Canada’s healthcare system continues to score poorly compared to its international peers.
According to a C.D. Howe Institute report authored by Tingting Zhang, Canada ranks ninth out of 10 high-income countries, falling behind the international average for access to care, administrative efficiency, and equity, while ranking last in timeliness. However, for the select few who can access care, Canada has a relatively high quality of care.
“All Canadian provinces and territories fall below the international average for overall healthcare performance, with Newfoundland and Labrador and Nunavut showing the weakest outcomes,” reads the study. “Access to timely care, obtaining after-hours care, and long wait times are nearly universal challenges.”
A previous poll highlighted that almost half of Canadians were avoiding healthcare due to overwhelming wait times, with 11% seeking care abroad to bypass delays.
The C.D. Howe report showcased that Canada ranked last in timeliness. Every province ranked well below the international timeliness average. Almost half of Canadians, 47%, waited two months or longer to see a specialist, and 59% waited two months or longer for elective surgery.
The only country Canada outperformed in overall health system performance was the United States, which took last place. The Netherlands, the United Kingdom, France, and Australia led the pack in scores.
The study also analyzed each province independent from Canada, which saw Prince Edward Island take first place among the provinces in overall health system performance. In last place, and the only province scoring lower than the United States, was Nunavut.
The study compared Commonwealth Fund International Health Policy surveys from 2021 to 2023 to compare Canada’s healthcare performance to other countries. Other supplementary data were gathered from the World Health Organization, OECD, and Canadian Institute for Health Information.
Compared to a similar study conducted in 2018, Quebec saw the biggest improvement in healthcare — climbing from 7th place to 1st among Canadian jurisdictions. Alberta saw the largest decrease in healthcare performance — falling from 1st to 5th.
The C.D. Howe study analyzes the “access to care” category, which consists of affordability and timeliness. Canada ranked 9th out of 10 in this category. When taking each province individually, every province ranked beneath all countries except the United States.
A previous report highlighted that Canada’s healthcare spending was among the highest in the OECD and was outpacing the economy. The country’s annual healthcare spending hit $372 billion in 2024, costing each Canadian around $9,054. Of all 38 OECD countries, only France and Sweden spent more per capita on healthcare than Canada.
However, the C.D. Howe Institute study said that Canada’s affordability of healthcare has improved from seventh to sixth place since 2018, despite the serious issues that remain.
“Affordability continues to be a significant barrier in the Atlantic provinces (excluding PEI), Alberta, BC and Yukon, where a higher proportion of adults reported forgoing medications, needed mental health services or homecare due to cost concerns,” reads the study. “PEI was the only province with an affordability score significantly higher than the international average.”
The study added that almost one-quarter of low or average-income Canadians reported at least one cost barrier to accessing healthcare in 2023, more than double those with high incomes.
“This suggests strongly that people with lower or average incomes may have forgone medical care or failed to follow care instructions as prescribed, potentially exacerbating their health issues,” reads the study.
A different study published by the C.D. Howe Institute highlighted that Canada’s healthcare system will require $2 trillion to meet the ageing population’s needs.
Zhang suggested that Canada implement best practices from countries like the Netherlands and Germany.
She added that Canada’s recent expansions in drug and dental care coverage are not yet reflected in surveys. However, even those improvements would bring only two provinces above the international average.
Zhang called for broader improvements across all jurisdictions, emphasizing the need for affordable mental health and home care services, shorter wait times, enhanced patient engagement, and addressing equity challenges.
