JANUARY

The Canadian Health Care System, 2015
Sara Allin and David Rudoler
University of Toronto
What is the role of government?
Provinces and territories in Canada have primary responsibility for organizing and delivering health services and
supervising providers. Many have established regional health authorities that plan and deliver publicly funded
services locally. Generally, those authorities are responsible for the funding and delivery of hospital, community,
and long-term care, as well as mental and public health services. Nearly all health care providers are private.
The federal government cofinances provincial and territorial programs, which must adhere to the five underlying
principles of the Canada Health Act—the law that sets standards for medically necessary hospital, diagnostic,
and physician services. These principles state that each provincial health care insurance plan needs to be:
1) publicly administered; 2) comprehensive in coverage; 3) universal; 4) portable across provinces; and
5) accessible (i.e., without user fees).
The federal government also regulates the safety and efficacy of medical devices, pharmaceuticals, and natural
health products; funds health research; administers a range of services for certain populations, including First
Nations, Inuit, Métis, and inmates in federal penitentiaries; and administers several public health functions.
Who is covered and how is insurance financed?
Publicly financed health care: Total and public health expenditures were forecast to account for an estimated
10.9 percent and 8.0 percent of GDP, respectively, in 2015; by that measure, 70.7 percent of total health
spending comes from public sources (Canadian Institute for Health Information, 2015a). The provinces and
territories administer their own universal health insurance programs, covering all provincial and territorial
residents according to their own residency requirements (Health Canada, 2013a). Temporary legal visitors,
undocumented immigrants (including denied refugee claimants), those who stay in Canada beyond the duration
of a legal permit, and those who enter the country “illegally,” are not covered by any federal or provincial
program, although provinces and territories provide some limited services.
The main funding sources are general provincial and territorial spending, which was forecast to constitute
93 percent of public health spending in 2015 (Canadian Institute for Health Information, 2015a). The federal
government contributes cash funding to the provinces and territories on a per capita basis through the Canada
Health Transfer, which totaled CAD34 billion (USD27 billion) in 2015–2016, accounting for an estimated
24 percent of total provincial and territorial health expenditures (Canadian Institute for Health Information, 2015a;
Government of Canada, 2015a). 1
Privately financed health care: Private insurance, held by about two-thirds of Canadians, covers services
excluded from public reimbursement, such as vision and dental care, prescription drugs, rehabilitation services,
home care, and private rooms in hospitals. In 2013, approximately 90 percent of premiums for private health
plans were paid through group contracts with employers, unions, or other organizations (Canadian Life and
Health Insurance Association, 2014). In 2015, private health insurance accounted for approximately 12 percent
of total health spending (Canadian Institute for Health Information, 2015a). The majority of insurers are
for-profit.
1
Please note that, throughout this profile, all figures in USD were converted from CAD at a rate of about CAD1.26 per USD,
the purchasing power parity conversion rate for GDP in 2014 reported by OECD (2015) for Canada.
International Profiles of Health Care Systems, 2015 21