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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This Sunday, June 8, is Tax Freedom Day, when Canadians finally start working for themselves

Published on June 5, 2025

Todayville

From the Fraser Institute

By Milagros Palacios, Jake Fuss and Nathaniel Li

This Sunday, June 8, Canadians will celebrate Tax Freedom Day, the day in the year when they start working for themselves and not government, finds a new study published by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“If Canadians paid all their taxes up front, they would work the first 158 days of this year before bringing any money home for themselves and their families,” said Jake Fuss, director of fiscal studies at the Fraser Institute.

Tax Freedom Day measures the total annual tax burden imposed on Canadian families by federal, provincial, and municipal governments.

In 2025, the average Canadian family (with two or more people) will pay $68,266 in total taxes. That’s 43.1 per cent of its annual income ($158,533) going to income taxes, payrolltaxes (including the Canada Pension Plan), health taxes, sales taxes (like the GST), property taxes, fuel taxes, “sin” taxes and more.

Represented as days on the calendar, the total tax burden comprises more than five months of income—from January 1 to June 7. On June 8th—Tax Freedom Day—Canadians finally start working for themselves, and not government.

But Canadians should also be worried about the nearly $90 billion in deficits the federal and provincial governments are forecasting this year, because they will have substantial tax implications in future years.

To better illustrate this point, the study also calculates a Balanced Budget Tax Freedom Day—the day of the year when the average Canadian finally would finally start working for themselves if governments paid for all of this year’s spending with taxes collected this year.

In 2025, the Balanced Budget Tax Freedom Day won’t arrive until June 21. “Tax Freedom Day helps put the total tax burden in perspective, and helps Canadians understand just how much of their money they pay in taxes every year,” Fuss said. “Canadians need to decide for themselves whether they are getting their money’s worth when it comes to how governments are spending their tax dollars.”

Tax Freedom Day for each province varies according to the extent of the provincially and locally levied tax burden.

2025 Provincial Tax Freedom Days

Manitoba May 17
Saskatchewan May 31
British Columbia May 31
Alberta May 31
Prince Edward Island June 2
New Brunswick June 4
Ontario June 7
Nova Scotia June 10
Newfoundland & Labrador June 19
Quebec June 21

CANADA June 8

Canadians Celebrate Tax Freedom Day on June 8, 2025

In 2025, the average Canadian family will earn $158,533 in income and pay an estimated $68,266 in total taxes (43.1%).
If the average Canadian family had to pay its taxes up front, it would have worked until June 7 to pay the total tax bill imposed on it by all three levels of government (federal, provincial, and local).
This means that Tax Freedom Day, the day in the year when the average Canadian family has earned enough money to pay the taxes imposed on it, falls on June 8.
Tax Freedom Day in 2025 comes one day earlier than in 2024, when it fell on June 9. This change is due to the expectation that the total tax revenues forecasted by Canadian governments will increase slower than the incomes of Canadians.
Tax Freedom Day for each province varies according to the extent of the provincially levied tax burden. The earliest provincial Tax Freedom Day falls on May 17 in Manitoba, while the latest falls on June 21 in Quebec.
Canadians are right to be thinking about the tax implications of the $89.4 billion in projected federal and provincial government deficits in 2025. For this reason, we calculated a Balanced Budget Tax Freedom Day, the day on which average Canadians would start working for themselves if governments were obliged to cover current expenditures with current taxation. In 2025, the Balanced Budget Tax Freedom Day arrives on June 21.

Milagros Palacios

Director, Addington Centre for Measurement, Fraser Institute

Jake Fuss

Director, Fiscal Studies, Fraser Institute

Nathaniel Li

Senior Economist, Fraser Institute

Business

The world needs energy. Canada has the supply. Other nations eagerly fill the demand.

Published on June 4, 2025

Todayville

From the Fraser Institute

By Jock Finlayson

Spend time on the websites of Canada’s leading environmental non-governmental organizations (ENGOs) and you will see repeated references to the “energy transition”—the shift away from fossil-fuel energy sources to no- and low-carbon alternatives, to help lower the greenhouse gas (GHG) emissions that lie behind concerns over climate change.

While most countries—albeit not Donald Trump’s America—notionally support the 2015 Paris Agreement goal to limit global temperature increases to between 1.5 and 2.0 degrees centigrade, few are on track to slash their emissions sufficiently to reach that target. Indeed, emissions are still climbing, mainly due to the ravenous appetite for energy in many emerging economies.

Notwithstanding decades of climate change conferences, humanity remains firmly wedded to fossil fuels, which currently supply about four-fifths of global primary energy demand—a share that has fallen only slightly since the late-1990s. Moreover, as Canadian energy scholar Vaclav Smil recently noted, the absolute quantity of fossil fuels consumed by the world has risen by more than half since 1997.

Stupendous amounts of energy are needed to provide electrical power, for heating and cooling, transportation and agriculture, and to support many industrial processes. Today, fossil fuels are ubiquitous in all these areas. Only in the case of electricity have we observed a quantitatively significant move away from fossil fuel energy.

A glance at recent energy supply/demand projections highlights the dominant role of fossil fuels in the world’s energy system. The latest global outlook from multinational giant Shell is a good example.

According to Shell’s 2025 baseline forecast, worldwide demand for energy “will continue to increase as the global population grows and living standards rise.” By 2050, energy demand “could be nearly a quarter higher than in 2024 depending on economic growth rates, energy efficiency gains and the pace of electrification.”

Global oil demand is expected by grow by another 3-5 million barrels per day into the mid-2030s, confounding earlier forecasts of imminent “peak oil” consumption. Shell notes that “petroleum fuels remain affordable and convenient in transport, particularly in long-distance haulage, aviation and marine.” Oil also remains crucial to the petrochemicals sector.

Meanwhile, natural gas use is set to increase into the 2040s at least, with liquefied natural gas (LNG) representing a steadily rising share of the total natural gas market. Natural gas is a principal source of “industrial heat, fuel for power generation and heat for buildings.” It’s also critical to “helping the world move away from coal.”

Significant investments in oil and gas exploration, production, infrastructure and downstream processing “will be required for decades to come.” So much for the argument of Canadian environmental activists that it’s time to starve the oil and gas business of capital.

What are the implications of all of this for Canada?

We are endowed with an almost unmatched abundance of energy riches, notably the world’s third-largest oil reserves and vast amounts of natural gas. Canada is also a global leader in producing electricity from carbon-free sources. And energy plays an outsized role in our economy, directly accounting for one-tenth of GDP and supplying roughly a quarter of the country’s merchandise exports.

As a major energy producer, Canada has well-respected environmental standards and rigorous project approval and permitting processes. These are a long-term competitive advantage.

Even as efforts continue to reduce the carbon intensity of energy use and expand renewable power capacity, a growing world will need prodigious quantities of energy including oil and gas. Canada is well-placed to help meet it.