Health-care lessons from Switzerland for a Canada ready for reform

Last year marked the 40th anniversary of the Canada Health Act, long considered a pillar of national identity. But today, that symbol is showing signs of strain. Despite record government spending, health-care wait times have reached historic highs—more than 30 weeks on average for planned treatment—and access to care continues to deteriorate. Fewer than one in five Canadians now say the system works well.

While political leaders tinker at the margins, countries such as Switzerland have taken bold steps to build universal health-care systems that are more responsive, more flexible and, above all, more accessible.

Switzerland achieves universal health coverage through a fundamentally different and patient-centered model. Instead of relying on a government monopoly, the Swiss health-care system is organized around principles of regulated competition. Forty-four private non-profit insurers offer standardized basic coverage, and every resident must enroll. But unlike in Canada, Swiss patients are free to choose their insurer and switch plans twice a year. This freedom of choice drives insurers to innovate, tailor benefits, and ultimately improve service.

Switzerland’s universal system is also more comprehensive than Canada’s. It covers not only hospital and physician services, but also prescription drugs, mental health care and certain long-term care services. At the same time, patients can choose from a variety of plan designs, which have varying deductibles and premiums, and manage care based on their preferences.

By contrast, the Canadian system offers virtually no choice. The government enrols every citizen in the same plan, with the same benefits, on the same terms. The Canada Health Act, the federal legislation meant to promote equity, prohibits flexibility. It’s a lowest-common-denominator model—rigid, bureaucratic and unresponsive to patient needs.

Nowhere is this clearer than how we access care. In Canada, patients must go through a family doctor—compulsory gatekeeping—before seeing a specialist. But six million Canadians don’t even have a family doctor. For them, this requirement isn’t just inconvenient, it’s a dead end. The result is long delays, lost diagnoses and growing public frustration.

Conversely, the Swiss model prioritizes adaptability, driven by the power of patient choice and regulated competition among insurance providers. Because residents can switch insurers twice a year and select among different care models, insurers are incentivized to innovate and respond to evolving needs. As a result, patients can choose from a variety of insurance plans: a standard model with no gatekeeping; managed care with family doctors; pharmacy-based coordination; telemedicine-first plans, or other models. And they don’t have wait long. According to the latest survey from the Commonwealth Fund, 76 per cent of Swiss residents are able to obtain a medical appointment with a doctor or nurse within five days, compared to only 46 per cent of Canadians.

In addition to expanding patient choice, these different plan options help insurers control costs by reducing unnecessary consultations and hospitalizations. Studies show that such models can lower the cost of care by up to 34 per cent without compromising quality while also discouraging unnecessary treatments or hospital visits. And these plans encourage health-care providers to focus on prevention and chronic care management, ultimately improving efficiency and outcomes while the savings allow insurers to reduce premiums and control long-term spending. In fact, despite offering greater choice and a broader package of health-care services than Canada, real health-care spending (per person) in Switzerland has grown by less than 2 per cent annually since the mid-1990s compared to 2.7 per cent in Canada.

These Swiss facts, which are likely music to the ears of Canadians, raise a key question: how much do Swiss citizens pay out-of-pocket for health care?

While Swiss residents do share some costs through deductibles and co-payments, these costs are capped and vulnerable populations (children, pregnant women, low-income people, etc.) are exempt.

In 2022 (the latest year of available data), average annual out-of-pocket spending per insured person in Switzerland was 581 Swiss francs, equivalent to C$792. For people who don’t require much care, the costs are much lower or non-existent. And nearly 28 per cent of the population receives subsidies to cover their premiums.

Of course, many Canadians assume our system as “free,” forgetting that it’s funded through general taxation. They also tend to overlook our significant out-of-pocket costs not covered by the public system (prescription drugs, mental health care, long-term care, etc.).

