Time to finally change the Canada Health Act for the sake of patients

Back in 1984, the Canada Health Act (CHA) received royal assent and has since reached near iconic status. At the same time, under its purview, the Canadian health-care system has become one of the least accessible—and most expensive—universal health-care systems in the developed world.

Clearly, policymakers should reform the CHA to reflect a more contemporary understanding of how to structure a truly world-class universal health-care system.

Consider for a moment the remarkably poor state of access to health care in Canada today. According to international comparisons of universal health-care systems, we endure some of the lowest access to physicians, medical technologies and hospital beds in the developed world. Wait times for health care in Canada also routinely rank among the longest in the developed world.

None of this is new. Canada’s poor ranking in the availability of services reaches back at least two decades. And wait times for health care have nearly tripled since the early 1990s. Back then, in 1993, Canadians could expect to wait 9.3 weeks for medical treatment after GP referral compared to 30 weeks in 2024.

This is all happening despite Canadians paying for one of the world’s most expensive universal-access health-care systems. And this brings us back to the CHA, which contains the federal government’s requirements for provincial policymaking. To receive their full federal cash transfers for health care from Ottawa, provinces must abide by CHA rules and regulations. And therein lies the rub.

We can find the solutions to our health-care woes in other countries such as Germany, Switzerland, the Netherlands and Australia, which all provide more timely access to quality care. Every one of these countries requires patient cost-sharing for physician and hospital services, and private competition in the delivery of universally accessible services with money following patients to hospitals and surgical clinics. And all these countries allow private purchases of health care, as this reduces the burden on the publicly-funded system and creates a valuable pressure valve for it.

Unfortunately for Canadians, the CHA expressly disallows requiring patients to share the cost of treatment while the CHA’s often vaguely defined terms and conditions have been used by federal governments to discourage a larger role for the private sector in the delivery of health-care services. At the same time, every new federal commitment to fix health care means increased provincial reliance on Ottawa. In 2024-25, federal cash transfers for health care are expected to total $52 billion, which means there’s $52 billion on the line for perceived non-compliance with the CHA. In short, this is why the provinces beholden to a policy approach that’s clearly failing Canadians.

So, what to do?

For starters, Ottawa should learn from its own welfare reforms in the 1990s, which reduced federal transfers and allowed provinces more flexibility with policymaking. The resulting period of provincial policy innovation reduced welfare dependency and government spending on social assistance (i.e. savings for taxpayers). When Ottawa stepped back and allowed the provinces to vary policy to their unique circumstances, Canadians got improved outcomes for fewer dollars.

We need that same approach for health care today, and it begins with the federal government reforming the CHA to expressly allow provinces the ability to explore alternate policy approaches, while maintaining the foundational principles of universality.

Next, the federal government should either hold cash transfers for health care constant (in nominal terms), reduce them or eliminate them entirely with a concordant reduction in federal taxes. By reducing (or eliminating) the pool of cash tied to the strings of the CHA, provinces would have greater freedom to pursue reform policies they consider to be in the best interests of their residents without federal intervention.

After 40 years, it’s high time to remove ambiguity and minimize uncertainty—and the potential for politically motivated interpretations—of the CHA. If federal policymakers want Canadians to finally have access to world-class health care, they should allow the provinces to choose their own set of universal health-care policies. The first step is to fix the 40-year-old legislation that has held the provinces back.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Alberta

Don’t stop now—Alberta government should enact more health-care reform

Published on May 22, 2025

Todayville

From the Fraser Institute

By Mackenzie Moir

It’s unusual to see a provincial government take on health-care reform. But not so in Alberta, where major reforms have been underway for almost a year. The province has long struggled with lengthy waits for non-emergency care and a majority (58 per cent) of Albertans last year were unsatisfied with the government’s handling of health care.

And who could blame them?

The median wait last year in Alberta was 19.2 weeks to see a specialist (after getting a referral from a family doctor) followed by the same amount of time to receive treatment. This combined 38.4-week wait marked the longest delay for non-emergency care in Alberta since data were first published more than 30 years ago. Also last year, an estimated 208,000 patients waited for care in Alberta. These waits are not benign and can result in prolonged pain and discomfort, psychological distress, and can impact our ability to work and earn money.

