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Canadian Health Care System

Healthcare provision is one of the biggest concerns and priorities for all governments. Therefore, many governments spend considerable resources to fund a comprehensive health care system for their citizens. For instance, Canada provides universal healthcare for all its citizens through the Medicare program. The federal government disburses funds to the provincial administrations, who run the health insurance programs. However, the system faces some challenges related to increased waiting time, aging population, and uncomprehensive medical covers. Despite these challenges, the Canadian government has identified ad implemented various solutions to ensure the optimal provision of health care for its citizens.

Canadian Health System

The Canadian health care system mainly relies on universal health care, where all eligible persons receive health insurance from the government. The system relies on the Canada Health Act of 1984 to define what care provision entails and the extent to which citizens are covered (Ridic, Gleason, & Ridic, 2012). The main insurance system, Medicare, provides all funding for care in Canada. Under the Act, the health plans are the provincial administrations’ responsibility who avail comprehensive coverage for all medically necessary services for patients. Apart from a few exceptions, the health coverage plan is available for all Canadian residents with non-existent out-of-pocket charges. However, the package of services differs in different regions. For instance, some provinces cover legal abortions while others do not.

It is unlawful to offer private insurance for covered services, but most Canadians take additional insurance to cover the services not listed in the government insurance plan. The government health plan covers all essential basic care services, eliminating the need to get various plans. However, some elective surgeries do not fall under the essential care coverage (Martin et al., 2018). Thus, patients can pay for these services out of their pockets or take private insurance covers. In some provinces, dental care is not included in the universal cover. These services are usually covered through supplement insurance, which employers provide.

The system facilitates physicians to receive payment through the fee-for-service system, and their claims are submitted directly to the provincial health insurance plan. The health plan ensures that all residents within Canada are served equally. Generally, patients play no role in the payment process since it occurs exclusively between the public insurer and the caregivers (Allin, Marchildon, & Peckham, 2020). No monetary exchange occurs between a health practitioner and a patient in Canada. Each provincial administration has a ministry of health controlling medical costs within the region. The department prepares fixed budgets and determines practitioner fees. Moreover, the ministry approves and completely funds the hospitals’ operating budgets. Budget negotiation between the department and individual hospitals occurs annually.

Normally, the ministry holds periodic negotiations with the provincial associations representing doctors to determine physician fees. The provincial administration increases the negotiated fees in steps, depending on the service increase. Moreover, the ministry closely controls and facilitates hospital financing (Allin et al., 2020). The provinces provide minimal capital funding for hospital development. Most of the capital comes from residual community fundraisers. In contrast, the operating budgets mainly come from the provincial administration. Hospitals formulate budgets in conjunction with the health ministry to approve them and disburse funds to hospitals. The hospitals can also raise money from other services such as accommodation and parking.

Health Care Delivery Systems

Primary Care

Family physicians and general practitioners (GPs) are mainly responsible for providing primary care in Canada. In most cases, these caregivers provide initial contact with the main health care system in the country. The general practitioners and physicians control admission to health units, diagnose diseases, provide prescriptions for ailments, and control access to specialists (Marchildon & Allin, 2021). Most GPs work in the private sector and practice independently or in groups, enjoying high autonomy. However, some practitioners work in hospital outpatient departments and community health units but still enjoy the same degree of independence. The doctors working in the private sector receive payment through the fee-for-service system, and their claims are submitted directly to the regional health insurance system.

Other health caregivers also collaborate with the physicians and GPs in the hospitals. For instance, the hospital sector usually employs nurses who provide support services for primary care. Midwives work as independent professionals, while pharmacists provide prescriptions and prepare drugs (Marchildon & Allin, 2021). The pharmacists also act as sources of knowledge by giving patients and caregivers information about prescribed drugs. Patients may also access primary healthcare through the emergency room. However, the government generally discourages this practice due to the costs related to emergency care.

Secondary and Tertiary Health Care

Specialized physicians provide care to patients on an equal basis as general practitioners. These specialists conduct diagnostic testing, prescribe necessary drugs, and refer patients to other allied specialists (Marchildon & Allin, 2021). Nevertheless, to practice as a specialist, they have to undergo specialized training and get certification for practice. In most instances, these physicians main in the private sector or work as affiliates within a hospital outpatient program.

Typically, Canadian hospitals operate as private non-profit organizations under the leadership of trustees or community boards. Thus, Canadian hospitals are highly independent entities, with the regional government only conducting capital budgeting, funding, and comprehensive healthcare planning (Marchildon & Allin, 2021). Even though there were municipality hospitals, Medicare’s introduction resulted in closing down or mergers with other hospital systems. Today, provincial administrations only operate psychiatric institutions. In contrast, the national government only runs military hospitals, native care centers, and veterans’ hospitals.

Challenges in the System

The Canadian health care system faces various challenges hindering optimal service provision. For instance, Medicare’s health insurance system does not cater to all medical services. The level of health care depends on the province where the patient receives treatment. The federal places various conditions to disburse healthcare funds to a province. The region must comply with the Canadian Healthcare Act, which stipulates that medical insurance covers only necessary medical services. Nevertheless, the concept is undefined, meaning each province interprets it at its discretion (Valle, 2016). Thus, various services may not be available in some provinces. Moreover, other services, including psychology and dental services, which are necessary, are not included in the care plan. Thus, the system fails to cover some important services required by citizens.

