Understanding Canada's health care system
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! Serious 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.
Core Differences and Key Facts
|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.
||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 a real emergency that is life threatening. You get immediate care - today. Fact: You will have to wait for 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 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) 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 $175,000 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 $380,000 (CAD $475,000), 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.
Frequently Asked Questions (FAQ's)
- "Can I get a family doctor in Canada? I heard they were impossible to find now."
The concept of a "family doctor" is fading in Canada, so yes, it is harder to find a traditional family doctor now in most cities in Canada. Small towns and rural areas can be "hit and miss". Sometimes there will be a group of physicians who open a practice and you can get a real family doctor. In other places there is only emergency care (hospitals) and no family doctors available at all.
Why is the role and availability of a "family doctor" fading?
What is replacing the "family doctor" in Canada?
- A family doctor who really knows you, your life context, and your health situation is becoming an artifact from the past. Except for in some smaller towns and cities it is almost impossible for a doctor to have the time to get to know you and your life context and connect that to your health. Doctors are paid to help many people, not a few, and with the high demands on them they do not usually have the time necessary to address much more than your immediate health concerns.
- Specialists have more time to address your complex and chronic health concerns. Family doctors will typically refer you to emergency departments at a hospital for emergencies and specialists for more complex health concerns.
- You have more power to understand your own general medical concerns today thanks to the Internet. Family doctors would educate you in the past on even basic aspects of health and medical issues but this is not so necessary now. This is another reason they can spend less time with you - you can learn the basics on your own.
- Being a doctor used to be a "vocation". Now it is a "job" for many. With this fundamental shift in philosophy comes a real change in how doctors wish to work. They want time off, a life with their families, and after all the years they must study to become a doctor they want to enjoy the rewards of their "profession". It was noted to me that female doctors, a rapidly growing percentage compared to what was a male-dominated profession in the past, are holding strong boundaries when they wish to have children of their own and to ensure quality parenting. Choosing to take time out from their professional lives to have and raise their children does impact physician availability and continuity with patient care. It should be noted that male doctors are similarly demanding flexibility for their family life, for professional upgrading and training, and personal reasons as well.
Drop-in clinics are replacing the role of a family doctors. You can now even have continuity of attention and care at a drop-in medical clinic. Some clinics allow you to call in and make an appointment as well. The difference is that you don't typically have a relationship with a specific doctor, but with the clinic itself instead. While this may seem impersonal, it is a reality in most busy urban settings.
I heard an explanation shared by an older family doctor as to why younger doctors are practicing in drop-in clinics and not starting their own independent family practices: It is easier administratively, reduces their reporting requirements to the government, is cheaper to work out of a drop-in clinic, and doing so allows them to treat their work as a "job", not a 24x7 vocation.
But to be clear, family doctors are still available and with diligence in seeking one out you can find one. One retired couple's recent experience:
We have acquired BC Care Cards and new family doctors, all in a relatively timely fashion.
- "When can we get public health insurance after we move to Canada?"
The provinces and territories with a 3 month waiting period:
Saskatchewan, Ontario, Quebec, The Yukon, Northwest Territories, and Nunavut.
Special case: BC - 2 months waiting period + the remainder of the month in which you arrive.
Provinces with no waiting period for health insurance:
Alberta, Manitoba, New Brunswick, Nova Scotia, PEI, and Newfoundland.
For those provinces with a waiting period: You sign up for health insurance when you get here through a mix of online and offline steps (including usually visiting a government office with proof that you are now living in Canada) and within 3 months you are insured. In the meantime, you will need to get private coverage or be covered by your current health care insurance. (See the next FAQ for details on this)
Important: Registering for public health insurance in Canada now requires more stringent identification requirements, particularly in BC. In helping a family member register for BC Medical Services Plan (MSP) the staff at ICBC - the agency which does the identification screening for MSP - were very clear on the strict requirements. If you or someone you will be registering was not born in Canada, or there has been a marital name change, be sure to bring a full range of proof of who you or them are. For example, original birth certificate, marriage certificate, passport, driver's license, credit card, etc. Even if you were born in Canada, bring all of this ID, too!
- "How do people bridge the 3 month waiting period?"
