Канаданың денсаулық сақтау жүйесі: мәселелер мен перспективалар

none

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country." Canadian Medicare provides coverage for approximately 70 percent of Canadians' healthcare needs, and the remaining 30 percent is paid for through the private sector. According to the Canadian Institute for Health Information (CIHI), by 2019, Canada's aging population represents an increase in healthcare costs of approximately one percent a year, which is a modest increase. In 2019, 80 percent of Canadian adults self reported having at least one major risk factor for chronic disease: smoking, physical inactivity, unhealthy eating or excessive alcohol use. Canada has one of the highest rates of adult obesity among Organisation for Economic Co operation and Development (OECD) countries attributing to approximately 2.7 million cases of diabetes (types 1 and 2 combined). In 2022 Canada's per capita spending on health expenditures ranked 12th among health care systems in the OECD. and ranks above average for access to care, but the number of doctors and hospital beds are considerably below the OECD average. Identified weaknesses of Canada's system were comparatively higher infant mortality rate, the prevalence of chronic conditions, long wait times, poor availability of after hours care, and a lack of prescription drugs coverage. An increasing problem in Canada's health system is a shortage of healthcare professionals and hospital capacity.

The primary objective of the Canadian healthcare policy, as set out in the 1984 Canada Health Act (CHA), 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." The federal government ensures compliance with its requirements that all Canadians have "reasonable access to medically necessary hospital, physician, and surgical dental services that require a hospital" by providing cash to provinces and territories through the Canada Health Transfer (CHT) based on their fulfilling certain "criteria and conditions related to insured health services and extended health care services."

Health Canada, under the direction of the Health Minister, is the ministry responsible for overseeing Canada's healthcare, including its public policies and implementations. This includes the maintenance and improvement of the health of the Canadian population, which is "among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system." Health Canada, a federal department, publishes a series of surveys of the healthcare system in Canada. Although life threatening cases are dealt with immediately, some services needed are non urgent and patients are seen at the next available appointment in their local chosen facility. In 1996, in response to an interest in renewing its healthcare system, the federal government established the Canadian Health Services Research Foundation (CHRSF) in the 1996 federal budget to conduct research in collaboration with "provincial governments, health institutions, and the private sector" to identify the successes and failures in the health system. The Canadian Institute for Health Information (CIHI) is a not for profit, independent organization established by the provincial, territorial, and federal government to make healthcare information publicly available. The CIHI was established in 1994 to serve as a national "coordinating council and an independent institute for health information" in response to the 1991 report, "Health Information for Canada" produced by the National Task Force on Health Information. In 1994, the CIHI merged the Hospital Medical Records Institute (HMRI) and The Management Information Systems (MIS) Group. The study notes that supporting physician leadership and facilitating engagement of the care providers could reap great gains in efficiency. Additionally, the study suggested facilitating the exchange of information and interaction between health providers and government figures as well as flexible funding would also contribute to the improvement and solve the problem of differences in regional care by allowing regions to determine the needs of their general populace and meet those needs more efficiently by allowing target specific allocation of funds. For 24 years, the CIHI has produced an annual detailed report updating "National Health Expenditure Trends" which includes data tables with the most recent report published in January 2021. For over a decade, until 2014, the HCC produced 60 reports on access and wait times, health promotion, seniors healthcare, aboriginal healthcare, home and community care, pharmaceuticals management, and primary health care.

By February 2024, the median age in Canada was 40.6 years in 2023 compared to 39.5 in 2006. By July 2020, there were 6,835,866 individuals who were 65 years old and older and 11,517 centenarians. The same data reported that by July 2020, 16% of Canadians were 14 years old or under, 66.5% were between the ages of 15 and 65, and 17.5% were 65 years and older. By 2016, there were about six million seniors in Canada, which then had a population of approximately 34 million. This significantly influences Canada's healthcare services;

