2024
The Canadian health care system in general continues to be under stress for various reasons. This is particularly acute in BC and ON but in contrast the AB health system is still functioning pretty well. I have personally witnessed the challenges in BC and heard direct reports of the following:
For returning Canadian citizens and people moving to Canada for the first time the Canadian health care and medical system is often an important consideration. Canada's model can at first glance be unsettling...until you learn how it works. Family doctors, walk-in clinics, hospitals, pharmacies, public health insurance (such as MSP in BC and OHIP in Ontario), private plans, etc. are aspects of the system that are somewhat different in Canada from the U.S. comparatives, for example, even if they have the same name and description of what they do.
The purpose of this resource is to provide practical information to help you understand the most important aspects of the Canadian health care system. I have worked with dozens of clients who shared medical system questions and concerns after their many years living in the U.S. or abroad and these questions and concerns caused them much anxiety. Not knowing if you will be safe in the Canadian health care system when you intimately understand and trust another country's system can be worrying, especially if you have serious and chronic health concerns.
Here is an email I received which is indicative of the concern over the differences in our health care systems:
Being a breast cancer survivor and knowing how quickly I received treatment following my diagnosis, I was looking for information on this site that would give me an idea of how this is handled in Canada. With cancer, you don't mess around. I'm gathering that cancer is not considered an emergency in Canada and, therefore, you could wait months (while it spreads) before receiving the treatment you need ASAP. Is this really the case?
As you might assume, I immediately emailed this person and clarified that this is NOT the case! Immediately life threatening cancer situations are treated promptly and professionally in Canada, completely in accordance with their seriousness.
I had the privilege of several in-depth conversations on the subject of the Canadian health care system with a Canadian physician who is also a senior provincial medical association leader and policy advisor to the Canadian federal government. The information presented in this document has been reviewed and edited with care and is in alignment with what was shared with me.
Please share your thoughts and experiences with the U.S. and Canadian health care system to help improve this resource.
Canada |
USA |
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Who pays: The government of the province you live in pays almost all of your emergency and most of your elective health/medical care. | There are a variety of ways that your emergency medical and most of your elective care will be paid. Government, private health insurance companies, personal payments, and even donations are sources of money. |
My costs? Nothing. In BC, a single adult used to pays $37.50 per month until 2020 when the government eliminated this fee. You still pay for some parts of medications and extended health costs, but note that medications are up to 90% lower in cost than in the U.S. | Depending on your income and circumstances, you may have to pay hundreds or even thousands of dollars a month for your health care insurance, treatments, and for pharmaceuticals. |
What is covered? Your hospital care, specialist visits, most of your pharmaceuticals, and some extra costs are covered. | A variety of things are covered...or not covered. The system in the U.S. is complex and private health insurers have a profit incentive to pay for as little as possible. This means that every private health insurance plan's coverage is different. |
What is not covered? Eye care and dental care are the most commonly noted items not covered by public health care in Canada. Pharmaceuticals are not fully covered and in some cases not at all. That said, they are a fraction of the cost of the U.S. and you can purchase extended health insurance coverage in Canada to pay for what is not covered. | Optical care is often covered in the U.S., but dental may or may not be covered by health care insurance plans. |
Pharmaceuticals: A few pharmaceuticals available in the U.S. are not available in Canada. Doctors here will assess your health situation and likely prescribe the same pharmaceuticals or a protocol that will meet your needs. Pharmaceuticals are generally much lower in price in Canada than in the U.S. Often 80-90% lower in price. | Almost all pharmaceuticals are available in the U.S. and are regularly prescribed by doctors for your needs. Pharmaceuticals are generally very high priced in U.S., dramatically more than in Canada and most other countries in the world. |
Philosophy: Canada's system is based on a "priority of need" philosophy. | The U.S. system is based on a "fastest treatment" and a "customer" philosophy. |
Wait times: Myth: There are long waits for real emergency care, including emergency surgeries. Fact: There are no waits in Canada when you have an immediate real emergency that is life threatening. You get immediate care - today. Fact: You will have to wait for chronic, non-life threatening issues, and most minor and elective surgeries in Canada. And for non-life threatening but still important surgeries there can also be more of a wait (days and perhaps a week or two at most, but NOT months). You will not get your surgery "this afternoon" for such cases. This is a real issue and cannot be sugar-coated. | You can get immediate emergency and important but not life threatening health issue care. You can get fast elective surgeries and treatments. |
