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Should Canada Keep its Current Single-Payer Health Care System?

Updated on October 31, 2016


Canadians have consistently reported distinct satisfaction with the current health care service they receive (Health Canada 2010), however evidence suggests that healthcare in Canada would be improved by moving away from a single-payer system for hospital and medical insurance. In this case ‘improvement’ will be defined as more choice in coverage and easier access to health care. Especially when compared to the statutory health insurance employed in countries such as Germany (Drogus and Orvis 2015, 596), one can see the potential benefits would be manifested by a departure from our current system. Moving away from a single-payer system in Canada will facilitate greater choice and provide easier access to health care for citizens.

Canada's System

To begin, it will be useful to establish the context of this paper by developing an understanding of how the Canadian healthcare system currently functions. Regulated by the federal government and funded through general taxation, the current system is composed of separate provincial and territorial socialized health insurance plans that provide “medical treatments from primary care physicians as well as access to hospitals and additional medical services” ( 2007). However, this system is not truly universal in the sense that there are a number of services not covered by government insurance, “including dental service, optometrists, and prescription medication” ( 2007). Thus, many Canadian also pay for private insurance plans, which act as a supplement to government insurance and are often provided through employment ( 2007). Keeping this current healthcare system in mind, we can begin to examine the improvements that will result from moving away from a single-payer healthcare system in Canada and to compare it with statutory health insurance of Germany.

Deficiencies in Choice of Coverage

Firstly, moving away from a single-payer system would lead to greater choice in health care for Canadian citizens. Currently, in terms of primary care and hospital services, Canadians are restricted to the services provided by their provincial or territorial government and private insurers are prohibited from providing services that infringe upon government coverage (Commission on the Future of Health Care in Canada 2002, 4-6). This system leaves Canadians very little choice when choosing their primary care and hospital usage, which constituted 70.5% of Canadian health care expenditures in 2014 (Canadian Institute for Health Information 2014, 30-31). This means that, in 2014, decisions regarded the allocation of approximately $151.5 billion of health care spending were effectively beyond the control of individuals (Canadian Institute for Health Information 2014, 30-31). In a single-payer healthcare system, Canadians do not have adequate influence over how their money is spent. Without sufficient control over the type of coverage that they have access to, Canadians have little influence over the value that they will receive from the health system. Allowing Canadians greater choice concerning their health care would give them the opportunity to select coverage that serves their needs while ensuring that they receive the best return from their health care expenditure. In this way, greater choice facilitates greater equity in how Canadians receive health care.

Improved Choice of Coverage

The Canadian system can be contrasted with the statutory health insurance system that exists in Germany. While Germany also mandates universal health care for its citizens, it does so in a way that provides greater choice (Orvis and Drogus 2015, 602). German health care is distributed through a variety of ‘sickness funds’, which are “non profit organizations run by boards of employers and employees”, regulated closely by the German federal government, and paid for through general taxation (Orvis and Drogus 2015, 603). This variety of funds, and the freedom to choose between them, means, “German patients have exceptional levels of choice among sickness funds and, once they’ve selected a fund, among doctors” (Orvis and Drogus 2015, 603). By offering a number of private options to German citizens, thus increasing choice, the statutory health insurance system allows citizens to pick an insurance plan that best serves their coverage needs. Improved choice increases individual influence on health care usage, while also ensuring that citizens receive the best care possible for the money they contribute. When comparing this to Canada’s system, which only allows for limited freedom of choice and restricts the care available to citizens, one can see that Canada would benefit by moving away from a single-payer system. Additional benefits can be seen by examining access to care in the Canadian health care system.

Deficiencies in Access to Care

Another challenge that faces Canadian citizens under a single-payer system is limited access to care. In particular, a major challenge to accessibility can be found in the form of excessive wait times, exacerbated by a single-payer system. In a 2011 report from The Commonwealth Fund, Canadians were found to have the longest wait times for specialist and elective surgeries among countries examined, (this included: Australia, France, Germany, The Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US), with 41% of Canadians having waited two months or more to see a specialist and one in four Canadians waiting four months or more for elective surgery. (The Common Wealth Fund 2011, 8). These wait times have lead to statements that the Canadian health care system “violates patients' constitutional rights by forcing them to endure grueling wait times that often exacerbate their health problems” (Omand 2016). Furthermore, it is has been argued that these wait times are largely a product of “wasteful bureaucracy, a lack of competition, and a misguided attachment to universal coverage” (Omand 2016). This claim, corroborated by Canada’s low accessibility ranking among other similar countries, means that Canada’s single-payer system leads to inefficiencies in the health care market that would not exist under other systems. By requiring that all citizens utilize the same government-run system without alternatives, the Canadian government is requiring that citizens be subjected to long wait times and, thus, limited access to care.

Improved Access to Care

The access to care in Germany’s statutory health insurance system juxtaposes the accessibility issues present in Canada. Germany successfully “achieves unusually high levels of care” while still providing “widespread patient choice and universal coverage” (Orvis and Drogus 2015, 605). For example, in the same 2011 report that ranked Canada poorly, Germany was among the top performers, with only 7% of German citizens waiting two months or more for a specialist appointment and 0% of Germans waiting four months or more for elective surgery (The Common Wealth Fund 2011, 8). A major source of this improved access to service is the competition that exists in the German health care system (Orvis and Drogus 604). By distributing funds on a per capita basis and allowing sickness funds to provide rebates and charge premiums, (depending on their expenditures compared to the money they receive on that per capita basis), German health care policy “is designed to increase efficiency as the funds compete for members” (Orvis and Drogus 604). This means that funding mechanisms within the German health care system incentivize sickness funds to provide efficient care and increase access to care (Orvis and Drogus 604). From this, one can see that the German statutory health care system provides greater access to care than the Canadian system, through the use of competition in the health care system. As a single-payer system does not allow for any competition, it is clear that Canada would experience increased access to care by moving away from a single-payer system.


In conclusion, by examining the deficiencies in choice and access to care that exist in the Canadian health care system and the way that the German statutory health insurance system prevents these deficiencies from occurring, it becomes clear that health care in Canada would be improved by moving away from a single-payer system for hospital and medical insurance. As the Canadian health car system continues to change and evolve, it is important that we take in to account the problems associated with a single-payer system and consider the benefits that a statutory health insurance system would provide. Future health care policy in Canada should seriously consider the potential advantages to be gained from adopting aspects of the statutory health insurance system.

Should Canada keep its Single-Payer Health Care System?

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The Common Wealth Fund. 2011. “International Profiles of Health Care Systems, 2011.” Report/2011/Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf.

Canadian Institute for Health Information. 2014. “National Health Expenditure Trends, 1975 to 2014.” 2007. “Canadian Health Care.” Canadian Health Care.

Health Canada. 2010. “Healthy Canadians: A Federal Report on Comparable Health Indicators 2010.”

Omand, Geordon. 2016. “Landmark Private Health Care Lawsuit Heads to Court.” CBCnews.

Orvis, Stephen, and Carol Ann Drogus. 2015. Introducing Comparative Politics: Concepts and Cases in Context. 3rd ed. Los Angles: CQ Press.

Commission on the Future of Health Care in Canada. 2002. “Consumer Choice in Canada’ S Healthcare System.”

The Common Wealth Fund. 2011. “International Profiles of Health Care Systems, 2011.” Report/2011/Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf.


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