An Introduction to Canada’s Healthcare System
Healthcare is one of the most common reasons why people immigrate to Canada. They are planning for their future and know that Canada’s free, universal healthcare system is a huge benefit to their retirement years and the lives of their children. One of the advantages of being a Canadian Citizen or Permanent Resident of Canada is access to our public healthcare system. This allows anyone with this status to visit doctors and hospitals to seek medical care for free in Canada. Canada’s system is unique to other countries around the world and while there is a basic understanding that Canada has free and universal healthcare, a lot of people don’t actually know what this entails.
In this blog, we are going to break down the healthcare system, who qualifies for healthcare in Canada, the history of healthcare in Canada and its structure, the advantages of the Canadian healthcare system, and some of the difficulties and problems that exist in the Canadian healthcare system. We hope this blog will educate you on the healthcare system and all the benefits of universal healthcare.
Who Qualifies for Free Healthcare in Canada?
When you become a Permanent Resident of Canada, you may apply for a health card. This allows you to access a family doctor, specialist physicians, and any care you may need in a hospital. Emergency medical services are available for temporary resident visa holders in Canada as well, but temporary residents must have additional health insurance to access family doctors, all non-emergency hospital care, and specialist physicians.
As we will discuss later, healthcare is the jurisdiction of the provinces in Canada. Each province regulates its own healthcare systems, and health cards are no different. To receive your provincial health card, you must apply directly in your home province. In some provinces there is also a three-month waiting period to get your healthcare card, so you should apply as soon as you receive your permanent residence status. Some people opt to apply for health insurance during this waiting period, to avoid potential emergencies or medical needs.
As a refugee, protected person, or a person waiting on an application for refugee status while in Canada, you will qualify for Interim Federal Health Program. If you are out of the country and were chosen to come to Canada as a refugee then this program will also cover your vaccinations, immigration medical exams and follow-up treatment, medical support for safe travel, and extra health measures during disease outbreaks or pandemics.
Although Canada is a nation with universal healthcare, our healthcare system only covers the associated costs for doctor and hospital visits. You may need private insurance to cover additional medical expenses. Some employers offer this private insurance to cover these additional expenses, but if you do not have additional medical insurance through your employer, you can purchase additional coverage. Typically, third-party medical insurance in Canada covers dental care, eyeglasses, prescriptions, medical devices, and physiotherapy. Sometimes, depending on your healthcare plan, there are additional things covered like alternative medicine and mental health care. If you are employed by the Canadian military, RCMP, Correctional Services Canada, or hold Veteran or Indigenous status, then your additional health expenses are covered by the federal government.
History and Structure of Universal Healthcare in Canada
Let’s take it back. Healthcare in Canada was not always free and universal. Universal Healthcare in Canada has a very long history which began in the province of Saskatchewan, following the Second World War. Elected at the end of the war in 1944, Tommy Douglas was the premier of Saskatchewan and the leader of the Co-Operative Commonwealth Federation Party.
In 1947, the Saskatchewan provincial government, under Douglas, created a province-wide universal hospital plan. Other western provinces, Alberta and British Columbia soon followed in developing a universal plan for the coverage of hospital visits in 1950 and 1949 respectively. In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act which mandated the federal government to pay half to the hospital expenses generated under universal healthcare to the provinces. After the 1960 election, which was filled with controversy, Saskatchewan introduced universal medical insurance, allowing anyone in the province to visit the doctor for free. In response, the federal government passed the Medical Care Act, in 1966 which split the costs for doctors’ visits between the provincial and federal governments. By 1972 all provinces and territories in Canada had created a provincial or territorial healthcare plan which shared the costs of doctors’ visits and hospital trips between the provincial and federal governments.
In 1984 the federal government passed the Canada Health Act. This consolidated all the previous federal legislation on cost-sharing with provinces for healthcare-related expenses. It also set out a clear objective for health care policy in Canada, which 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.” This created the universal healthcare system that we have in Canada today. The act also sets out five criteria that the provinces and territories must fulfill in their healthcare programs to receive their full Canada Health Transfer from the federal government. This criterion includes public administration, comprehensiveness, universality, portability, and accessibility. As of 2019, the Canada Health Transfer covered approximately 23.9% of a province or territory’s healthcare expenses.
With that said, provinces and territories are responsible for the individual administration of their healthcare plans and make up the remainder of the publicly funded healthcare expenditure. Therefore, when you become a Permanent Resident or Canadian Citizen, you must apply for and renew your healthcare card within your home province.
As discussed above, universal healthcare in Canada does not cover prescriptions, physiotherapy, eyeglasses, medical devices, or dental care. In some provinces, there are additional programs available for individuals who fall below a certain income threshold or who are elderly. For example, in Ontario, there is a universal prescription drug program for seniors, children (under 18 years of age), and those on social assistance.
