CANADA | Summary

OVERVIEW | HISTORY | HEALTH & HEALTH SYSTEM | HEALTH INDICATORS & DEMOGRAPHICS

• Population: 37.74 million
• Housing: 81.2% Urban, 18.8% Rural 

The Government of Canada tells the story of the history of its health care system. Under the Constitution Act of 1867, health care was the responsibility of provinces, and was privately funded and delivered through World War II.⁴ In 1947, led by leader Tommy Douglas, the province of Saskatchewan provided the first provincial hospital care program.⁴ Then, in 1957, major health legislation was passed called the Hospital Insurance and Diagnostic Services Act (HIDS). It financed approximately 50% of health care expenses in the provinces and territories.⁴ During this time, doctors, insurance companies, and big businesses were fighting against the expansion of public health coverage. In 1960, according to the Canadian Health Coalition, the Canadian Medical Association joined in the protest by opposing all publicly funded health care.⁵ In 1962, Saskatchewan’s government introduced the first medical insurance plan for physicians' services.⁴ Doctors refused to comply with the government-controlled scheme, and many went on strike and closed their offices or took a temporary leave from providing health services. The strike collapsed in just three weeks.⁴

 

The Medical Care Act, also known as Medicare, passed in 1966.⁴ This act, "offered to reimburse, or cost share, one-half of provincial and territorial costs for medical services provided by a doctor outside hospitals. Within six years, all the provinces and territories had universal physician services insurance plans.⁴" The last major health legislation was the Canada Health Act in 1984.⁴ The act addressed the issue of “extra-billing,” which doctors were using to raise their income, by banning it.⁴ It also set requirements for all provincial and territorial health plans to abide by by setting "conditions and criteria on portability, accessibility, universality, comprehensiveness, public administration."⁴

Canada has universal health coverage funded through a health system called Medicare. It was created from the Canada Health Act and must comply with the five pillars of that act.⁶ The system must be universal, publicly administered, have comprehensive coverage, portable across provinces, and accessible to the population.⁶ Medicare covers 100% of the population and each province or territory manages all of its own residents with their specific residency requirements. The health system is funded mainly by provincial or territorial general tax revenue with some federal transfers and is free at the point of delivery for citizens. There is no cost-sharing for inpatient or outpatient care and prescription drug prices vary but are still inexpensive. There are some safety-net, public programs that assist low-income individuals, children with disabilities, and the elderly with prescription drug costs. Non-citizens such as temporary legal visitors and undocumented immigrants are not entitled to Medicare but provinces and territories may provide limited emergency services to these populations since medical care can’t be refused in an emergency.⁶

 

According to The Commonwealth Fund, about 67% of Canadians have some sort of private, supplementary coverage for prescription drugs, dental and eye care, rehabilitation services, and private hospital rooms which Medicare does not cover. Overall, Canadians are allowed to choose where they receive health care services and even have flexibility in other provinces and territories. If a Canadian citizen receives care outside of their province or territory, they pay upfront and receive reimbursements from their home province or territory. It is important to note an individual is reimbursed at their home province’s fee schedule, therefore, if rates are different they may end up covering the rest.¹⁰

 

Most hospitals are publicly funded and are required to function under a fixed budget. Most family physicians are private and operate on a fee-for-service payment system. The Canadian government also heavily regulates the health system and may limit services as a strategy to contain costs which may lead to longer wait times. Another challenge for the Canadian health system is a lack of cohesiveness and coordination within the system. Although they have universal health coverage and favorable health outcomes, Canada doesn’t reach better results like the Netherlands or other Nordic countries due to the lack of efficiency in the health system.¹¹

• Fertility Rate: 1.5 live births per woman  
• Life Expectancy (Female, Male): 85, 81
• Infant Mortality Rate:  3.9 deaths per 1,000 live births  
• Child Mortality Rate: 4.8 per 1,000 live births
• Maternal Mortality Rate: 8.3 deaths per 100,000 live births  
• Prevalence of Obesity: 26.3%

• White NH: 75% 
• Asian: 14% 
• Native: 5% 
• Black NH: 3% 
• Hispanic/Latino: 2% 
• Other: 1% 

• 0-14 years: 15.4% 
• 15-24 years: 11.6%
• 25-54 years: 39.6%
• 55-64 years: 14.2%
• 65 years and over: 19.1%