Nevertheless, Canada can’t simply copy-and-paste the Swiss model. The Canada Health Act currently prohibits co-payments and mandates uniform public insurance. But that doesn’t mean we have nothing to learn. Switzerland shows that universality isn’t incompatible with choice and competition. In fact, these goals can strengthen each other. When patients have freedom of choice, a health-care system becomes not only more efficient but also more responsive to their needs and preferences. In other words, it becomes a true health-care system.

Canada’s health-care debate has long been framed as a rigid dichotomy between a government monopoly and a privately-funded system where any reform is seen as a threat to universality. This mindset has stifled innovation and made it harder to build a system that is both universal and responsive. Switzerland points the way forward, with a model that reconciles equity, choice and adaptability in ways Canadian policymakers can no longer afford to ignore.

Yanick Labrie

Senior Fellow, Fraser Institute

Related Topics:#FraserInstitute #UniversalHealthCare #YanickLabrie CanadaHealthCareSystem HealthCareLessonsFromSwitzerland

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Carney government’s housing GST rebate doesn’t go far enough

Published on September 15, 2025

Todayville

From the Fraser Institute

By Austin Thompson

While there are many reasons for Canada’s housing affordability crisis, taxes on new homes—including the federal Goods and Services Tax (GST)—remain a major culprit. The Carney government is currently advancing legislation that would rebate GST on some new home purchases, but only for a narrow slice of the market, falling short of what’s needed to improve affordability. A broader GST rebate, extending to more homebuyers and more new homes, would cost Ottawa more, but it would likely deliver better results than the billions the Carney government plans to spend on other housing-related programs.

Today, Ottawa already offers some GST relief for new housing: partial rebates for homes under $450,000, full rebates for small-scale rental units (e.g. condos, townhomes, duplexes) valued under $450,000, and a full rebate for large-scale rental buildings (with no price cap). Rebates can lower costs for homebuyers and encourage more homebuilding. However, at today’s high prices, these rebate programs mean most new homes, and many small-scale rental projects, remain burdened by federal GST.

The Carney government’s new proposal would offer a full GST rebate for new homes—but only for first-time homebuyers purchasing a primary residence at under $1 million (a partial rebate would be available for homes up to $1.5 million). Any tax cut on new housing is welcome, but these criteria are arbitrary and will limit the policy’s impact.

Firstly, by restricting the new GST rebate to first-time buyers, the government ignores how housing markets work. If a retired couple downsizes into a new condo, or a growing family upgrades to a bigger house, they typically free up their previous home for someone else to buy or rent. It doesn’t matter whether the new home is purchased by a first-time buyer—all buyers can benefit when a new home appears on the market.

Secondly, by limiting the GST rebate to primary residences, the government won’t reduce the existing tax burden on rental properties—recall, many small-scale projects still face the full GST burden. Extending the rebate to include rental properties would reduce costs, unlock more construction and expand options for renters.

Thirdly, because the proposed GST rebate only applies in-full to homes under $1 million, it will have little effect in Canada’s most expensive cities. For example, in the first half of 2025, 31.8 per cent of new homes sold in Toronto and 27.4 per cent in Vancouver exceeded $1 million. Taxing these homes discourages homebuilding where it’s most needed.

Altogether, these restrictions mean the Carney proposal would help very few Canadians. According to the Parliamentary Budget Officer, of the 237,324 housing units projected to be completed in 2026—the first full year of the proposed GST rebate program—only 12,903 (5.4 per cent) would qualify for the new rebate. With such limited coverage, the policy is unlikely to spur much new housing or improve affordability.

The proposed GST rebate will cost a projected $390 million per year. However, if the Carney government went further and expanded the rebate to cover all new homes under $1.3 million, it would cost about $2 billion. That’s a big price tag, especially given Ottawa’s strained finances, but it would do much more to improve housing affordability.

Instead, the Carney government plans to spend $3 billion annually on “Build Canada Homes”—a misguided federal entity set to compete with private builders for scarce construction resources. The government has earmarked another $1.5 billion per year to subsidize municipal fees on new housing projects—an approach that merely shift costs from city halls to Ottawa. A broader GST rebate would likely be a more effective, lower-risk alternative to these programs.