There are a variety of ways to bridge the 3 month waiting period:
A. If you have no serious pre-existing conditions you can easily purchase "Visitors to Canada" insurance packages from Blue Cross or CAA/BCAA, which specifically include new and returning residents of Canada.
B. You may be able to keep your U.S. or international insurance and have them add a "travel" rider for the 3 months.
C. You can pay for any medical expenses "out of pocket" for the 3 months. This is viable choice for anyone with either perfect health or pre-existing conditions that mean paying for private insurance would be expensive.
No, really, to the surprise of many, simply paying for doctor visits, emergencies, medications and treatments out-of-pocket is very doable in Canada. A vial of insulin, for example costs $35 on average in Canada and $350 in the U.S. (as of 2021). Recent real cost examples quoted from returning Canadians for various treatments, surgeries, and injuries:
Examples of health care costs paid out-of-pocket in Canada
"How long are health care "waiting times" in Canada...really?"
Please note that the spreading of FUD (Fear, Uncertainty, and Doubt) about the Canadian health care system is prevalent in the U.S. Why? Because the health insurance, medical, and pharma system in the U.S. is a multi-trillion dollar business (yes, trillion and yes, a business). There are huge vested interests in keeping it private and profitable in the U.S., unlike the Canadian system, which is mostly "public funded and privately delivered", which balances the power between the government "protecting" the public and the desires for profit in the private delivery. And there are fundamental philosophical mind frame differences, too, between Canada and the U.S. that encourage fear, derision, and outright mis-information about the Canadian health care system being portrayed publicly in the U.S.
Fact: You will get immediate care for your life threatening emergencies. No waits.
The philosophical differences also lead to many people in the U.S. having a "customer" perspective of health care, with attendant expectations. In Canada we have a "priority of need" perspective. This is a very important difference to be aware of if you are used to "customer service" in the U.S. medical system and have the personal wealth and/or a health insurance plan to pay for it there. In Canada you will get prompt, respectful, professional, and very "human" care. But you will likely not be considered a "customer" as you would in the U.S., and this has a direct impact on perceptions of wait times for service.
The following anecdote shared with me highlights the different expectations and concerns that arise at the patient interface of the Canadian and U.S. medical systems:
...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.
If you are dealing with chronic and/or serious health concerns while living in the U.S. or further abroad and are used to the speed of treatment for all your needs there please think carefully about when to move back to Canada...or whether to move back at all. The last thing you need is aggravation of your health concerns and unnecessary worry while having to learn to navigate the Canadian health care system. Long waiting times in Canada for non-emergency specialist services are real. Note: Many Canadians who are willing to pay for faster service do use third-party countries like Mexico for common knee surgeries, for example, and dental care and cosmetic surgery, as other examples.
- "Will I be covered by Canadian public health insurance when I travel outside of Canada or "snowbird" in the U.S.?"
You will not be fully covered by Canadian health care insurance when you travel or snowbird outside of Canada. You will have to purchase private "top-up" insurance to cover your travels and time outside of Canada.
Note: You must be resident in Canada for most of the year to be covered by Canadian health care, and stay covered. It varies a bit by province, but typically this means being physically in Canada 6 months in a year at least. BC allows those who are vacationing ("snowbirding") for up to 7 months in a year to keep BC MSP. Ontario allows 212 days: "You may be out of the province for up to 212 days in any 12-month period and still maintain your Ontario health insurance coverage provided that you continue to make Ontario your primary place of residence." Source: OHIP web site.
- "Are vaccinations covered by public health insurance and are they required for public school and work in Canada?"
Vaccinations are a complex and very contentious topic right now, both in Canada and in the U.S., so just the facts:
- In general vaccinations are paid for by Canadian health insurance.
- Some vaccinations are encouraged for most public schools. Exemptions are possible in most jurisdictions in Canada.
- Some workplaces, such as nursing homes, require staff to either have vaccinations or use a face mask instead during flu outbreaks.
A few suggestions...
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!
Your ideas, considerations, and experiences?
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.
Latest update to this resource: February 2021.
I offer professional support to help you prepare for a smooth and easy return to Canada so you can feel confident and organized!
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 18 years of supporting over 1,300 clients gives me a depth of expertise across all aspects of planning and returning to Canada.
Paul Kurucz - Canada
A happy client:
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,
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