Working together, we can examine existing Canada Health Transfers, and look at innovation in the system.
Much has been said recently about the state of the health-care system in Canada. In 2005, Canada ranked in the top four of all health-care systems. Sadly, according to the Commonwealth Fund, which ranks the health systems of the 11 richest countries, in 2021 we slid to 10th, just above the United States (which consistently ranks last). In 2024, we rose slightly to seventh place overall.
But general rank does not tell the whole story. The Commonwealth Fund uses five indicators to evaluate systems: access to care, care process, administrative efficiency, equity, and health outcomes. The United Kingdom, Australia, and the Netherlands rank consistently in the top three, though they spend the lowest per capita on health care. In care process and health outcomes, Canada is in the top five. But we have slid in access to care and administrative cost per capita, and now have the longest wait times for access and one of the costliest administrative systems.
So, what went wrong?
Canada has a dire shortage of health-care workers, which, to some extent, we can blame on COVID-19 burnout. Yet, Australia, New Zealand, and the Netherlands were less affected because they put in place immediate, stringent vaccine, community, and border-restriction protocols that contained the spread of infection and diminished strain on their health-care systems. Health-care professionals are doing the best they can with the resources they are provided.
Only 81 per cent of Canadians have a family doctor according to the Canadian Medical Association. In the high-performing countries, 97 to 99 per cent of patients have a GP. Good primary care is essential to timely diagnosis and treatment, freeing emergency rooms for critical care only. Their multidisciplinary clinics, with different health workers, provide comprehensive primary care and chronic disease management all in one place. Good community care, long-term care, and home care in these countries free up hospitals and beds for acute care and surgical or critical interventions. Wait lists go down, and costs decrease.
Unfortunately, Canada faces a unique challenge. We have, in effect, 13 separate health-care systems. Provinces decide when and where care is delivered, and by whom. The federal government provides tax and cash transfers under the Canada Health Act, which guarantees accessibility, portability, and universality, regardless of ability to pay. The Act clearly spells out penalties for contravening those principles, but not since then-health minister Diane Marleau applied them successfully—due to a private eye clinic operating in Alberta in the 1990s—have they been implemented.
This unequal delivery of care across the country is evidenced by the C.D. Howe Institute, using Commonwealth Fund, Organisation for Economic Co-operation and Development, World Health Organization, and Canadian Institute for Health Information data, which places Prince Edward Island, Quebec, Ontario, and British Columbia as top performers, and Nova Scotia, Newfoundland and Labrador, and Nunavut as needing improvement. As we break down the Commonwealth Fund data, we see that the costliest systems do not provide the best care, efficiencies, or outcomes. Therefore, throwing more money at the problem is not the answer.
Canadian medicare performed well for decades, but it faces new challenges. It is time to look at how the system can be managed differently.
Some small provinces, like P.E.I., have large senior populations. Geographically challenging regions, like Newfoundland and Labrador and Nunavut, have larger rural and isolated communities where access is a challenge. Let us level the playing field.
Working together, we can examine existing Canada Health Transfers that are solely per capita and factor in demographics and need—such as seniors, youth at risk, or geography, where distance increases the cost of care. We must look at innovation in the system, including increased use of artificial intelligence and technology to link isolated communities with tertiary care centres for diagnosis and acute care delivery. In Holland, incentives are in place to encourage health-care providers to keep some clinics open 24 hours, lifting the burden on emergency rooms.
Canada’s ranking was also affected by inadequate provision of mental health supports, and limited access to prescription drugs and dental care. Our government has started on these programs, but there is a need to continue negotiations with provinces and territories so they can be pan-Canadian.
As we move to an independent, competitive economy, we must recognize that an essential component is a healthy, productive population.
– Hedz Sez
Published in the Hill Times on February 11, 2026.
Hill Times: A plan to strengthen health care and measure outcomes