In fact, according to our new study, last year health-care wait times in Alberta cost patients $778 million—or more than $3,700 per-patient waiting. This estimate, however, doesn’t include leisure time after work or on weekends. When this time was included in the calculation, the total cost of these waits balloons to more than $2.3 billion or around $11,000 per patient.

Again, to its credit, the Smith government has not shied away from reform. It’s reorganized one of province’s largest employers (Alberta Health Services) with the goal of improving health-care delivery, it plans to change how hospitals are funded to deliver more care, and it continues to contract out publicly funded surgeries to private clinics. Here, the government should look at expanding, based on the success the Saskatchewan Surgical Initiative (SSI), which helped increase that province’s surgical capacity by delivering publicly funded surgeries through private clinics and shortened the median health-care wait from 26.5 weeks in 2010 to 14.2 weeks by 2014.

The SSI also “pooled” referrals in Saskatchewan together and allowed patients to choose which specialist they wanted to see for treatment, and patients received estimates of how long they would wait before choosing.

In Alberta, however, family doctors still refer patients to one specific specialist at a time yet remain potentially unaware of other appropriate doctors with shorter waits. But if Alberta also put specialist wait lists and referrals into one list, and provided updated wait times information, a family doctor could help patients choose a specialist with a shorter wait time. Or better yet, if Albertans could access that information online with an Alberta health card, they could make that decision on their own while working with their family doctor.

Make no mistake, change is in the air for health care in Alberta. And while key policy changes are now underway, the Smith government should consider more options while this window for reform remains open.

Business

New fiscal approach necessary to reduce Ottawa’s mountain of debt

Published on May 21, 2025

Todayville

From the Fraser Institute

By Jake Fuss and Grady Munro

Apparently, despite a few days of conflicting statements from the government, the Carney government now plans to table a budget in the fall. If the new prime minister wants to reduce Ottawa’s massive debt burden, which Canadians ultimately bear, he must begin to work now to reduce spending.

According to the federal government’s latest projections, from 2014/15 to 2024/25 total federal debt is expected to double from $1.1 trillion to a projected $2.2 trillion. That means $13,699 in new federal debt for every Canadian (after adjusting for inflation). In addition, from 2020 to 2023, the Trudeau government recorded the four highest years of total federal debt per person (inflation-adjusted) in Canadian history.

How did this happen?

From 2018 to 2023, the government recorded the six highest levels of program spending (inflation-adjusted, on a per-person basis) in Canadian history—even after excluding emergency spending during COVID. Consequently, in 2024/25 Ottawa will run its tenth consecutive budget deficit since 2014/15.

Of course, Canadians bear the burden of this free-spending approach. For example, over the last several years federal debt interest payments have more than doubled to an expected $53.7 billion this year. That’s more than the government plans to spend on health-care transfers to the provinces. And it’s money unavailable for programs including social services.

In the longer term, government debt accumulation can limit economic growth by pushing up interest rates. Why? Because governments compete with individuals, families and businesses for the savings available for borrowing, and this competition puts upward pressure on interest rates. Higher interest rates deter private investment in the Canadian economy—a necessary ingredient for economic growth—and hurt Canadian living standards.

Given these costs, the Carney government should take a new approach to fiscal policy and begin reducing Ottawa’s mountain of debt.

According to both history and research, the most effective and least economically harmful way to achieve this is to reduce government spending and balance the budget, as opposed to raising taxes. While this approach requires tough decisions, which may be politically unpopular in some quarters, worthwhile goals are rarely easy and the long-term gain will exceed the short-term pain. Indeed, a recent study by Canadian economist Bev Dahlby found the long-term economic benefits of a 12-percentage point reduction in debt (as a share of GDP) substantially outweighs the short-term costs.

Unfortunately, while Canadians must wait until the fall for a federal budget, the Carney government’s election platform promises to add—not subtract—from Ottawa’s mountain of debt and from 2025/26 to 2028/29 run annual deficits every year of at least $47.8 billion. In total, these planned deficits represent $224.8 billion in new government debt over the next four years, and there’s currently no plan to balance the budget. This represents a continuation of the Trudeau government’s approach to rack up debt and behave irresponsibly with federal finances.

With a new government on Parliament Hill, now is the time for federal policymakers to pursue the long-ignored imperative of reducing government debt. Clearly, if the Carney government wants to prioritize debt reduction, it must rethink its fiscal plan and avoid repeating the same mistakes of its predecessor.