Since the 2010s, Statistics Canada health research on aging has focused on "chronic diseases," "social isolation" and senior's mental health needs, and "transitions to institutional care" including long term care. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing. The Canada Health Act does not cover prescription drugs, home care, or long term care or dental care. Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. Costs are paid through funding from federal and provincial general tax revenues, which include income taxes, sales taxes, and corporate taxes. In British Columbia, taxation based funding was (until January 1, 2020) supplemented by a fixed monthly premium that was waived or reduced for those on low incomes. In Ontario, there is an income tax identified as a health premium on taxable income above $20,000. In addition to funding through the tax system, hospitals and medical research are funded in part by charitable contributions. For example, in 2018, Toronto's Hospital for Sick Children embarked on campaign to raise $1.3 billion to equip a new hospital. Charities such as the Canadian Cancer Society provide assistance such as transportation for patients. There are no deductibles on basic health care and co pays are extremely low or non existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). In general, user fees are not permitted by the Canada Health Act, but physicians may charge a small fee to the patient for reasons such as missed appointments, doctor's notes, and prescription refills done over the phone. Some physicians charge "annual fees" as part of a comprehensive package of services they offer their patients and their families. Such charges are completely optional and can only be for non essential health options. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity but excluding mental health and home care. Infertility costs are not covered in any province other than Quebec, though they are now partially covered in some other provinces. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. For example, Canadian health insurance plans do not cover non therapeutic circumcision. These can be paid out of pocket or through private insurers. Health coverage is not affected by loss or change of jobs, cannot be denied due to unpaid premiums, and is not subject to lifetime limits or exclusions for pre existing conditions. The Canada Health Act deems that essential physician and hospital care be covered by the publicly funded system, but each province has reasons to determine what is considered essential, and where, how and who should provide the services. There are some provinces that are moving towards private health care away from public health care. The result is that there is a wide variance in what is covered across the country by the public health system, particularly in more controversial areas, such as in vitro fertilization, gender affirming surgery, or autism treatments.). Residents of Quebec who are covered by the province's public prescription drug plan pay an annual premium of $0 to $660 when they file their Quebec income tax return. Due to changes in the past two decades, at least some provinces have introduced some universal prescription drug insurance. Nova Scotia has Family Pharmacare, introduced in 2008 by Rodney MacDonald's Progressive Conservative government. However, residents do not automatically receive it through their health care as they must register separately for it, and it covers a limited range of prescriptions. No premiums are charged. A deductible and out of pocket maximum for copayments are set as a percentage of taxable income of two years before. Pharmaceutical medications are covered by public funds in some provinces for the elderly or indigent, through employment based private insurance or paid for out of pocket. In Ontario, eligible medications are provided at no cost for covered individuals aged 24 and under. Most drug prices are negotiated with suppliers by each provincial government to control costs but more recently, the Council of the Federation announced an initiative for select provinces to work together to create a larger buying block for more leverage to control costs of pharmaceutical drugs. More than 60 percent of prescription medications are paid for privately in Canada. However, the Canada Health Act excludes care provided in a "hospital or institution primarily for the mentally disordered." Some institutional care is provided by provinces. The Canada Health Act does not cover treatment by a psychologist or psychotherapist unless the practitioner is also a medical doctor. Goods and Services Tax or Harmonized Sales Tax (depending on the province) applies to the services of psychotherapists. Some coverage for mental health care and substance abuse treatment may be available under other government programs. For example, in Alberta, the province provides funding for mental health care through Alberta Health Services. Most or all provinces and territories offer government funded drug and alcohol addiction rehabilitation, although waiting lists may exist. The cost of treatment by a psychologist or psychotherapist in Canada has been cited as a contributing factor in the high suicide rate among first responders such as police officers, EMTs and paramedics. According to a CBC report, some police forces "offer benefits plans that cover only a handful of sessions with community psychologists, forcing those seeking help to join lengthy waiting lists to seek free psychiatric assistance."

Among the OECD countries, Canada ranks second to last in the public funding of oral healthcare. Those who need dental care are usually responsible for the finances and some may benefit from the coverage available through employment, under provincial plans, or private dental care plans. "As opposed to its national system of public health insurance, dental care in Canada is almost wholly privately financed, with approximately 60% of dental care paid through employment based insurance, and 35% through out of pocket expenditures. Of the approximately 5% of publicly financed care that remains, most has focused on socially marginalized groups (e. g., low income children and adults), and is supported by different levels of government depending on the group insured." It is true that compared to primary care checkups, dental care checkups depend on the ability of people being able to pay those fees. Studies in Quebec and Ontario provide data on the extent of dental health care. For example, studies in Quebec showed that there was a strong relation among dental services and the socioeconomic factors of income and education whereas in Ontario older adults heavily relied on dental insurance with visits to the dentist. "According to the National Public Health Service in 1996/1997, it showed a whopping difference of people who were in different classes. About half of Canadians aged 15 or older (53%) reported having dental insurance. Coverage tended to be highest among middle aged people. At older ages, the rate dropped, and only one fifth of the 65 or older age group (21%) was covered." Attributes that can contribute to these outcomes is household income, employment, as well as education. Those individuals who are in the middle class may be covered through the benefits of their employment whereas older individuals may not due to the fact of retirement. Under the government healthcare system in Canada, routine dental care is not covered. There are a couple of provinces that offer child prevention programs such as Nova Scotia and Quebec. Other provinces make patients pay for medical dental procedures that are performed in the hospital. Some dental services that are possibly not covered by Medicare may include cavity fillings, routine dental check ups, restorative dental care, and preventive care, dentures, dental implants, bridges, crowns, veneers, and in lays, X rays, and orthodontic procedures. In 2022, however, the federal government announced the creation of a new Canada Dental Benefit which reimburses low to middle income parents up to $650 of dental fees per child. This was a transitional policy on the way to universal, public coverage of dental care. In 2023, the government established the Canadian Dental Care Plan, which began a staggered enrolment rollout in December 2023, to pay costs for covered dental services of eligible residents.

Coverage for services by physiotherapists, occupational therapists (also known as OTs) and Registered Massage Therapists (RMTs) varies by province. For example, in Ontario the provincial health plan, OHIP, does cover physiotherapy following hospital discharge and occupational therapy but does not cover massage therapy. To be eligible for coverage for physiotherapy in Ontario, insured individuals must have been discharged as an inpatient of a hospital after an overnight stay and require physiotherapy for the condition, illness or injury, or be age 19 or younger or age 65 or older.

