Future of health care in Canada
“ I felt that no boy should have to depend either for his leg or life upon he ability of his parents to raise enough money to bring a first class surgeon to his bedside. And I thin k it was out of the experience not at the moment consciously but through the years, I came to believe that health services ought not to have a price tag on them and that people should be able to get whatever health services they require, irrespective of their individual capacity to pay”, said Tommy Douglas, the Canadian Premier, who introduced the health care scheme in Canada. This essay deals with the aspects, which are likely to affect the future of health care in Canada. To deal with future, knowledge of the past is very essential. A brief overview of the past history precedes the discussion on future.
Canadian government is one of the very few governments, which gives top priority to the health of its citizens. The genesis of the Canadian health program lies in the mid 1940s when Tommy Douglas took the first steps towards introduction of Medicare. During 1944 to 1948, free health care for pensioners, free psychiatric treatment and establishment of mental hospitals, free cancer treatment, creation of medical colleges and air ambulances were introduced. On 1 January 1947, Tommy created the universal hospital services plan- Canada’s first universal and compulsory hospital insurance program. On 25 April 1959, he announced the revolutionary comprehensive medical care insurance program for the province. Despite stiff resistance from the medical professionals this scheme was launched in 1960. Medicare was founded on three major themes :
“A public system was necessary because a universal and comprehensive healthcare package would require citizens of the province to pay extremely high private insurance premiums,
A lot of public money was needed to fund such an extensive program,
The largesse of the program would require the government to be accountable for it’s
management.” ( Health )
In 1961, under the eladership of Premier W.Lloyd, all the ten provinces of Canada agreed
to start the health care program, and the HIDS act was passed. In 1966, The Medical care act
was passed introduced under the leadership of L.Pearson, which extended the HIDS
provisions tonallow each Province to set up health care plan on cost sharing basis with the
federal government. Mediare was also set up by the same government. IN 1984, th Canada
health act was passed, which prohibited extra billing and charging of private fees by the
The health care system of Canada known as “ Medicare”, all Canadians to receive
medical care. Funded by the Federal Government, this system represents Canadian values
like equal access to highh quality health care and make it available to all citizens, irrespective
of their fianancial status. With highest life expectancy rate and lowest infant mortality rate,
Canada sets an example to the rest of the world, on how to manage such health care system
successfully. ( Health care in Canada)
The ship of Medicare,ailed th till the 1980s. However, since 1990s, it has been facing
rough waters. The key issues are :
Financial implications due to demographic trends
Long waiting periods, even in emergenceis.
3. Lack of competent doctors.
Under the given circumsances what could be the future of health care in Canada? Should the
sytem exist atll? Should it undergo reforms? If yes, of what type ? How are these key issues
likley to affect the future of the health care system in Canada ?
Canada, is currently witnessing a very unique type of demographic trends. The baby boom which occurred in the 1950s and early 60s, is going to show its effect on the financial implications, once these ‘ babies’ reach an age of 65 . It is estimated that in 2001, 12.6 percent of the population was of 65 years or above, and according to the projected figures, his will rise to 19 percent in 2021 and to a staggering 25 percent in 2041. The baby boom as not sustained in the later years and the birth rate has decelerated towards the end of the 20th century. Moreover, due to improved health care facilities, the longevity of Canadians has increased. These factors have created a unique demographic reality before Canada. There is a severe imbalance between the aged and the young population. A large part of the population, is going to be retired in a very small time span. The government will be forced, in very near future, to nurture and look after a population which does not work for the nation. One interesting effect of this demographic trend is that he current workface of Canada has a majority of older workforce which is shrinking continuously.
Total health care expenditures are directly related to the average age of the population, since health problems occur more as age advances. Thus, Canada is faced with an exponential growth in the expenditures related to health care. In 2003, the total health care expenditure of Canada, according to Canadian Institute of Health Information data, reached $ 121 billion, which stands at $ 4000 per person. This will rise to an estimated $ 147 billion by 2020, out of which $ 102.5 billion will be on public funding.
The demographic trend faced by Canada has its effect on the workforce and the corresponding labor supply patterns also. Analysis of the current trends reveal that two thirds of Canadians prefer to retire at an early age, as compared to the prescribed age of 65. Education and Health sector witnesses early exit of workforce because of attractive retirement benefits. Similarly, shortage is also experienced in construction line, police force, medical profession and aviation industry. This problem assumes a more complex form, taking into account other factors, like the amount of time involved in preparing a talented work force, the inherent conditions at the work place and difficulty in mobilizing them. (Executive summary )
From a fiscal point of view, the following four factors are likely to have an impact on the future of the health care system in Canada. These are :
1. Health care system pressures : Few facts highlight the pressure built up due to health care system. In addition to the factors mentioned on page 3, it is worth to note that only 12 percent of Canadians currently have a long-term care insurance. This is despite the fact that most of the expenses of the government are in the last 2 to 3 years of a citizen, and by 2010, 60 percent of the boomers, who will be around 50 years, will have a surviving parent.
2. Labor supply Concerns: In addition to the factors mentioned on page 3, more labor concerns are likely to affect the fiscal aspects of health care system. Today, there are 19 retirees for every 100 workers in Canada. By 2030, this is likely to be 39 and 44 by 2050.
