From the Fraser Institute

By Nadeem Esmail and Mackenzie Moir

It’s an exciting time in Canadian health-care policy. But even the slew of new reforms in Alberta only go part of the way to using all the policy tools employed by high performing universal health-care systems.

For 2026, for the sake of Canadian patients, let’s hope Alberta stays the path on changes to how hospitals are paid and allowing some private purchases of health care, and that other provinces start to catch up.

While Alberta’s new reforms were welcome news this year, it’s clear Canada’s health-care system continued to struggle. Canadians were reminded by our annual comparison of health care systems that they pay for one of the developed world’s most expensive universal health-care systems, yet have some of the fewest physicians and hospital beds, while waiting in some of the longest queues.

And speaking of queues, wait times across Canada for non-emergency care reached the second-highest level ever measured at 28.6 weeks from general practitioner referral to actual treatment. That’s more than triple the wait of the early 1990s despite decades of government promises and spending commitments. Other work found that at least 23,746 patients died while waiting for care, and nearly 1.3 million Canadians left our overcrowded emergency rooms without being treated.

At least one province has shown a genuine willingness to do something about these problems.

The Smith government in Alberta announced early in the year that it would move towards paying hospitals per-patient treated as opposed to a fixed annual budget, a policy approach that Quebec has been working on for years. Albertans will also soon be able purchase, at least in a limited way, some diagnostic and surgical services for themselves, which is again already possible in Quebec. Alberta has also gone a step further by allowing physicians to work in both public and private settings.

While controversial in Canada, these approaches simply mirror what is being done in all of the developed world’s top-performing universal health-care systems. Australia, the Netherlands, Germany and Switzerland all pay their hospitals per patient treated, and allow patients the opportunity to purchase care privately if they wish. They all also have better and faster universally accessible health care than Canada’s provinces provide, while spending a little more (Switzerland) or less (Australia, Germany, the Netherlands) than we do.

While these reforms are clearly a step in the right direction, there’s more to be done.

Even if we include Alberta’s reforms, these countries still do some very important things differently.

Critically, all of these countries expect patients to pay a small amount for their universally accessible services. The reasoning is straightforward: we all spend our own money more carefully than we spend someone else’s, and patients will make more informed decisions about when and where it’s best to access the health-care system when they have to pay a little out of pocket.

The evidence around this policy is clear—with appropriate safeguards to protect the very ill and exemptions for lower-income and other vulnerable populations, the demand for outpatient healthcare services falls, reducing delays and freeing up resources for others.

Charging patients even small amounts for care would of course violate the Canada Health Act, but it would also emulate the approach of 100 per cent of the developed world’s top-performing health-care systems. In this case, violating outdated federal policy means better universal health care for Canadians.

These top-performing countries also see the private sector and innovative entrepreneurs as partners in delivering universal health care. A relationship that is far different from the limited individual contracts some provinces have with private clinics and surgical centres to provide care in Canada. In these other countries, even full-service hospitals are operated by private providers. Importantly, partnering with innovative private providers, even hospitals, to deliver universal health care does not violate the Canada Health Act.

So, while Alberta has made strides this past year moving towards the well-established higher performance policy approach followed elsewhere, the Smith government remains at least a couple steps short of truly adopting a more Australian or European approach for health care. And other provinces have yet to even get to where Alberta will soon be.

Let’s hope in 2026 that Alberta keeps moving towards a truly world class universal health-care experience for patients, and that the other provinces catch up.

From the Fraser Institute

By Ben Cherniavsky and Jock Finlayson

Initial public offerings down 94% since 2010, reflecting country’s economic stagnation

Canadian equity markets are flashing red lights reflective of the larger stagnation, lack of productivity growth and lacklustre innovation of the
country’s economy, with the number of publicly listed companies down 32.7 per cent and initial public offerings down 92.5 per cent since 2010, finds a new report published Friday by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“Even though the value of the companies trading on Canada’s stock exchanges has risen substantially over time, there has been an alarming decrease in the number of companies listed on the exchanges as well as the number of companies choosing to go public,” said Ben Cherniavsky, co-author of Canada’s Shrinking Stock Market: Causes and Implications for Future Economic Growth.

The study finds that over the past 15 years, the number of companies listed on Canada’s two stock markets (the TSX and the TSXV) has fallen from 3,141 in 2010 to 2,114 in 2024—a 32.7 per cent decline.

Similarly, the number of new public stock listings (IPOs) on the two Canadian exchanges has also plummeted from 67 in 2010 to just four in 2024, and only three the year before.

Previous research has shown that well-functioning, diverse public stock markets are significant contributors to economic growth, higher productivity and innovation by supplying financing (i.e. money) to the business sector to enable growth and ongoing investments.

At the same time, the study also finds an explosion of investment in what’s known as private equity in Canada, increasing assets under management from $21.7 billion (US) in 2010 to over $93.1 billion (US) in 2024.

“The shift to private equity has enormous implications for average investors, since it’s difficult if not impossible for average investors to access private equity funds for their savings and investments,” explained Cherniavsky.

Crucially, the study makes several recommendations to revitalize Canada’s stagnant capital markets, including reforming Canada’s complicated regulatory regime for listed companies, scaling back corporate disclosure requirements, and pursuing policy changes geared to improving Canada’s lacklustre performance on business investment, productivity growth, and new business formation.

“Public equity markets play a vital role in raising capital for the business sector to expand, and they also provide an accessible and low-cost way for Canadians to invest in the commercial success of domestic businesses,” said Jock Finlayson, a senior fellow with the Fraser Institute and study co-author.

“Policymakers and all Canadians should be concerned by the alarming decline in the number of publicly traded companies in Canada, which risks economic stagnation and lower living standards ahead.”

Canada’s Shrinking Stock Market: Causes and Implications for Future Economic Growth

• Public equity markets are an important part of the wider financial system.
• Since the early 2000s, the number of public companies has fallen in many countries, including Canada. In 2008, for instance, Canada had 3,520 publicly traded companies on its two exchanges, compared to 2,114 in 2024.
• This trend reflects [1] the impact of mergers and acquisitions, [2] greater access to private capital, [3] increasing regulatory and governance costs facing publicly traded businesses, and [4] the growth of index investing.
• Canada’s poor business climate, including many years of lacklustre business investment and little or no productivity growth, has also contributed to the decline in stock exchange listings.
• The number of new public stock listings (IPOs) on Canadian exchanges has plummeted: between 2008 and 2013, the average was 47 per year, but this dropped to 16 between 2014 and 2024, with only 5 new listings recorded in 2024.
• At the same time, the value of private equity in Canada has skyrocketed from $12.8 billion in 2008 to $93.2 billion in 2024. These trends are concerning, as most Canadians cannot easily access private equity investment vehicles, so their domestic investment options are shrinking.
• The growth of index investing is contributing to the decline in public listings, particularly among smaller companies. In 2008, there were 1,232 listed companies on the TSX Composite and 84 exchange-traded funds; in 2024, there were only 709 listed companies on the TSX and 1,052 exchange-traded funds.
• The trends discussed in this study are also important because Canada has relied more heavily than other jurisdictions on public equity markets to finance domestic businesses.
• Revitalizing Canada’s stagnant stock markets requires policy reforms, particularly regulatory changes to reduce costs to issuers and policies to improve the conditions for private-sector investment and business growth.

Ben Cherniavsky

Jock Finlayson

Senior Fellow, Fraser Institute