Coverage varies for care related to the feet. In Ontario, as of 2019, Medicare covers between $7–16 of each visit to a registered podiatrist up to $135 per patient per year, plus $30 for x rays. Although the elderly, as well as diabetic patients, may have needs that greatly exceed that limit, such costs would have to be covered by patients or private supplemental insurance. As of 2014, most, but not all provinces and territories provide some coverage for sex reassignment surgery (also known as gender confirming surgery) and other treatment for gender dysphoria. In Ontario, sex reassignment surgery requires prior approval before being covered. However, access to care does not meet WPATH guidelines in provinces covering 84% of Canada's population (excepting British Columbia, Prince Edward Island and Yukon Territory). Wait times are extensive for gender care in Canada, and can be as long as eight years. There are wide discrepancies in coverage for various assistive devices such as wheelchairs and respiratory equipment in Canada. Ontario, which has one of the most generous programs, pays 75% of the cost for listed equipment and supplies for persons with a disability requiring such equipment or supplies for six months or longer. The program does not have age or income restrictions. As with other health coverage, veterans and others covered by federal programs are not eligible under the provincial program. Only certain types of equipment and supplies are covered, and within categories only approved models of equipment from approved vendors are covered, and vendors may not charge more than specified prices established by the government.

Home care is an "extended" service, and is therefore not an insured service under the Canada Health Act. Home care is not considered to be a medically necessary service, like hospital and physician services, and provincial and territorial governments are under no obligation to provide home care services. Home care aids face intense job precarity, inadequate staffing levels as well as increasingly complex needs including different types of routinized, assembly lines types of work, and cost cutting on equipment and supplies. As the role of home care aids evolves, so does the need for more training and instruction. Nurses and HCAs are expected to think critically and execute real time, and make evidence based care decisions.

The largest group the federal government is directly responsible for is First Nations. Native peoples are a federal responsibility and the federal government guarantees complete coverage of their health needs. For the last twenty years and despite health care being a guaranteed right for First Nations due to the many treaties the government of Canada signed for access to First Nations lands and resources, the amount of coverage provided by the Federal government's Non Insured Health Benefits program has diminished drastically for optometry, dentistry, and medicines. Status First Nations individuals qualify for a set number of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye exams, fillings, root canals, etc. For the most part, First Nations people use normal hospitals and the federal government then fully compensates the provincial government for the expense. The federal government also covers any user fees the province charges. The federal government maintains a network of clinics and health centers on First Nations reserves. At the provincial level, there are also several much smaller health programs alongside Medicare. The largest of these is the health care costs paid by the workers' compensation system. Regardless of federal efforts, healthcare for First Nations has generally not been considered effective. Despite being a provincial responsibility, the large health costs have long been partially funded by the federal government.

While the Canadian healthcare system has been called a single payer system, Canada "does not have a single health care system" according to a 2018 Library of Parliament report. Public sector funding, which has represented approximately 70% of total health expenditure since 1997, "includes payments by governments at the federal, provincial/territorial and municipal levels and by workers' compensation boards and other social security schemes".

Private sector funding is regulated under the Canada Health Act, (CHA) which sets the conditions with which provincial/territorial health insurance plans must comply if they wish to receive their full transfer payments from the federal government. The CHA does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. In 2006, most doctors do not receive an annual salary, but receive a fee per visit or service. that the apparent success of the private telehealth provider Maple, with its hundreds of thousands of paying users, indicates the existence of a rapidly growing private healthcare tier.

In Canada private health insurances is mainly provided through employers. In many provinces purchasing duplicate health insurance for care already covered by the government's health insurance plan is prohibited.

From 1988 to 2016, the amount of out‑of‑pocket expenses paid by individuals had grown by about 4.6% annually. By 2016, it amounted to $972 per capita. The proportion spent on hospitals and physicians has declined between 1975 and 2009 while the amount spent on pharmaceuticals has increased. Of the three biggest health care expenses, the amount spent on pharmaceuticals has increased the most. In 1997, the total price of drugs surpassed that of doctors. In 1975, the three biggest health costs were hospitals ($5.5B/44.7%), physicians ($1.8B/15.1%), and medications ($1.1B/8.8%). Amalgamation of hospitals in the 1990s has reduced competition between hospitals. An OECD study in 2010 noted that there were variations in care across the different provinces in Canada. The study found that there was a difference in hospital admission rates depending on the number of people and what province they lived in. Typically, provinces with low population counts had higher hospital admission rates due to there being a lack of doctors and hospitals in the region.

By 2018, drugs—both prescription and non prescription—were the second largest healthcare expenditure in Canada at 15.3% of the total. The drug that contributed to about 26% of the increase in spending were drugs for diabetes. The CHA requires that public provincial and territorial health insurance policies must cover all "medicines used within the hospital setting out‑of‑hospital drug expenditures are paid for by private insurance and individuals, as well as by provincial health insurance for certain population groups". but a level of practising nurses that is higher than the OECD average, and below the US average in 2016. A record number of doctors was reported in 2012 with 75,142 physicians. The gross average salary was $328,000. Out of the gross amount, doctors pay for taxes, rent, staff salaries and equipment. Recent reports indicate that Canada may be heading toward an excess of doctors, though communities in rural, remote and northern regions, however, may still experience a shortage. Recent census data indicates that while Canada does not face a doctor shortage, limitations on which and how many physicians can complete Canada's required two year medical residency may prevent trained doctors from acquiring a license to practice medicine, leading to an effective shortage.

Basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis. CTV news reported that, in 2006, family physicians in Canada made an average of $202,000 a year. In 2018, to draw attention to the low pay of nurses and the declining level of service provided to patients, more than 700 physicians, residents and medical students in Quebec signed an online petition asking for their pay raises to be canceled.