Another interesting fact is that today, for every 6 people who leave work 10 people enter the work scene. This will equalize by 2016 and will be reversed to 13 exits against an intake of 10. The labor force growth between 200 to 2010 is expected to be 9 percent, which will reduce to 0.5 percent between 2011 to 2015, and there will be no growth between 2016 to 2025. ( Fact sheet )
Financial implications of the demographic trends, which Canada is facing, will make it mandatory for the government to review the provisions of he health care system.
The noble motive with which Premier Tommy Douglas had launched the Canadian health care system, does not seem to be coming through. There are several aspects o dissatisfaction with the system and its way of functioning. The aspect which pinches the most to a Canadian is – the waiting list. Tommy’s ream was to provide the health care as and when it is required. In the changed set of circumstances, that does not seem to be happening. The way this system is managed currently, offers access to quality health care, but does not guarantee that it can be accessed when it is required the most. “A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: “If the person named on this computer-generated letter is deceased, please accept our sincere apologies.” …….But there are many Canadians who claim the long wait for the test and the frigid formality of the letter are indicative of a health system badly in need of emergency care.” Reports an article from the CBS news. This article is an eye opener, in the sense that the spirit with which this service was launched, is almost dead. This article mentions that on an average, a Canadian family pays 48 percent of their income as taxes, part of which goes into health care, but they hardly get it when required. One of the reason underlying this scenario is that there is a shortage of medical and Para-medical professionals to give the service. The situation gets more complex due to the fact that the hospitals are facing financial crunch, and in Ontario, 10,000 nurses and staff are facing lay offs. There are many instances where the patient, not in a position to wait for long, gets the treatment done abroad. According to this article, the average wait for surgical or specialist treatment is nearly 18 months and for an Orthopedic surgeon it is more than 9 months. The situation reaches its climax when the health officials do not support the idea of sending a patient to a non government clinic within Canada. In an interesting case study, cited in this article, the expenses of sending a patient for surgery to USA, was a whopping $ 35000 on the government treasury. In Canada, the same surgery could have been done in $ 12000. (Canadian health care and crisis).
Shortage of doctors is another aspect, which is likely to affect the health care system in Canada. Partially, the roots of this problem lie in a 1991 report, in which two health economists Morris Bareer and Greg Studdart predicted that Canada was facing a surplus of doctors. This report was commissioned by the Provincial deputy ministers of health. As a consequence, there was a cut in enrolment to the first year medical schools by 10 percent. The realities are quite different. The College of Family Physicians of Canada estimates that 4102 million people had trouble in finding a family physician in 2002, and the situation is getting worse. In Hamilton, 40,000 to 50,000 people in the community did not have a doctor. The country lacks 3000 doctors, and if immediate steps are not taken, this may double to 6000 by 2011. According to a report co-authored by Dr.Dale Dauphinee, executive director of the medical council of Canada, the country produces,1750 new doctors a year, against a projected need of 2500. Well qualified foreign doctors seeking settlement in Canada, find it extremely difficult to get the license to practice, because of the 2 years compulsory residency practice rule, in Canada. Admissions to residency are extremely difficult for foreign doctors, if not impossible. These doctors are admitted only after the Canadian trained doctors fill up the available posts. According to Herb Emery, it is in the benefit of Canada to relax admission criteria to residency, because the cost of every single doctor trained in Canada, for three years in a medical school, is whopping $ 300,000. ( Cornwall Clandia )
Having analyzed the factors that underlie the future course the health care system in Canada will take, it would be proper to think of what is likely to happen.
1. If he system has to survive, privatization is a must. The government, under the set of given conditions has no option, but to allow private practice of qualified doctors, and look upon them as good supplements, rather than untouchables.
2. Canada may see a huge inflow of foreign trained doctors, if the rules for residency are relaxed.
3. The federal government may opt to reduce its responsibility, from total to partial, from a fiscal point of view. In other words, the citizens will have to be ready to bear the cost of health care service, which is free now.
4. Grass root changes in the tax structure, in relation to the health care may be witnessed.
Conclusively, it can be said that the health care system of Canada, is on the threshold of a major overhaul. Its position is like that of a cardiac patient in a critical care unit. The spirit of serving the citizens has evaporated, the fiscal implications are increasing by leaps and bounds, the care is not available when one needs it and the country lacks even the minimum number of doctors to make this scheme successful. If major corrective steps are not taken, the future of the health care service appears to be very grim.
1. Health, Achievements, Tommy Douglas the Greatest Canadian, Tommy Douglas Research
Institute, Retrieved on 2 October 2007 from :
2. Health care in Canada, wikipedia the free encyclopedia, retrieved on 3 October 2007 from:
< http://en.wikipedia.org/wiki/Health_care_in_Canada >
3. Executive summary, fact sheet [26 January 2005] Growing up: social and economic
implications of an aging population, Certified General Accountants Association of Canada,
Retrieved on 3 October 2007 from:
4….Canadian health care in crisis, [20 March 2005], CBS NEWS, Retrieved on 3 October 07 from: <http://www.cbsnews.com/stories/2005/03/20/health/main681801.shtml?cmp=EM8705
5. Cornwall Clandia, Why is Canada shutting out doctors ? Reader’s Digest- Canada,
Retrieved on 3 October 2007 from :
< http://www.readersdigest.ca/mag/2004/08/doctors.html >