What is the difference between public and private healthcare in Canada?

The Canadian healthcare system is a unique model that combines public and private funding, creating a mixed system with a clear division of functions and services. Although many consider Canadian healthcare to be entirely public, it actually has a more complex structure where both sectors coexist.

Structure and funding of the Canadian healthcare system

Overview of the system

The Canadian healthcare system is based on the principles of universality, accessibility, and comprehensiveness, enshrined in the Canada Health Act. The ratio of public to private funding is approximately 71% to 29%, reflecting a mixed funding model.

Distribution of expenditures in 2024

Total health care expenditures in Canada in 2024 reached $372 billion, or $9,054 per Canadian. These expenditures are distributed as follows:

  • Public sector (71%): 64.9% from provincial and territorial governments and 6.2% from other public sources
  • Private sector (29%): 14.6% direct payments by patients, 11.9% private insurance, 2.5% other sources

Public healthcare in Canada

What does the public system cover?

Canada's public healthcare system, known as Medicare, covers all medically necessary doctor and hospital services. This includes:

  • Consultations with family doctors and specialists
  • Diagnostic procedures (X-rays, blood tests, MRIs)
  • Surgical procedures and inpatient care
  • Emergency medical care

These services are provided free of charge at the point of delivery—patients do not pay directly for treatment, as the costs are covered by provincial health insurance plans.

Main categories of public spending

The largest categories of public spending on healthcare in 2024:

  • Hospitals: 25.8% of total spending, $2,334 per person
  • Medical services: 13.3% of total spending, $1,203 per person
  • Medicines: partially covered by the government, accounting for 13.7% of total expenditure

Limitations of the public system

Despite its broad coverage, the public system has significant limitations:

  1. Long waiting times – one of the biggest problems with Canadian public healthcare. According to a study by the Fraser Institute, in 2024, the average waiting time from referral by a family doctor to receiving specialized treatment reached a record 30 weeks.

  2. Limited coverage – the public system does not cover or only partially covers important services such as:

  • Dental care
  • Eye care and eyeglasses
  • Prescription drugs (except those provided in hospitals)
  • Physical therapy, massage, and alternative medicine
  1. Limited choice of doctors and appointment times – patients often cannot choose a specific specialist and have limited flexibility in terms of appointment times.

Private healthcare in Canada

The role of the private sector

The private sector plays an important role in Canadian healthcare, complementing the public system. It focuses primarily on services that are not covered or only partially covered by the public system. Private healthcare in Canada exists within a framework established by legislation and has certain limitations compared to fully privatized systems in other countries.

Private sector services

The private sector in Canadian healthcare includes:

  1. Dental services – most dental clinics are private, and patients pay for services directly or through private insurance.

  2. Ophthalmological services – eye exams and eyeglasses are not usually covered by the public system and are provided by private clinics.

  3. Pharmaceuticals – prescription drugs dispensed outside of hospitals are paid for by patients or through private insurance.

  4. Private clinics and hospitals – offer services with shorter waiting times, but for a direct fee.

  5. Additional services – physical therapy, massage, acupuncture, and other alternative treatments are usually provided by private practitioners.

Private health insurance

Private health insurance plays an important role in the Canadian healthcare system, covering services not included in public plans. Approximately 1 in 5 Canadians (about 7.5 million people) do not have prescription drug coverage and must pay for these costs out of pocket.

Many Canadians receive private insurance through their employers as part of their benefits package. For those who do not have this option, there are individual insurance plans that can be purchased independently.

Comparison of public and private healthcare

Waiting times

One of the biggest differences between public and private healthcare in Canada is waiting times. In the public system, patients can wait months for a specialist appointment or scheduled surgery. According to a 2024 study, the average wait time for a specialist appointment is 15 weeks.

In private clinics, waiting times are significantly shorter—patients can receive services within days or weeks rather than months. However, this advantage comes at a price—direct payment for services.

Quality of services

The quality of healthcare services in the public and private sectors is often comparable, as both employ qualified medical professionals. The main differences are:

  • Comfort – private clinics usually offer more comfortable conditions and a personalized approach
  • Accessibility – public services are available to all citizens and permanent residents regardless of their financial situation
  • Flexibility – private clinics offer more flexible schedules and the ability to choose a specific specialist

Cost

Cost is a key difference between public and private healthcare. Public services are funded through taxes, and patients do not pay directly for treatment. According to the Fraser Institute, a typical Canadian family of four with an average income of $176,266 pays approximately $17,713 per year for public health insurance through various taxes.

In contrast, private services are paid for by patients directly or through private insurance. The cost of private healthcare in Canada can be significant, but it offers faster access and greater flexibility.

Access to healthcare for immigrants

Public coverage for immigrants

Access to public healthcare for immigrants depends on their status:

  • Permanent residents are entitled to full coverage by the public healthcare system, just like Canadian citizens
  • Temporary residents (students, workers) may be eligible for public health insurance depending on the province and type of permit
  • Refugees receive temporary federal health coverage until they obtain provincial insurance

Some provinces have a waiting period (usually 3 months) before newcomers can obtain public health insurance.

Private insurance for immigrants

For immigrants who are not eligible for government health insurance or are in a waiting period, it is recommended to purchase private health insurance. This is especially important as the cost of medical services without insurance can be very high.

The future of Canadian healthcare

Trends and challenges

The Canadian healthcare system faces a number of challenges that affect both sectors:

  1. Rising costs – total healthcare spending in Canada increased by 5.7% in 2024, outpacing economic growth (3.7%)
  2. An aging population – increases the burden on the healthcare system and waiting times
  3. Rising costs of medical technology and drugs – increases overall healthcare spending

Reforms and innovations

In response to these challenges, various reforms and innovations are being implemented:

  1. Expansion of public coverage – for example, a recent initiative to provide free dental care for certain categories of the population
  2. Investment in medical personnel – the 2024 budget provides for the forgiveness of student loans of up to $60,000 for doctors and $30,000 for nurses working in rural and remote communities
  3. Recognition of foreign qualifications – $77.1 million over four years to ensure that every doctor and nurse who comes to Canada can contribute to the healthcare system

Conclusion

The Canadian healthcare system is a unique model where the public and private sectors coexist and complement each other. The public system provides universal access to basic medical services, while the private sector fills in the gaps and offers additional services.

The main differences between public and private healthcare in Canada are coverage, wait times, cost, and flexibility. Understanding these differences helps patients, especially new immigrants, navigate the system and get the care they need.

Despite the challenges, the Canadian healthcare system continues to evolve, seeking a balance between universality, accessibility, and efficiency. The future of Canadian healthcare will likely involve further integration of the public and private sectors to ensure optimal healthcare for all Canadians.