Each province regulates its medical profession through a self governing College of Physicians and Surgeons, which is responsible for licensing physicians, setting practice standards, and investigating and disciplining its members. The national doctors association is called the Canadian Medical Association (CMA); it describes its mission as "To serve and unite the physicians of Canada and be the national advocate, in partnership with the people of Canada, for the highest standards of health and health care." Since the passage of the 1984 Canada Health Act, the CMA itself has been a strong advocate of maintaining a strong publicly funded system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL). In December 2008, the Society of Obstetricians and Gynaecologists of Canada reported a critical shortage of obstetricians and gynecologists. The report stated that 1,370 obstetricians were practising in Canada and that number is expected to fall by at least one third within five years. The society is asking the government to increase the number of medical school spots for obstetrics and gynecologists by 30 percent a year for three years and also recommended rotating placements of doctors into smaller communities to encourage them to take up residence there. Some provincial medical associations have argued for permitting a larger private role. To some extent, this has been a reaction to strong cost control; CIHI estimates that 99% of physician expenditures in Canada come from public sector sources, and physicians—particularly those providing elective procedures who have been squeezed for operating room time—have accordingly looked for alternative revenue sources. The CMA presidency rotates among the provinces, with the provincial association electing a candidate who is customarily ratified by the CMA general meeting. Day's selection was sufficiently controversial that he was challenged—albeit unsuccessfully—by another physician.

Because healthcare is deemed to be under provincial/territorial jurisdiction, negotiations on behalf of physicians are conducted by provincial associations such as the Ontario Medical Association. The views of Canadian doctors have been mixed, particularly in their support for allowing parallel private financing. The history of Canadian physicians in the development of Medicare has been described by C. David Naylor. In 1991, the Ontario Medical Association agreed to become a province wide closed shop, making the OMA union a monopoly. Critics argue that this measure has restricted the supply of doctors to guarantee its members' incomes. In 2008, the Ontario Medical Association and the Ontario government agreed to a four year contract with a 12.25% doctors' pay raise, which was expected to cost Ontarians an extra $1 billion. Ontario's then premier Dalton McGuinty said, "One of the things that we've got to do, of course, is ensure that we're competitive  to attract and keep doctors here in Ontario  "

By 2019, Canada's aging population represented a modest increase in healthcare costs of about 1% a year. In 2013 the total reached $211 billion, averaging $5,988 per person. Figures in National Health Expenditure Trends, 1975 to 2012, show that the pace of growth is slowing. Modest economic growth and budgetary deficits are having a moderating effect. For the third straight year, growth in healthcare spending will be less than that in the overall economy. The proportion of Canada's gross domestic product will reach 11.6% in 2012 down from 11.7% in 2011 and the all time high of 11.9% in 2010. Total spending in 2007 was equivalent to 10.1% of the gross domestic product which was slightly above the average for OECD countries, and below the 16.0% of GDP spent in the United States. Since 1999, 70% of Canada's total health expenditures is from the public sector and 30% from the private sector. Public sector funding included most hospital and physician costs with the other 30% primarily paid by individuals through their private or workplace insurance or out of pocket. Half of private health expenditure comes from private insurance and the remaining half is supplied by out of pocket payments. According to a 2001 article in Annals of the Royal College of Physicians and Surgeons of Canada, applying a pharmacoeconomic perspective to analyze cost reduction, it has been shown that savings made by individual hospitals result in actual cost increases to the provinces.

The planning and funding of most publicly insured health services are the responsibility of provinces and territories. There is a regional variation in health system characteristics. Healthcare costs per capita vary across Canada with Quebec ($4,891) and British Columbia ($5,254) at the lowest level and Alberta ($6,072) and Newfoundland ($5,970) at the highest. According to a 2003 article by Lightman, "In kind delivery in Canada is superior to the American market approach in its efficiency of delivery." In the US, 13.6 percent of GNP is used in medical care. By contrast, in Canada, only 9.5 percent of GNP is used on the Medicare system, "in part because there is no profit incentive for private insurers." Lightman also notes that the in kind delivery system eliminates much of the advertising that is prominent in the US and the low overall administrative costs in the in kind delivery system. Since there are no means tests and no bad debt problems for doctors under the Canadian in kind system, doctors billing and collection costs are reduced to almost zero.

According to a 2020 survey, 75% of Canadians "were proud of their health care system." An August 31, 2020 PBS article comparing the American healthcare system to Canada's, cited the director of the University of Ottawa's Centre for Health Law, Policy and Ethics, Colleen Flood, who said that there was "no perfect health care system", and the "Canadian system is not without flaws." However, Canadians "feel grateful for what they have." At times, the complacency has resulted in Canadians not demanding for "better outcomes for lower costs". She said that, Canadians are "always relieved that at least [our healthcare system] not the American system." A 2009 Nanos Research poll found that 86.2% of Canadians "supported or strongly supported" "public solutions" to make Canadian "public health care stronger." According to the survey report, commissioned by the Canadian Healthcare Coalition, there was "compelling evidence" that Canadians "across all demographics" prefer a "public over a for profit health care system." A Strategic Counsel survey found 91% of Canadians prefer their healthcare system instead of a U. S. style system. A 2009 Harris Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States. A 2003 Gallup poll found 57% of Canadians compared to 50% in the UK, and 25% of Americans, were either "very" or "somewhat" satisfied with "the availability of affordable healthcare in the nation". Only 17% of Canadians were "very dissatisfied" compared to 44% of Americans. In 2003, 48% of Americans, 52% of Canadians, and 42% of Britons say they were satisfied. A 2016 Canadian Institute for Health Information survey found that Canadians wait longer to access health care services than citizens in 11 other countries including the United States and Switzerland. In a 2021 Ipsos poll, 71% of Canadians agreed that their health care system is too bureaucratic to respond to the needs of the population.