Quality: Canada has modern, up-to-date hospitals with some of the newest and highest quality equipment available. Doctors, nurses, and other medical staff are world-class. | The U.S. has modern, up-to-date hospitals with some of the newest and highest quality equipment available. Doctors, nurses, and other medical staff are often world class |
Advocacy: Having someone help you navigate the health care system in Canada and advocate for you is advisable, especially in an emergency. The system is complex. | Having someone help you navigate the health care system in U.S. and advocate for you is very advisable, especially in an emergency. The system is complex...and expensive. |
Just for context: Physician earnings. Doctors in Canada with their own practices (offices) now earn on average about CAD $350,000 +/- minus the costs of operating their practices (subtract 30% +/-). Family doctors earn less than specialists. There are many hospital employee doctors earning about $200,000 +/- per year, but most run their own practices or work out of shared drop-in clinics. | Doctors in the U.S. earn on average USD $400,000 +/- (CAD $525,000+), minus the costs of operating their practices (subtract 30% +/-). Family doctors earn substantially less than specialists. Many doctors work for private hospitals. Many work in their own or shared practices. |
Need a more in-depth understanding of the Canadian health care system?
The Commonwealth Fund creates annual profiles of health care systems of many countries. Check out the latest Health Care Profile for Canada.
We have acquired BC Care Cards and new family doctors, all in a relatively timely fashion.
...mandatory referrals and wait times to see specialists [in Canada] and great difficulty locating a family doctor. CT scans and MRI’s, which are frequent for me, seem to take weeks to schedule and even longer to be read and have the specialist follow up. All of this is a totally different matter in ________ [USA] where we both have our own team of specialists who liaise and share data with our internist but operate completely separately. Blood test and CT scans are scheduled in a day or two. 4 hours later we get the radiologists report and the scan. Blood test results are available online to us within 24 hours. So, you see the Canada scene is looking very different and very frustrating.Note for context: The person who shared this and their spouse both have private health care plans and have a very high level of wealth they can use to pay for any health care they wish in the U.S. This is not the case for most returning Canadians.
Here are a few things you can do proactively before you move back to Canada permanently if you have serious health concerns and want to feel more confident that Canada's system will support you well:
1. Come for a visit first and connect to the medical services you will need to access in the place you intend to live in Canada. Understanding who and what services are available can be a big help emotionally.
2. Speak with your current medical and health providers so they can help you plan a "bridge" to the Canadian system practically and psychologically. This can include 3 months worth of prescriptions, a portable health history information package, etc.
3. Find someone in Canada (a family member or close friend) who can be a health advocate for you now, before you return, and when you get back, too. They can reach out to their network of medical providers and may be able to get you faster access once you return. If nothing else, they can help you feel you have someone beside you in terms of health care support, making the journey home to Canada feel safer.
Health care is a complex topic in Canada, the U.S., the UK, and in many other countries.
If you are planning to move back to Canada, or move here for the first time, please educate yourself about how the Canadian health care system works.
If I can be of support for your move to Canada, and your understanding of the Canadian health care system as part of that move, please engage my professional support services. I will be pleased to help!
This resource is updated regularly, but the topic of health care in Canada is so big, and so complex, that not everything can be explained fully and some things will change each year.
Please contribute your learning and experiences, and suggest improvements, so that other Canadians moving back to Canada, and those moving here for the first time, may benefit from your wisdom.
Thank you!
Paul Kurucz
Latest update to this resource: July 2024.
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Your questions about when to move back, taxes, investments and finances, bringing back your household belongings, health care, and more will be answered promptly and professionally, with resources to back up what you need. My 20 years of supporting over 1,300 clients gives me a depth of expertise across all aspects of planning and returning to Canada.
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Hi Paul,
Just to update you - we landed and sailed through customs! So thank you so much for all of your advice...It was a thoroughly pleasant experience.
This is to say thank you for everything. Your advisory has been so incredibly helpful and saved us considerable time and removed room for error.
With best wishes,
Caroline
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