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Everything you ever wanted to know about Canadian health care in one post

By Sarah Kliff
Washington Post, July 1, 2013

We spend a decent amount of time talking about the Canadian health care system in our health care debate. Today being Canada Day (yes, really), it feels like a good time to brush up on how our northern neighbors actually deliver health care and how well it works. Without further ado, a completely painless guide to the Canadian health care system.

So, how exactly does the Canadian health care system work?

The Canadian health care system was built around the principle that all citizens will receive all “medically necessary and hospital physician services.” To that end, each of Canada’s 10 provinces and three territories finance and run a statewide health insurance program. There is no cost-sharing for the health care services guaranteed under federal law.

While Canadians are guaranteed access to hospital and physician services, it is up to each province to decide whether to cover “supplementary” benefits, like dental care and drug coverage. About two-thirds of Canadians take out private, supplemental insurance policies (or have an employer-sponsored plan) to cover these services.

While Canada is traditionally thought of as a publicly financed system, spending on these supplemental benefits means that 30 percent of health spending comes from private sources. One 2011 study found that nearly all Canadian spending on dental care came from non-government dollars, 60 percent covered by employer-sponsored plans and 35 percent paid out of pocket. Some Canadian legislators have made pushes to increase the scope of Canada’s public health plan, to cover more services, but have so far proved unsuccessful.

While Canada’s health care system is publicly financed, many providers are not government employees. Instead, doctors are usually reimbursed by the government at a negotiated fee-for-service rate. The average primary care doctor in Canada earns $125,000 (in the United States, that number stands at $186,000).

How much does it cost? 

In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries:

This probably has a lot to do with the lower unit cost of health care in Canada. An MRI that costs, on average, $1,200 in the United States comes in at $824 north of the border. It also has to do with lower administrative costs: A 2010 Health Affairs studyfound that doctors in Ontario, a Canadian province, spent $22,205 each year dealing with the single-payer agency, compared to the $82,975 American doctors spend dealing with private insurance companies, Medicare and Medicaid.

How well does the Canadian health care system work?

The OECD tends to give the Canadian health care system high marks on outcomes in its regular look at international health care systems. “Canada’s survival rates for breast and colorectal cancer are among the highest in the OECD,” the international organization noted in its 2011 report. “Canada also does well in primary care, preventing costly hospital admissions from chronic conditions such as asthma and uncontrolled diabetes.”

Where Canada does not do well is on wait times, which tend to be longer than in other countries, especially to see specialists or obtain an elective surgery. A Commonwealth Fund survey in 2010 found that 59 percent of respondents reported waiting more than four weeks for an appointment with a specialist, more than double the number in the United States:

Canada has recently started taking steps to address this: In 2005, it had each province set evidence-based benchmarks for wait times for various procedures. “Provinces have made considerable progress with efforts to manage and reduce wait times, and many now meet wait-time benchmarks for at least 75 percent of patients,” the Commonwealth Fund found in 2010 report. “Generally, when available, trend data show waits for care are decreasing in the areas of joint replacement, sight restoration, cardiac surgery, and diagnostic imaging scans.”

Do Canadians like their health care system?

Canadians certainly view their health care system as crucial to national identity: 85 percent say that eliminating the public plan would “result in a fundamental change to the nature of Canada.”

That does not, however, mean there isn’t gripping about its shortcomings. A 2007 pollconducted by Queens University in Kingston, Ont. found that, while public opinion had ticked up slightly, “a large majority of Canadians still believe that the system is unsustainable and urgently in need of substantive change.” Most of the concerns had to do with long wait times and difficulty accessing care. The survey also found widespread support for increasing health care spending.

Put into an international perspective, however, Canada’s system looks to be relatively well liked. A 2011 Gallup Poll found that 57 percent of Canadians felt “satisfied” or “very satisfied” with their access to health care services (in the United States, that number stood at just 25 percent).