In a May 28, 2020, report by the Organisation for Economic Co operation and Development (OECD) that examined wait times in member nations—all of which are democratic countries with high income economies with a very high Human Development Index (HDI), found that long waiting times for health services was an important policy issue in most OECD countries. In 2017, Canada ranked above the average on OECD indicators for wait times and access to care, with average scores for quality of care and use of resources. In the 1980s and the 1990s, wait times for certain surgeries, such as knee and hip replacements, had increased. The year before the 2002 Romanow Royal Commission report was released, in 2001, the Ontario Health Coalition (OHC) called for increased provincial and federal funding for Medicare and an end to provincial funding cuts as solutions to unacceptable wait times. In December 2002, the Romanow Report recommended that "provincial and territorial governments should take immediate action to manage wait lists more effectively by implementing centralized approaches, setting standardized criteria, and providing clear information to patients on how long they can expect to wait." In April 2007, Prime Minister Stephen Harper announced that all ten provinces and three territories would establish wait time guarantees by 2010. Canadians will be guaranteed timely access to healthcare in at least one of the following priority areas, prioritized by each province: cancer care, hip and knee replacement, cardiac care, diagnostic imaging, cataract surgeries or primary care. In 2015, Choosing Wisely Canada promoted evidence based medicine in 2015. Organizations like this focus on facilitating doctor patient communication to decrease unnecessary care in Canada and to decrease wait times. In 2014, wait times for knee replacements were much longer in Nova Scotia, compared to Denmark, Germany, the Netherlands and Switzerland. A 2016 study by the Commonwealth Fund, based in the US, found that Canada's wait time for all categories of services ranked either at the bottom or second to the bottom of the 11 surveyed countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States). Canada's wait time on emergency services was the longest of the 11 nations, with 29% of Canadians reporting that they waited for more than four hours the last time they went to an emergency department. Canada also had the longest wait time for specialist appointments, with 56% of all Canadians waiting for more than four weeks. Canada ranked last in all other wait time categories, including same or next day appointments, same day answers from doctors, and elective surgeries, except for access to after hour care, where Sweden ranks lower. The 2016 study also noted that despite government investment, Canada's wait time improvements were negligible when compared to the 2010 survey. The 2021 Waiting Your Turn: Wait Times for Health Care in Canada report by the Fraser Institute found that the average waiting time between referral from a general practitioner and delivery of elective treatment by a specialist rose from 9.3 weeks in 1993 to 25.6 weeks in 2021. It has been hypothesized that women experience a higher rate of health related issues because of their reduced access to the material and social conditions of life that foster good health, as well as a heightened level of stress associated with their gender and marital roles. Moreover, research has shown that women with low income and who work full time outside of the house have poorer health status in comparison to their male counterparts. The added responsibilities women hold as primary caregivers in households not only creates additional stress, but also indirectly increases the difficulty of the scheduling and meeting of medical appointments; these implications explain women's poorer self rated health status in comparison to men, as well as their report of their unmet healthcare needs.

Disparities between men and women's access to healthcare in Canada have led to criticism, especially regarding healthcare privatization. While most healthcare expenses remain covered by Medicare, certain medical services previously paid for publicly have been shifted to individuals and employer based supplemental insurance. While this shift has affected both genders, women have been more affected. Compared to men, women are generally less financially stable, and individual payments are a greater burden. Furthermore, many women work part time or in fields that do not offer supplemental insurance, such as homemaking. As such, women are less likely to have private insurance to cover the costs of drugs and healthcare services. The shift from public to private financing has also meant additional labor for women due to families relying on them as caregivers. Less public financing has shifted care to women, leaving "them with more support to provide at home." Women's additional healthcare requirements, such as pregnancy, further exacerbate the gender gap. Despite comprising approximately half of Canada's population, women receive the majority of Canadian healthcare. Another recent study re assessed this relationship and found similar results that demonstrated that people with higher levels of education or income experience longer life expectancies and health adjusted life expectancies. The study discovered a distinct stepwise gradient in Canada, with life expectancy and health adjusted life expectancy incrementally increasing as social position improves. Certain relationships between socioeconomic status and health outcomes can be relatively easily explained through direct exposures. Higher income levels allow for the purchase of higher quality resources, including food products, produce and shelter, as well as faster access to services. Higher education is often thought to lead to greater health literacy, resulting in the adoption of healthier lifestyles. Longer, more complex pathways can also be used to explain potential relationships between socioeconomic status and health outcomes. Duration of poverty has been related to increased chronic stress levels. Recent studies have described how these stress levels can result in the biological "wear and tear" for these individuals constantly exposed to social and environmental stressors. Increased stress and lower SES has been correlated with increased blood pressure, worser cholesterol profiles and increased risk for other cardiovascular diseases.