Advantages of the Canadian Healthcare System
There are many advantages to the Canadian universal healthcare system. The first of which is the ability for citizens and permanent residents to access hospital and doctors’ services at no out-of-pocket expense. This means that if you are in a car accident, give birth, or need surgery then you are not going to face a financial burden from the cost of going to the hospital or visiting a doctor. In Canada, the government (both provincial and federal) cover approximately 75% of healthcare costs as of 2019, with the remaining 25% being those additional costs like eyeglasses and prescription drugs covered by private third-party health insurance.
Canada is comparable to many European nations with that level of public expenditure on healthcare, but behind nations like Norway, Luxembourg, Sweden, and Denmark. Nations with universal healthcare have the advantage of having a “single-payer” healthcare system. This is hugely advantageous, as there is only one entity in each province administering health and incurring those costs. It is also important for the sale of prescription drugs because drug companies negotiate with one payer, Health Canada, so costs are kept slightly down.
Although Canada is a bit far behind some European countries listed above, we often see the advantage and comparison with our neighbouring country, the United States. Many of our American clients want to immigrate to Canada for the benefit of healthcare. Whether they have gone through expensive treatments themselves, or are planning for their future expenses, they want that security of healthcare.
Although healthcare is “free” in Canada, Canadians pay for healthcare through taxes. In comparison, Americans pay for their healthcare up-front but do not have these costs reflected on their tax rates. Americans often rely on their employer to provide health insurance and senior Americans rely on Medicare. Let’s talk about the common comparison of childbirth. In Canada, residents with insurance pay little to no cost to give birth to their children. Residents without insurance could pay up to $10,000 depending on the procedure. In America, residents with insurance can pay up to $20,000 depending on the procedure and state, while residents without insurance can pay up to $30,000 - $70,000.
In addition, Canada has become a highly ranked country for the quality of medical care available. In 2021, Toronto General Hospital and the University Health Network were rated fourth in the world by Newsweek Magazine. Overall, Canada has four hospitals on the Newsweek list of the 200 best hospitals in the world. This speaks to the quality of care, patient experience, and overall innovation in the Canadian healthcare system. We really like to stress this because not only is Canadian healthcare free, but it is also of quality. There are many well-known doctors, researchers, and other medical professionals that work in Canada and continue to show how great the system is.
Issues and Problems in Canadian Healthcare
Canada’s healthcare system has many benefits, but it is not without its problems and difficulties. Today we will explore some of the problems that exist in the Canadian healthcare system and some possible solutions to them.
Canada covers a very large geographic area and that can often cause additional problems and difficulties for those who live in more remote parts of the country. As of 2019, 81.48% of the Canadian population lived in cities. But people living in rural and more remote parts of the country need access to medical care as well, ideally without having to travel long distances to urban centres.
According to a report from The Commonwealth Fund, 92% of doctors practice in urban areas. Some provinces have rural initiatives to encourage doctors to practice in these parts of the country. Provinces with lower populations, however, often struggle to even attract medical practitioners. In places with few family doctors or general practitioners, people often must resort to the emergency room at their local hospital for their care. This is a problem because it is more expensive and going to the emergency room all the time does not provide consistent care for chronic conditions. Ideally, for healthcare in Canada to be truly universal people would have access to family doctors, hospitals, and medical specialists regardless of the part of the country they are in.
Elective surgery is a surgery that can be scheduled in advance. This includes cancer surgeries, hip and knee replacements, and other types of surgery. With an aging population (which we will discuss shortly) many of the wait times for these surgeries has ballooned. Hip and knee replacements have longer than usual wait times. British Columbia, for instance, has begun to experiment with private surgeries available for hip replacements, to reduce the wait times significantly for individuals who can pay and take them off the long provincial waiting list. Surgery wait times again have increased in Canada due to the Covid-19 pandemic. In some cases, patients have lost their lives waiting for cancer and heart surgery that was scheduled and cancelled due to the pandemic. This is something that healthcare systems around the world will have to reckon with as the pandemic winds down.
Canada also has an aging population, and without immigration would have negative population growth. This means that the number of people reaching retirement age has outstripped the number of babies born in Canada. These risks putting an additional strain on the healthcare system, as older individuals have higher healthcare costs. Some politicians have used this to argue in favour of a two-tiered or public and private healthcare system, but Canadians are generally very resistant to this idea. Under the Canada Health Act, as well as the Canadian constitution, healthcare administration and decisions are made by the individual provinces. But, our current Prime Minister has made clear the fact that if provinces violate the criteria set out in the act (particularly universality) then the federal government will not give those provinces their Canada Health Transfer.
Final Thoughts
The Canadian healthcare system has many advantages: state-of-the-art hospitals and free access to doctors, diagnostic tests, and medical care. Canada is also a single-payer health system, which aids in lowering costs when negotiating with pharmaceutical companies. When you become a Canadian citizen or permanent resident you are given access to all of Canada’s health system. At the same time, some difficulties exist in Canadian healthcare — accessing health services in rural or remote communities, wait times for some medical procedures, and Canada’s aging population but all in all there is a good system in place and while it is not perfect, it still meets the needs quite well. Healthcare in Canada has a long history and is protected by the Canada Health Act. It benefits many Canadians and improves our quality of life significantly in this country.
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