Annual household out-of-pocket payment, current USD per capita (2019): $753

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed July 21, 2022.

Current Health Expenditure Per Capita in US$ (2019): $5,048

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 14.91%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure Per Capita in US$ (2019): $753

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.9%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Universal medicare in Canada precludes extra billing or user fees, patient charges for medical, hospital-based services are not permitted under the CHA, and OOP payments are only relevant to non-medicare goods and services. Informal payments are almost non-existent in Canada: they have not been documented in any PT health system.

“OOP payments make up just under 50% of expenditures on privately financed health services and products. In particular, OOP payments comprise the chief source of funding for vision care, over-the-counter pharmaceuticals as well as complementary and alternative medicines and therapies. OOP payments also cover some of the costs of long-term care including facility-based care and home care.”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

“Of the total of $ 255 billion (€ 154 billion) spent on health care in 2018, about 70% was from public sources, and 30% from private sources (CIHI, 2019a).* This 70–30 split has been constant since the late 1990s, thus there has been little change in the role of private finance except for a slight shift away from out-of-pocket (OOP) spending towards private health insurance. Private health insurance has grown more rapidly than OOP payments in part because of the continuing centrality of private health insurance as part of employment-based benefit packages in unionized and professional workplaces.”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

“FPT income taxes are progressive and make up a large share of health financing. The reliance on income taxes to finance medicare has the effect of redistributing income from higher to lower income groups, and to reduce income inequality (CIHI, 2013). However, there has been a long-term reduction in progressivity in the income tax system since the 1980s. Federal tax reforms introduced in 2016, such as a new income tax bracket for taxpayers earning over $ 200,000 (€ 130 000), have led to an increase in progressivity (Milligan, 2016b). In British Columbia the removal of the health premium in 2020, found to be a regressive form of financing in an earlier study (McGrail, 2007), may slightly increase progressivity of finance in that province. Also in British Columbia, the change to their provincial public drug plan from an age-based programme (coverage started at age of 65 years) to a plan based on income had the effect of making funding slightly more progressive over the period 2001–2004 (Hanley et al., 2008). This move towards more progressive finance was due to the decrease in public subsidy directed towards high-income seniors, and not due to an increased benefit for low-income seniors (Hanley et al., 2008).”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

“Costs are controlled principally through single-payer purchasing, and increases in real spending mainly reflect government investment decisions or budgetary overruns. Cost-control measures include mandatory global budgets for hospitals and regional health authorities, negotiated fee schedules for providers, drug formularies, and resource restrictions vis-à-vis physicians and nurses (e.g., provincial quotas for students admitted annually), as well as restrictions on new investment in capital and technology. The national health technology assessment process is one of the mechanisms for containing the costs of new technologies (see above).

“The federal Patented Medicine Prices Review Board, an independent, quasi-judicial body, regulates the introductory prices of new patented medications. The board regulates “ex-factory” prices but does not have jurisdiction over wholesale or pharmacy prices, or over pharmacists’ professional fees. Since 2010, the Pan-Canadian Pharmaceutical Alliance⁵⁷ has negotiated lower prices for 95 brand-name medications and has set price limits at 18 percent of equivalent brand-name drugs for the 15 most common generics.⁵⁸ Notwithstanding this pan-Canadian collaboration, jurisdiction over prices of generics and control over pricing and purchasing under public drug plans (and, in some cases, pricing under private plans) are held by provinces, leading to some interprovincial variation. The “Choosing Wisely Canada” campaign provides recommendations to governments, providers, and the public on reducing low-value care.⁵⁹“

Source: Commonwealth Fund. International Health Care System Profiles: Canada. Last accessed January 22, 2020.

“Private health insurance is relegated to non-medicare sectors such as dental care, prescription drugs, rehab and mental health services, as well as a few non-medically necessary medical and hospital services. As a share of private health spending, private health insurance has grown relative to OOP expenditures since the late 1980s. In 2017, private health insurance spending made up 41.3% of total private health spending up from 31.3% in 1990 compared with 48.8% from OOP payments (from 56% in 1990) (CIHI, 2019a). Of the $ 30.1 billion (€ 17.8 billion) expended through private health insurance in 2017, 39.6% was spent on prescription drugs, 27.8% on dental care and 5.5% on hospital accommodation – mainly on private rooms (CIHI, 2019a).

“The majority of private health insurance comes in the form of employment-based group policies that are benefit plans sponsored by employers, unions, professional associations and similar organizations (Hurley & Guindon, 2020). Since this type of insurance “comes with the job”, it is not strictly “voluntary”. Canadians receiving or purchasing private health insurance are exempt from taxation on these benefits or premiums by the federal government and all provincial governments except Quebec.

“In 2015, approximately 90% of premiums for private health plans were paid through employers, unions, or other organizations under a group contract or uninsured contract (by which a plan sponsor provides benefits to a group outside of an insurance contract) (Canadian Life and Health Insurance Association, 2016). Private health insurance is held by about two thirds of the population. In the context of limited regulation of the private insurance market in Canada, the costs of insurance have increased over the period 1991 to 2011 due in large part to an increase in nonmedical spending (profits and administration) as opposed to an increase in benefits paid (Law et al., 2014).”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

“Equity in financing is determined by the extent to which individual sources of health financing are progressive, proportional or regressive. The more progressive the health-financing system, the greater the equity in financing. The overall income tax system in Canada is progressive; however, the trend over the past 50 years shows a long-term reduction in progressivity in the personal income tax system since the 1980s, with some increase in progressivity with tax reforms introduced in 2016 (Milligan, 2016b).

“The Canada Health Transfer provides implicit regional redistribution of finances across provinces. Through the Canada Health Transfer, revenues that are collected on a national basis are redistributed to the provinces, and those provinces with shallower tax bases benefit from the revenues collected in wealthier provinces. Prior to 2014 there was also explicit equalization built into the Canada Health Transfer where the formula that calculated the share of each province involved a degree of equalization in which less wealthy provinces received slightly more per capita than wealthier provinces. After 2014, this element of equalization was terminated in favour of pure per capita payments. Nonetheless, as long as federal revenues fund some portion of provincial health care costs, there is some redistribution from wealthier parts of the country (where taxpayers pay more federal income and corporate taxes) to less wealthy parts of the country – an implicit form of revenue redistribution that would not exist if provinces alone raised revenues for their own health care expenditures.

“Comparable data suggest that Canada has achieved a considerable degree of financial protection for its population. About 3% of Canadians are estimated to spend more than one tenth of their disposable incomes on health care, compared with 2% in the UK, 5% in the USA and 6% in Sweden (Fig. 7.1). Not surprisingly, there is a big gap between income groups: nearly 8% of Canadians in the lowest income quintile reported to spend 10% of their income on health care compared with 1% of those in the highest income quintile (World Bank, 2018).”

Source: Marchildon G.P., Allin S., Merkur S. Canada: Health system review. Health Systems in Transition, 2020; 22(3): i–194.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Oct. 19, 2022 by Doug McVay, Editor.