In Canadian healthcare, Black individuals encounter pervasive discrimination from overt acts like harassment to subtle daily indignities, eroding trust and discouraging Black Canadians from seeking medical care. A quantitative study in the Greater Toronto Area found that all 24 Black women participants experienced objectification, maltreatment, and unequal power dynamics in healthcare, mirroring historical patterns of oppression and exposing racial treatment disparities amid challenging healthcare access. Black Canadians encounter significant racial treatment disparities, including lower rates of receiving biologic treatments such as medications for rheumatoid arthritis and psoriasis, compared to White patients. Additionally, limited participatory visits with physicians and clinical trials, undermining treatment validation. Despite Canada's universal healthcare access, socioeconomic status exacerbates these disparities, hindering low income individuals' access to prescription drug coverage and specialist care. For instance, in Ontario, Black people, constituting 5% of the population, represented one quarter of new HIV diagnoses. Additionally, throughout the first 14 months of the COVID 19 epidemic in Toronto, Black people accounted for 14% of cases and 15% of hospitalizations, despite comprising 9% of the city's population. These findings highlight that Black Canadians face insensitivity and discrimination from healthcare providers, dissuading individuals from seeking care and exacerbating disparities in health outcomes. Studies highlight that evidence informed health promotion initiatives and interventions targeting racism's impact on health and within Canadian healthcare are crucial for promoting health equity, rebuilding trust within the healthcare system, and improving public health outcomes in Canada. Additionally, collecting ethically disaggregated ethno racial data for monitoring outcomes is essential for positive changes within the Canadian healthcare system.

It is well documented in the literature that Indigenous peoples in Canada lack equitable access to healthcare services for a variety of reasons. One major reason for this inequitable access is due to Indigenous locations of residence. Statistics Canada reported that the majority of Métis live in urban centres, while almost half of First Nations people live on reserves. In rural northern communities, they struggle to attract and retain healthcare professionals, leaving a great shortage in services that results in far lesser access to care. In the Inuit Nunangat, it was found that just 23% of Inuit had a medical doctor they regularly visited. Additionally, due to the lack of healthcare access in northern communities, many are forced into lengthy transportation to southern Ontario to receive necessary care. One study examined an Inuit community in Rigolet, Canada, and looked at the direct and indirect costs of these long distance healthcare visits, including missed paid employment, mental well being costs, transportation costs and others. Altogether, this community experiences healthcare costs greater than other Canadian non Indigenous and urban areas. Another prominent reason for inequitable access to care is the persistence of racism that remains in Canada. In 2012, The Health Council of Canada conducted a series of meetings across the country with a variety of healthcare workers, researchers and Aboriginal people. Through their conversations, they discovered that a large part of the problem comes from the healthcare system. They found that many Indigenous people simply do not trust mainstream health service due to stereotyping, racism and that they feel intimidated. One participant described their experiences as "being treated with contempt, judged, ignored, stereotyped, racialized, and minimized." Finally the Health Council of Canada went on to describe that this lack of equitable access comes as an extension of systemic racism in Canada. Participants described their lack of access to health services to stem from the racism and sexism experienced in the system. In the same study, the researchers interviewed multiple key informants, including various types of health practitioners. They described how important it is for the health system to implement culturally safe care. They also discussed how many stereotyping problems occur in medical school and that Canada requires further Indigenous centred training. They recommend higher education and awareness training amongst medical schools and healthcare institutions to address the growing healthcare disparities between Indigenous and non Indigenous peoples in Canada. Researcher Emily Colpitts states that LGBT members in Nova Scotia experience ambiguous or alienating language in their health policies. According to Colpitts, the "heteronormative and gender binary language and structure of medical intake forms have the consequence of alienating LGBT populations." Colpitts adds that in the previous study of queer and transgender women in Nova Scotia, patients experienced significant discomfort in their meetings with healthcare providers and feared that because of the language of health policy, they would not be able to receive adequate healthcare based on their sexual identities. According to researcher Judith MacDonnell, LGBT members, especially childbearing lesbians, have trouble navigating through health policy. MacDonnell states that LGBT women encounter challenges at every point of the childbearing process in Canada and have to rely on personal and professional means to receive information that they can understand, such as in reproductive health clinics and postpartum or parenting support. The healthcare needs of the LGBT community are affected by a number of social, behavioural, and structural factors. Various bodies of literature have identified the health disparities associated with the LGBT community, and how these individuals receive disproportionate healthcare services. For example, mental health disorders such as depression and anxiety, eating disorders, obesity, and cardiovascular diseases are all of higher prevalence and a major concern amongst LGBT persons. lesbians have lower reported rates of using family physicians. Another barrier that exists with regard to the healthcare disparities experienced by LGBT persons is the stigma that continues to persist in society. Moreover, LGBT populations may fear that their health needs are not considered in primary health since healthcare has been historically been constituted through a cisnormative and heteronormative framework. As a result, LGBT populations are less likely to access primary healthcare services due to the fear of discrimination. Cultural competence is an important consideration in assessing the quality of care received by the LGBT community, as a lack of cultural competency in healthcare professionals and systems leads to a reduced life expectancy, a lower quality of life, and an increased risk of acute and chronic illness amongst LGBT persons. Another important consideration in addressing the quality of care received by the LGBT community is patient physician communication. Many health risks LGBT persons face come as a result of avoidance and/or dissatisfaction of healthcare services; this is in part due to assumptions made by the patient's healthcare providers, such as assuming the sexuality of the patient and predicting their sexual behaviours. The "healthy immigrant effect" is a term that recognizes how immigrants on average enter Canada with better health than those born in the country. However, over time, this health advantage experienced by immigrants may begin to decline. Multiple factors contribute to this health decline, including: racialization and discrimination, stress of immigration, barriers accessing healthcare practitioners and others. Moreover, the distribution of physicians has a direct impact on the utilization of primary care services by immigrants. Immigrants tend to settle in suburbs, and long term immigrants tend to migrate toward suburban areas. These areas offer the most affordable housing options for immigrants, however this creates a "spatial mismatch" Other racialized immigrants, specifically seniors, may be reluctant to access mental health services due to the stigmatization that surrounds these issues. Immigrants in Canada face multiple barriers to accessing mental health services. As with primary care access, the language barrier between healthcare providers and immigrants remains one of the greatest challenges in delivering mental health care and often leads to underuse. Many subpopulations of immigrants, including but not limited to: African women, Latin American men, Iranian immigrants and South Asian immigrants have been shown in studies to underuse mental health services due to the limited amount of services offered outside of the English language, which hinders their access to mental health care. One study discussed how immigrants avoided, or did not benefit from, mental health counselling services as there lacks an adequate amount of professional interpretation services. Another study conducted in Montreal examined the reasons behind why immigrants were reluctant to access mental health services. They found a multitude of reasons as to why immigrants were hesitant to seek help, including the fact that their perception of Western doctors' over willingness to utilize pharmaceutical medications, while they believed in the curative powers of non pharmaceutical interventions, such as God and traditional folk medicine.