Moreover, the aging Canadian population will cause an increase in healthcare expenditure as a proportion of total government spending. At least 14% of Canadians were aged above 65 years in 2011, and the number is expected to rise to 36 percent by 2036 (Valle, 2016). The rise in the aging population means that the government will have to revise its public health policies in the future. Even though the older people only accounted for 145 of the total Canadian population in 2011, 44 percent of the total healthcare expenditure went to this age group. With the increasing number of older people, the cost of healthcare will continue to rise (Valle, 2016). Projections indicate that by 2036, expenditure in the healthcare sector will account for at least 10 percent of the Gross Domestic Product. Moreover, the aging population will increase the demand for services not covered in the Medicare program. Thus, there will be a need to revise policies to tackle this issue.

Another pertinent issue with Canadian health care is the extended waiting time to access services. For instance, a patient requiring surgery or other diagnostic procedures has to wait for an average of 13.3 weeks. Most Canadian physicians agree that the average waiting time for most procedures is a third longer than clinically reasonable durations (Valle, 2016). The situation is even worse in scenarios where a patient requires diagnostic imaging. Some vulnerable categories of the Canadian population are suffering from delays. For instance, the elderly who require fast access to cardiovascular surgery, hip replacement, and cataract surgery do not get timely services. This challenge causes diminishing health outcomes in the Canadian population.

Possible Solutions

There is a need for the federal government to effect universal policies for cover in all provinces. In the current system, the provinces have the discretion to determine what medical services are deemed necessary. This causes an imbalance in healthcare provision across regions in the country. Therefore, a policy standardizing the practices for all provinces will be useful (Dhalla & Tepper, 2018). The Canadian Healthcare Act should be amended to include compliance requirements for provincial admirations to follow the standard policy. Moreover, the government needs to revise its policy on the services included in the medical care plan. Important dental and psychology sessions should be part of necessary medical services.

Moreover, the government can invest further resources into the healthcare system to reduce waiting time in hospitals. For decades, Canadians have widely publicized this issue and demanded that the government address this issue. In response, the government invested billions into alleviating the problem, particularly for some procedures, including cancer treatment and heart procedures. In 2004, the government invested 5.5 billion Canadian dollars in reducing hospital waiting times (Valle, 2016). However, these measures are not enough. The government needs to continue investing in the healthcare system to ensure that this problem does not endure.

The Canadian government also needs to reconsider the ‘single-payer’ system. Currently, all Canadian residents depend on the government healthcare plan to access basic medical services. Even though it is comprehensive, the funds may sometimes not be enough to cater to all patient needs. Thus, they are a need to consider other avenues for patients to access medical coverage (Ridic et al., 2012). For instance, the government could repeal the Act outlawing private insurance use on medically necessary services. Allowing private insurance to provide coverage to willing clients will increase resource allocation into the health sector. Increased funding will translate to better health care for Canadian residents.

Comparison between the United States and Canadian Health Care Systems

In both countries, the private sector plays a significant role in health care provision. For example, in the United States, private entities are the main providers for both health insurance and medical care services. Insurance companies compete for customers by selling their policies directly to customers. The private enterprises also operate private hospitals providing medical services to Americans (St George’s University, 2019). Most of the hospitals in the United States are private-owned. Similarly, Canada’s main system of health provision is through the private sector. All hospitals apart from military and psychiatric institutions are privately owned and operated. Communities, religious organizations, and non-profit institutions operate the hospitals. Practitioners and physicians work independently through private hospitals or health-affiliated institutions. However, the government supports these hospitals by funding their operational budgets.

In Canada, the government provides funding for universal medical coverage for its citizens through the provinces. The only condition is that the provinces have to abide by the requirements of the Canadian Health Act. The funds from the federal government cover Canadian residents on all medically necessary services. In contrast, United States residents cover their medical insurance (St George’s University, 2019). However, there are few exceptions where the government provides insurance for special groups depending on income, disability, age, and occupation. Some government policies include Medicaid, Medicare, and the Veterans Health Administration. Most of the private insurances covering citizens originate from employment. Companies and businesses deduct part of their employees’ salaries to cater to insurance benefits.


Even though the Canadian healthcare system faces some challenges, the government has actively tried to provide good medical care for its citizens. The country’s universal health policy supports the medical care system in Canada. Through Medicare, the government provides insurance for all its residents for medically necessary services. Private entities usually provide medical services through general practitioners and physicians who work autonomously. Specialized physicians also operate similarly. However, the system experiences various problems, including increased waiting time, an aging population, and uncomprehensive medical covers. Possible solutions include changing the insurance policies and additional investment into the healthcare system.


Allin, S., Marchildon, G., & Peckham, A. (2020). International health care system profiles: Canada. The Commonwealth Fund. Retrieved from

Dhalla, I. A., & Tepper, J. (2018). Improving the quality of health care in Canada: Canadian Medical Association Journal 190(39), 1162–1167. DOI: 10.1503/cmaj.171045.

Marchildon, G., & Allin, S. (2021). Health systems in transition: Canada (3rd Ed.). University of Toronto Press.

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal healthcare system: achieving its potential. The Lancet391(10131), 1718-1735. DOI: 10.1016/S0140-6736(18)30181-8.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada. Materia Socio-Medica24(2), 112–120. DOI: 10/5455/MSM/ 2012.24. 112-120.

St George’s University. (2019). Comparing the US and Canadian health care systems: Fouur differences you need to know. Retrieved from

Valle, V. M. (2016). An assessment of Canada’s healthcare system weighing achievements and challenges. Norteamérica11(2), 193-218. DOI: 10.20999/nam.2016/b008.


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