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Health Systems and Policy Monitor (HSPM)

An innovative platform that provides a detailed description of health systems and provides up-to-date information on reforms and changes that are particularly policy relevant. In parallel, the Health Reform Tracker (see the Tracker tab) provides an overview of health reforms in over 30 countries across the WHO European Region and North America. For detailed information on country policy responses to the COVID-19 pandemic during 2020-2021, see our separate COVID-19 Health Systems Response Monitor (HSRM).

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Canada

Health Systems in Transition (HiT) profile

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  1. Country Overview

  2. Health Systems in Transition (HiT) profile

    1. 1. Introduction
      1. 1.0. Introduction
      2. 1.1. Geography and sociodemography
      3. 1.2. Economic context
      4. 1.3. Political context
      5. 1.4. Health status
    2. 2. Organization and governance

      Updated: 11 June 2024
      1. 2.0. Introduction
      2. 2.1. Historical background
      3. 2.2. Organization
      4. 2.3. Decentralization and centralization

        Updated: 11 June 2024
      5. 2.4. Planning
      6. 2.5. Intersectorality
      7. 2.6. Health information systems
      8. 2.7. Regulation
      9. 2.8. Person-centred care
    3. 3. Financing

      Updated: 01 December 2025
      1. 3.0. Introduction
      2. 3.1. Health expenditure
      3. 3.2. Sources of revenue and financial flows
      4. 3.3. Overview of the statutory financing system
      5. 3.4. Out of pocket payments
      6. 3.5. Voluntary health insurance
      7. 3.6. Other financing
      8. 3.7. Payment mechanisms

        Updated: 01 December 2025
    4. 4. Physical and human resources

      Updated: 29 September 2025
      1. 4.0. Introduction
      2. 4.1. Physical resources
      3. 4.2. Human resources

        Updated: 29 September 2025
    5. 5. Provision of services

      Updated: 28 January 2026
      1. 5.0. Introduction
      2. 5.1. Public health

        Updated: 09 December 2022
      3. 5.2. Patient pathways
      4. 5.3. Primary care

        Updated: 07 February 2025
      5. 5.4. Specialized care

        Updated: 13 January 2023
      6. 5.5. Urgent and emergency care
      7. 5.6. Pharmaceutical care

        Updated: 28 January 2026
      8. 5.7. Rehabilitation / intermediate care
      9. 5.8. Long term care

        Updated: 28 January 2025
      10. 5.9. Services for informal carers
      11. 5.10. Palliative care
      12. 5.11. Mental health care
      13. 5.12. Dental care

        Updated: 01 March 2024
      14. 5.13. Health services for Indigenous peoples
    6. 6. Principal health reforms

      Updated: 01 December 2025
      1. 6.0. Introduction
      2. 6.1. Analysis of recent reforms

        Updated: 18 September 2023
      3. 6.2. Future developments

        Updated: 01 December 2025
    7. 7. Assessment of the health system
      1. 7.0. Introduction
      2. 7.1. Health system governance
      3. 7.2. Accessibility
      4. 7.3. Financial protection
      5. 7.4. Health care quality
      6. 7.5. Health system outcomes
      7. 7.6. Health system efficiency
    8. 8. Conclusions
      1. 8.0. Introduction

6.2. Future developments

In recent years, there has been an emerging expert and public consensus to add outpatient pharmaceutical therapies to the package of UHC in Canada. Beginning with a Canadian House of Commons Standing Committee on Health review of the prospects for a national Pharmacare programme in Canada between 2016 and 2018 followed by an Advisory Council on the Implementation of National Pharmacare, the Government of Canada has received recommendations in favour of adding outpatient drugs to UHC. Both the House of Commons Standing Committee on Health (2018) and the government-appointed Advisory Committee on the Implementation of National Pharmacare (2019) have recommended in favour of a medicare-style model in which provinces and territories would administer single-payer coverage plans under national standards. This change, if actually adopted, would be the most significant reform since universal medical care coverage was implemented in the late 1960s and early 1970s. However, there is significant opposition to the programmes from the private insurance companies and, to some extent, by the pharmaceutical companies.