Refugees in Canada experience numerous barriers to healthcare, such as gaps in knowledge regarding healthcare needs, which may not be always considered by public health initiatives and policies. Immigrants and refugees are among the groups most at risk for negative health effects resulting from persistent health disparities; differences in race, socioeconomic status, income, citizenship status, and other social factors further exacerbate healthcare inequalities. Compared to immigrants, refugees often require additional healthcare due to previous conditions in their countries of origin. The 2012 Protecting Canada's Immigration System Act formed a tiered system that classified refugees and separated care based on these classifications. Differing levels of care were provided to refugees based on each refugee's home country and other factors. The changes in refugee healthcare programs created in a rise in emergency room (ER) visits due to a lack of provisions of healthcare to refugees. This created concerns among Canadian citizens that the overall cost of healthcare will rise due. According to one study, the cuts to IFHP also made funding uncertain for programs that helped pay for ER costs. In July 2014, Canada's Federal Court ruled that denying health services to asylum seekers was "cruel and unusual treatment" and therefore unconstitutional. One study suggested open dialogue among policymakers, clinicians, and researchers and working with settlement programs to effectively respond to challenges encountered by the healthcare system regarding refugees. The study notes that supporting primary care and focusing on social accountability training in medical schools will help ensure the sustainability of the healthcare system's response to refugees. A study conducted in Quebec, Canada investigated healthcare utilization and access amongst people with intellectual disabilities in comparison to the general population. Of the study sample, approximately 30 percent reported not having had a comprehensive medical examination in the past year, which is what is currently advised in the 2018 Canadian consensus guidelines for practitioners providing primary care for those with intellectual disabilities. Compared to the general population, women with intellectual disabilities aged 18–69 years were found to undergo cervical cancer screening less often. Results demonstrated them to be 1.5 times less likely to undergo a Pap test in the past three years compared to similar aged women without disabilities.

Canada since at least 2016 has legally allowed for a so called right to die, or legalized euthanasia. Critics have raised concerns that doctors and medical professionals in Canada may have an added incentive to encourage patients to self select an early or possibly even unnecessary instance of euthanasia as a cost cutting procedure due to governmental budget pressures based around a system of socialized medicine. Scott Shackford of Reason magazine reported on September 7, 2022, that, "Unfortunately, the philosophical argument for the right to die can also end up colliding with troubling decisions in a country where the government funds and controls access to healthcare. That is reportedly happening in Canada, where some citizens say health officials are actively encouraging people with disabilities and other chronic medical issues to consider suicide." The Katz study—based on an analysis of data from the 1996–1997 National Population Health Survey (NPHS)—a large survey representative of the Canadian noninstitutionalized population, including 17,276 Canadian residents, reported that 0.5% sought medical care in the U. S. in the previous year. Of these, less than a quarter had travelled to the U. S. expressly to get that care. Prime Minister Jean Chrétien traveled to the Mayo Clinic twice in 1999 for medical care. Chrétien allegedly kept the visits a secret, with one occurring during a publicly announced ski trip to Vancouver. Canadian Liberal MP Belinda Stronach went to the United States for breast cancer surgery in June 2007. Stronach's spokesperson Greg MacEachern was quoted in the article saying that the U. S. was the best place to have this type of surgery done. Stronach paid out of pocket for the surgery. Stronach had stated in an interview that she was against two tier health care. When Robert Bourassa, the premier of Quebec, needed cancer treatment, he went to the U. S. to get it. In 2010, Newfoundland and Labrador Premier Danny Williams travelled to the U. S. for heart surgery. One 2008, KOMO TV report said that some Canadian pregnant women were "forced" to give birth in U. S. One pregnant woman from Calgary had to deliver her quadruplets in Great Falls, Montana because at that time, in 2007, there were hospitals with enough neonatal intensive beds to accommodate the extremely rare quadruple birth. A January 19, 2008, article in The Globe and Mail said that, "More than 150 critically ill Canadians—many with life threatening cerebral hemorrhages—have been rushed to the United States since the spring of 2006 because they could not obtain intensive care beds here. Before patients with bleeding in or outside the brain have been whisked through U. S. operating room doors. Some wait times for these patients in Canada waiting as long as eight hours in emergency wards Canadian health care workers found solutions for them in the U. S.