Finally, it’s important to note that exempting new homes from GST is not a slam dunk. GST is one of the more efficient ways for the federal government to raise revenue, since it doesn’t discourage work or investment as much as other taxes. GST rebates mean the government may increase more economically harmful taxes to recoup the lost revenue. Still, tax relief is a better way to increase housing affordability than the Carney government’s expensive spending programs. In fact, the government should also reform other federal taxes on housing-related capital gains and rental income to help encourage more homebuilding.

The Carney government’s proposed GST rebate is a step in the right direction, but it’s too narrow to meaningfully boost supply or ease affordability. If Ottawa is prepared to spend billions on questionable programs such as “Build Canada Homes,” it should first consider a more expansive GST rebate on new home purchases, which would likely do more to help Canadian homebuyers.

Business

Upcoming federal budget likely to increase—not reduce—policy uncertainty

Published on September 12, 2025

Todayville

From the Fraser Institute

By Tegan Hill and Grady Munro

The government is opening the door to cronyism, favouritism and potentially outright corruption

In the midst of budget consultations, the Carney government hopes its upcoming fall budget will provide “certainty” to investors. While Canada desperately needs to attract more investment, the government’s plan thus far may actually make Canada less attractive to investors.

Canada faces serious economic challenges. In recent years, the economy (measured on an inflation-adjusted per-person basis) has grown at its slowest rate since the Great Depression. And living standards have hardly improved over the last decade.

At the heart of this economic stagnation is a collapse in business investment, which is necessary to equip Canadian workers with the tools and technology to produce more and provide higher quality goods and services. Indeed, from 2014 to 2022, inflation-adjusted business investment (excluding residential construction) per worker in Canada declined (on average) by 2.3 per cent annually. For perspective, business investment per worker increased (on average) by 2.8 per cent annually from 2000 to 2014.

While there are many factors that contribute to this decline, uncertainty around government policy and regulation is certainly one. For example, investors surveyed in both the mining and energy sectors consistently highlight policy and regulatory uncertainty as a key factor that deters investment. And investors indicate that uncertainty on regulations is higher in Canadian provinces than in U.S. states, which can lead to future declines in economic growth and employment. Given this, the Carney government is right to try and provide greater certainty for investors.

But the upcoming federal budget will likely do the exact opposite.

According to Liberal MPs involved in the budget consultation process, the budget will expand on themes laid out in the recently-passed Building Canada Act (a.k.a. Bill C-5), while also putting new rules into place that signal where the government wants investment to be focused.

This is the wrong approach. Bill C-5 is intended to help improve regulatory certainty by speeding up the approval process for projects that cabinet deems to be in the “national interest” while also allowing cabinet to override existing laws, regulations and guidelines to facilitate such projects. In other words, the legislation gives cabinet the power to pick winners and losers based on vague criteria and priorities rather than reducing the regulatory burden for all businesses.

Put simply, the government is opening the door to cronyism, favouritism and potentially outright corruption. This won’t improve certainty; it will instead introduce further ambiguity into the system and make Canada even less attractive to investment.

In addition to the regulatory side, the budget will likely deter investment by projecting massive deficits in the coming years and adding considerably to federal debt. In fact, based on the government’s election platform, the government planned to run deficits totalling $224.8 billion over the next four years—and that’s before the government pledged tens of billions more in additional defence spending.

A growing debt burden can deter investment in two ways. First, when governments run deficits they increase demand for borrowing by competing with the private sector for resources. This can raise interest rates for the government and private sector alike, which lowers the amount of private investment into the economy. Second, a rising debt burden raises the risk that governments will need to increase taxes in the future to pay off debt or finance their growing interest payments. The threat of higher taxes, which would reduce returns on investment, can deter businesses from investing in Canada today.

Much is riding on the Carney government’s upcoming budget, which will set the tone for federal policy over the coming years. To attract greater investment and help address Canada’s economic challenges, the government should provide greater certainty for businesses. That means reining in spending, massive deficits and reducing the regulatory burden for all businesses—not more of the same.