William HoggWilliam Hogg is Senior Research Advisor at the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute in Ottawa, Ontario



Primary care in Canada

What do populations need?

Canada ranks last among the developed countries surveyed by the Commonwealth Fund for access to primary care services. About 10% of Canadians do not have a primary care provider, and those who do have difficulty seeing their provider in a timely fashion.

How does the system provide for these needs?

Health care is a provincial responsibility in Canada. Each of our 13 territories and provinces has its own single-payer (Medicare) health care system, and no two are exactly the same. In all parts of Canada, all medically necessary hospital costs are covered by public funds, and all medically necessary physician costs are covered. It is illegal for physicians to charge patients for medically necessary services.

Substantial investment and serious reforms are underway in all parts of the country to increase the supply of family physicians and nurse practitioners and transform the delivery of primary care services.

Who pays for the primary care system?

Canada has privatization creep. Overall, Canadians now pay 30% of health care expenses directly out of pocket. The remaining 70% is paid through tax-supported government expenditures. Sixty-six percent of Canadians have private supplemental health insurance.

What are the strengths?

Medicare is truly a part of the Canadian national identity. Inequities in primary care service delivery are minimal: we all get to wait the same length of time for our care!

What are the weaknesses?

Until recently, the primary care sector has been poorly valued and neglected. Canadian health care systems remain acute hospital and specialist-focused, and are expensive as a result. The various provincial governments’ budgets for Medicare costs are now approaching 50% of their total budgets. Sustainability of the system is in question.

Public debate about the health care system is of poor quality. Politicians have learned not to question the tenets of the Canadian Medicare system. Public discussion about the primary care sector is limited by the absence of performance information. Most reform efforts are at the practice level. Practices continue to work independently one from another and are not well integrated with the other components of the health care system.