Some U. S. citizens travel to Canada for healthcare related mainly to access lower costs. Many U. S. citizens purchase prescription drugs from Canada, either over the Internet or by travelling there to buy them in person, because prescription drug prices in Canada are substantially lower than prescription drug prices in the United States; this cross border purchasing has been estimated at $1 billion annually. Some states like Florida have signed bills to import prescription drugs from Canada but are awaiting federal approval. Because marijuana is legal in Canada but illegal in some of the U. S., many U. S. citizens with cancer, AIDS, multiple sclerosis, and glaucoma have travelled to Canada for medical treatment. One of those was Steve Kubby, the Libertarian Party's 1998 candidate for governor of California, who suffered from adrenal cancer. Recent legalization of marijuana in some states of the U. S. has reduced this type of travelling.

The Canada Health Act covers residents of Canada, which are persons "lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but does not include a tourist, a transient or a visitor to the province." When traveling within Canada, a Canadian's health card from his or her home province or territory is accepted for hospital and physician services. Transients, self employed itinerant workers (e. g. farm workers) who move from province to province several times within a year, and peripatetic retired or unemployed individuals who move from province to province (e. g. staying with various relatives, or living in a recreational vehicle) may find themselves ineligible for health coverage in any province or territory, even though they are Canadian citizens or landed immigrants physically present in Canada 365 days a year. "Snowbirds" (Canadians who winter in warm climates) and other Canadians who are out their home province or territory for a total of more than 183 days in twelve months lose all coverage, which is reinstated after a three month waiting period. Students attending a university or college outside their home province are generally covered by the health insurance program of their home province, however, "Typically this coverage (while out of province but within Canada) is for physician and hospital services only."

thumb|250px|Life expectancy vs healthcare spending of rich OECD countries. US average of $10,447 in 2018. Based on OECD 2018 data, in terms of life expectancy at birth by gender, women in France is 85.9, Switzerland's 85.7, Canada's 84.1, the Netherlands's 83.4, Germany's 83.3, and the U. S.' 81.2 years. The Commonwealth Fund report ranked Canada at slightly above average in life expectancy and the U. S. at the bottom of the list with a life expectancy of 78.6 years. In comparison, in the U. S. during the same period, the rate decreased slowly from 22.49 to 6.98 deaths per 1000.

In 2018, the maternal mortality rate per 100,000 live births in Canada was 8.3 deaths. Since 2008, the rate has been between "4.5 and 8.7 deaths per 100,000 live births". In June 2005, the Supreme Court of Canada ruled in Chaoulli v. Quebec (Attorney General) that Quebec AG had violated the Quebec Charter of Human Rights and Freedoms by forbidding private health insurance for medically necessary health services. The ruling raised concerns for some and hope for others that there could be an increase in private sector participation in the health system. Chief Justice McLachlin ruled that "[a]ccess to a waiting list is not access to health care". The Cambie Surgeries Corporation v. British Columbia case was settled on September 10, 2020, when Justice Steeves of the Supreme Court of British Columbia ruled against legalizing private health care.

In 2006, the Government of British Columbia threatened to shut down one private clinic because it was planning to start accepting private payments from patients. Since 2008, Dr. Brian Day has been suing the British Columbia government on the basis that the Canada Health Act is unconstitutional. In 2016, the Government of Quebec was sued for passing Bill 20, which allows and regulates add on fees. Capitation based models are used in some provinces as in place of or in parallel with the traditional fee for service model. An April 2006 perspective on private healthcare in Canada in the New England Journal of Medicine included an interview with Michael McBane and Brian Day on the future of health care in Canada. In August 2007, the Canadian Medical Association (CMA) elected as president Brian Day, who owns the largest private hospital in Canada and who vocally supports increasing private healthcare in Canada. A 2006 New York Times article entitled "Canada's Private Clinics Surge as Public System Falters" said that the "Cambie Surgery Center"—"Canada's most prominent private hospital— was operating in plain view of health authorities as a "rogue enterprise". By 2006, Cambie, which was founded by Dr. Brian Day, Cambie's medical director and president, had a staff of 120 doctors. Day was quoted in the 2006 Times saying, without evidence, that, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." According to a May 1, 2006 Maclean's in depth article, private medical providers in British Columbia and Quebec were expanding their services encouraged by the Supreme Court's 2005 Chaoulli v. Quebec ruling. Quebec was influenced by the success of the blend of private and public healthcare services in France, and Brian Day was influenced by similar health services in New Zealand. Maclean's provided a consumer guide to private healthcare services in 2006. In 2009, the Canadian Medical Association met to discuss the potential for an increase in private clinics in Canada's healthcare system A European study presented at the meeting was "expected to call for private clinics, such as the chain of radiology centres owned by Ouellet, to play a bigger role in Canada's health care system." The healthcare sector in Canada contributes to climate change, and it was responsible for 4.6% of national greenhouse gas emission in 2009 to 2015. With the relationship between air pollution and human health, it was estimated by researchers that "every year, health care emissions result in 23 000 years of life lost due to disability or early death". The health sector has contributed to pollution in various ways, with Hospitals and Pharmaceutical companies as the largest drivers of its emissions according to the PLOS Medicine study. There is also the impact of medical waste, anesthetics used in surgery, and unsustainable materials which are all greenhouse gases. There have been projects led by The Canadian Coalition for Green Health Care with the aim to reduce the environmental impacts of providing healthcare, such as reducing toxic chemicals when cleaning and promoting sustainable foods in hospitals. They recently studied medical imaging equipment's energy consumption. When patients and hospital staff travel to hospitals and clinics they release greenhouse gas, which can be viewed as part of the equation.