Canada: Health System Reforms and Challenges

“Extraordinary challenges, particularly during the COVID-19 pandemic, have strained Canada’s health infrastructure and delayed initiatives. Although the government’s response to the pandemic was commendable—prioritising public health and securing vaccines—systemic issues persist. One in five Canadians lack access to a regular primary care doctor, jeopardising timely diagnosis and management of chronic conditions. Nurses continue to leave public health care for private agencies due to overwhelming workloads, safety concerns, and inadequate mental health support. Canada needs substantial expansion of its health workforce. The national pharmacare and dental plans need to be fully implemented and, although Canada’s public health-care system is one of the most celebrated in the world, its model—federally funded but administered by 13 provinces and territories—creates variations in coverage, access issues, long waiting times, obstacles to health-care worker mobility, and inconsistent care protocols. Addressing systemic issues within the health-care system will require cooperation from all provincial and territorial governments, and interjurisdictional barriers need to be eased. The 2015 Truth and Reconciliation Commission of Canada called for the government to address the disparities in Indigenous health services delivery. Despite some progress, Indigenous peoples still face unacceptably long waiting times for primary care and barriers to mental health services. More than a quarter report having experienced unfair treatment and discrimination within the health-care system. Indigenous peoples need greater control over their health-care systems, including integration of traditional Indigenous knowledge within care systems and restoring local health authority councils to effectively address community health needs, especially for those in Northern Canada.”

Source: Health in Canada: a pivotal political moment, The Lancet, March 15, 2025, Volume 405, Issue 10482, 867, DOI: 10.1016/S0140-6736(25)00501-X.

“But key observations from international comparisons point to a decades-long struggle with wait times for some elective care and inequitable access to services outside the traditional Medicare strength of hospitals and doctors.⁶⁷ Average life expectancy also masks variations in vulnerable groups, most notably Indigenous populations: First Nations people have a projected life expectancy of 73–74 years for men and 78–80 years for women; for the Inuit, living in the far north, life expectancy was 64 years for men and 73 years for women as of 2017.⁶⁸

“What is most distressing to many observers of the Canadian system is the persistence of its problems over time.⁶⁹ Change in Canada is often slow and incremental, by contrast with the major and rapid transformations often observed in reforms of the UK’s National Health Service.⁷⁰ It is thus most accurately described not as a system in crisis, but a system in stasis.⁷¹ Within that context, and considering the complex needs of many segments of the Canadian population, three crucial problems require action.”

Source: Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada’s universal health-care system: achieving its potential. Lancet. 2018;391(10131):1718-1735. doi:10.1016/S0140-6736(18)30181-8.

“Urgent medical and surgical care is generally timely and of high quality in Canada, as indicated by outcomes such as acute myocardial infarction mortality (table). However, the timeliness of elective care, such as hip and knee replacements, non-urgent advanced imaging, and outpatient specialty visits, is problematic.⁷² The proportion of Canadians waiting more than 2 months for a specialist referral is 30% (table), which is far greater than any OECD comparator in the Commonwealth Fund’s comparison of 11 countries.⁶⁷ Similarly, the proportion of Canadians waiting more than 4 months for elective nonurgent surgery is greatest at 18%.”

“Up to a third of working Canadians do not have access to employer-based supplemental private insurance for prescription medicines, outpatient mental health services provided by professionals such as social workers or psychologists, and dental care.²¹ These individuals are more likely to be women, youths, and low-income individuals. Public coverage of those services varies between provinces, but generally focuses on seniors and unemployed people receiving social assistance, leaving the working poor most vulnerable.⁸⁹ Thus, inequities in health outcomes driven by the social determinants of health are at risk of being compounded by the narrow but deep basket of publicly funded services.

“Notably, Canada is the only developed country with universal health coverage that does not include prescription medications, and 57% of prescription drug spending is financed through private means.^18,90 Nearly one in four Canadian households reports that someone in that household is not taking their medications because of inability to pay.⁹¹

“Beyond prescription drugs, inequitable access to homebased care and institutional long-term care is pressing. In 2012, nearly 461 000 Canadians aged 15 years or older reported that they had not received help at home for a chronic health condition even though they needed it.⁹² Because such layer two services receive inadequate public financing, Canadians aged 65 years or older have cited inability to pay as the main barrier to accessing the home and community care support they needed.92 Some combination of inspired leadership, public financing, engaged governance, robust regulation, and intergovernmental cooperation seems to be needed to protect the public interest and address inequities of access to layer two services.”

“As in other settler societies such as Australia, New Zealand, and the USA, Indigenous populations in Canada were colonised and marginalised. In the Canadian case, marginalisation took the forms of Indian Residential Schools, government-enforced relocation, and historically segregated Indian hospitals, to name a few.^93,94 Three distinct and constitutionally recognised groups—First Nations, Inuit, and Métis—constitute 4·3% of the Canadian population and experience persistent health disparities relative to the nonIndigenous population, including higher rates of chronic disease, trauma, interpersonal and domestic violence, and suicide, as well as lower life expectancy and higher infant mortality rates.^95–97 For example, Canada’s infant mortality rate dropped by 80% from more than 27 deaths per 1000 livebirths in 1960, to five per 1000 livebirths on average in 2013.⁹⁸ However, the estimated rate in Nunavut (the northern territory in which approximately 85% of the population is Inuit) was more than three times the national rate at 18 deaths per 1000 livebirths in 2013.⁹⁸

“Other far-reaching inequities exist in the social determinants of health that even the best health-care systems cannot redress. Indigenous Canadians face substantial wage gaps of up to 50% compared with nonIndigenous groups, after adjustment for education and age.⁹⁹ Persistent racism and social exclusion permeate not only the health-care but also the education and justice systems, with subsequent disparities in high school education rates, incarceration rates, and other factors often driving egregious health statistics.¹⁰⁰“

Canada: Health System Reforms and Challenges - National Policies - World Health Systems Facts

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

Page last updated August 5, 2025 by Doug McVay, Editor.