Health System in Canada

  • Gregory MarchildonEmail author
Reference work entry
Part of the Health Services Research book series (HEALTHSR)


With a population of 35 million people spread over a vast area, Canada is a highly decentralized federation. Provincial governments carry much of the responsibility for the governance, organization, and delivery of health services although the federal government plays an important role in maintaining broad standards for universal coverage, direct coverage for specified populations, data collection, health research, and pharmaceutical regulation. Roughly 70% of total health spending is financed from the general tax revenues of federal, provincial, and territorial governments. Most public revenues are used to provide universal access to acute, diagnostic, and medical care services that are free at the point of service as well as more targeted (nonuniversal) coverage for prescription drugs and long-term care services. In the last decade, there have been no major pan-Canadian health reforms, but individual provincial and territorial governments have focused on reorganizing and fine-tuning their regional health system structure and improving the quality, timeliness, and patient experience of primary, acute, and chronic care services. While Canada’s system of universal coverage has been effective in providing citizens with deep financial protection against hospital and physician costs, the narrow scope of coverage has also produced some gaps in coverage and equitable access (Romanow 2002).


  1. Canadian Healthcare Association. New directions for facility-based long term care. Ottawa: Canadian Healthcare Association; 2009.Google Scholar
  2. CIHI. Health care cost drivers: The facts. Ottawa: Canadian Institute for Health Information; 2011.Google Scholar
  3. CIHI. National health expenditure trends, 1975–2013. Ottawa: Canadian Institute for Health Information; 2013.Google Scholar
  4. Fine BA, et al. Leading lean: a Canadian healthcare leader’s guide. Healthc Q. 2009;12(3):32–41.CrossRefGoogle Scholar
  5. Flood CM, Roach K, Sossin L, editors. Access to care, access to justice: the legal debate over private health insurance in Canada. Toronto: University of Toronto Press; 2005.Google Scholar
  6. Jackman M. Charter review as a health care accountability mechanism in Canada. Health Law J. 2010;18:1–29.PubMedGoogle Scholar
  7. Marchildon GP. Canada: health system review. Health Syst Transit. 2013;15(1):1–179. Copenhagen: WHO Regional Office for Europe on behalf on the European Observatory on Health Systems and Policies.Google Scholar
  8. Marchildon GP, Torgerson R. Nunavut: a health system profile. Montreal/Kingston: McGill-Queen’s University Press; 2013.Google Scholar
  9. Murray CJL, Richards MA, Newton JN, et al. UK health performance: findings of the Global Burden of Disease Study. Lancet. 2013;381:997–1021.CrossRefGoogle Scholar
  10. Nolte E, McKee M. Measuring the health of nations: updating an earlier analysis. Health Aff. 2008;27(1):58–71.CrossRefGoogle Scholar
  11. Ostry A. Change and continuity in Canada’s health care system. Ottawa: CHA Press; 2006.Google Scholar
  12. Paris V, Docteur E. Pharmaceutical pricing and reimbursement policies in Canada. Paris: Organisation of Economic Co-operation and Development, Health Work Group; 2006.Google Scholar
  13. Romanow RJ. Building on values: the future of health care in Canada. Saskatoon: Commission on the Future of Health Care in Canada; 2002.Google Scholar
  14. Schoen C, et al. A survey of primary care physicians in eleven countries. Health Aff. 2009;28(6):w1171–83.CrossRefGoogle Scholar
  15. Schoen C, Osborn R, Squires D. How health insurance design affects access to care and costs, by income, in eleven countries. Health Aff. 2010;29:w2323–34.CrossRefGoogle Scholar
  16. Taylor MG. Health insurance and Canadian public policy: the seven decision that created the Canadian healthcare system. 2nd ed. Montreal: McGill-Queen’s University Press; 1987.Google Scholar
  17. Tuohy CH. The cost of constaint and prospects for health care reforms in Canada. Health Aff. 2002;21(3):32–46.Google Scholar
  18. Urowitz S, et al. Is Canada ready for patient accessible electronic health records? A national scan. BCM Med Inform Decis Making. 2008;8:33. Accessed 25 Sept 2012.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada

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