long waits for elective surgeries such as knee replacements are a longstanding issue in some provinces. Some Canadians who can afford, resort to “medical tourism” abroad to get surgeries faster. Reforms to legislation and funding over the past decade has brought progress in reducing backlogs. However, the global pandemic has led to setbacks.
- Elder care: The pandemic has also shone a spotlight on Canada’s inadequately funded system for long-term care homes (also known as nursing homes), which care for elderly and chronically infirm patients. Publicly funded homes, which are difficult to get into, and private for-profit homes, which are often not staffed adequately, were both hit hard by Covid-19 and have accounted for a disproportionate number of Canada’s deaths to the disease. However, the pandemic has had the positive effect of highlighting the need to better fund these homes.
- New challenges: The pandemic has had the helpful effect of making telemedicine more accepted, as doctors can now bill the provincial health agencies for conducting virtual appointments. New technologies and drugs keep people healthy longer but are often expensive. Canadians are living well beyond retirement age, and that produces cost strains on the health care system.