Canada HiT (2020)

Life expectancy in Canada is high, while health inequalities persist

Life expectancy is high at 81.9 years, but it plateaued between 2016 and 2017. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Numerous factors adversely influence the health of Canadians, including the consumption of alcohol and tobacco, while major public health challenges include increasing obesity rates, and increasing rates of opioid addiction and deaths. Cancer and cardiovascular disease are the two main causes of death, both of which have occupied the top positions since 2000.

The provinces and territories administer health coverage systems

Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets broad national standards through the Canada Health Act and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet, there are major gaps in medicare, such as prescription drug therapies administered outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments in overall health financing. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas.

Reforms point towards consolidated health authorities, primary care reform and Indigenous self-governance

Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. However, major challenges such as access to non-medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.