Furthermore, the COVID-19 pandemic of 2020 has led to rapid health system change across Canada, such as the escalation of virtual care in primary and ambulatory care; it has also drawn attention to some of the major weaknesses in the health system. Broadly, there are at least three changes triggered by the pandemic that may have lasting impacts on health care in Canada. The first is a shift in political and public focus from Pharmacare to LTC reform due to the concentration of COVID-19 cases and deaths in LTC institutions and retirement homes, the sustained media reporting on the LTC sector, and reports from the Canadian Armed Forces in May 2020 detailing the mistreatment, abuse and inadequate care and infection control within LTC homes in Ontario and Quebec, the two provinces to which they were deployed to provide support during outbreaks. The second area of change relates to the high cost of pandemic measures, both health system and economic relief measures, that have significantly increased FPT governments’ deficits and overall public debt. These deficits may lead to a period of health spending restraint after the crisis, and perhaps at the same time when PT governments in particular are coping with the spillover effects of the restrictive public health measures and backlog of elective and non-urgent care. The third area of change relates to increased awareness of the need to shore up and improve public health infrastructure across Canada and to improve FPT collaboration and data-sharing.

Ontario’s Primary Care Action Plan is considering granting psychologists with advanced postdoctoral training in clinical psychopharmacology authority to prescribe certain psychotropic medications, such as antidepressants, and order or interpret diagnostic tests like bloodwork, urinalysis, and ECGs for mental health or addiction care. The reform aims to address long wait times, prescriber shortages, and demand for integrated, community-based services. Goals include improving access, ensuring continuity between therapy and medication management, and relieving pressure on primary care and psychiatric systems. Supporters, including the Ontario Psychological Association, call the proposal a milestone in modernizing care. Critics, such as the Ontario Medical Association and family physician groups, warn it risks fragmenting care and compromising patient safety, citing reduced training and supervision standards. Consultations ran until 3 November 2025, but no regulatory amendments have been enacted. Success, if adopted, will depend on rigorous training, integration with primary care teams, and careful monitoring of safety, equity and continuity.
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Ontario is considering expanding optometrists’ scope to prescribe topical and oral medications, remove superficial corneal foreign bodies, manage open-angle glaucoma, order diagnostic tests and perform select in-office procedures such as laser therapy and minor non-intraocular surgery. The reform aims to address long wait times for ophthalmologists and overburdened emergency departments. Between 2010 and 2020, patients waiting for ophthalmological surgery in Ontario increased by 74%, with cataract, vitreoretinal and strabismus surgeries facing the longest delays. The goal is to improve timely access, reduce unnecessary referrals and ease hospital pressure, particularly in rural or underserved areas. Supporters, including the Ontario Association of Optometrists and the College of Optometrists of Ontario, argue the changes reflect modern training and will enhance efficiency. Critics, notably the Canadian Ophthalmological Society, warn surgical and laser procedures require specialized expertise and could pose safety risks. Proposals submitted in 2024 remain under consultation, with no enacted changes or outcome data.
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Alberta is proposing legislation to let residents pay out-of-pocket for diagnostic and preventive tests, for example, MRIs, CT scans, ultrasounds and full-body scans, without needing a physician’s order. Currently, private diagnostic options are limited, and public wait times can stretch months or years. The reform responds to concerns about unused system capacity, rationing of publicly funded procedures, and delayed detection of health issues. The government argues that expanding private-pay options will modernize health care, attract investment and professionals, ease pressure on public resources and improve early detection. Features include reimbursement if a privately purchased scan reveals a significant condition, while physician-ordered tests remain fully covered. Critics, including the Alberta Medical Association, warn the policy could worsen inequities, drain technologists from hospitals, and create a two-tier system. Supporters counter it will reduce wait times and expand choice. Outcomes are unknown, with legislative updates expected in 2026.
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