Canada’s Battle with Disparities in Healthcare By: Rachelle Madison

Canada’s healthcare system is designed to provide comprehensive and accessible medical services to all citizens, regardless of status or income. Funded jointly by the federal and provincial governments, the system aims to eliminate financial barriers to healthcare through publicly administered health insurance plans. However, despite its universal structure, significant disparities remain, particularly among marginalized groups such as Aboriginal populations and rural residents. While the Canada Health Act mandates universal coverage and aims to eliminate financial obstacles, factors such as geography, ethnicity, gender, and socioeconomic status continue to influence healthcare outcomes. Despite efforts to bridge these gaps, challenges remain in ensuring that all Canadians, regardless of background, receive equal access to quality healthcare.

Canada has a decentralized, publicly funded universal health care system known as Canadian Medicare.[1]However, significant health disparities persist, particularly among individuals of Aboriginal descent, who are more likely to face inequalities within the healthcare system.[2] Under Canadian Medicare, all Canadian citizens receive comprehensive health insurance, funded jointly by the federal government and the thirteen provincial and territorial governments.[3] Each province and territory operates its own health insurance plan, with per-capita financial support from the federal government.[4] The Canada Health Act aims to ensure reasonable access to healthcare services without financial barriers.[5]  To receive federal funding, provincial and territorial health insurance plans must adhere to the Act’s principles: public administration, comprehensiveness, universality, portability across provinces, and accessibility. The Canada Health Act’s purpose is to facilitate reasonable access to health services without financial barriers.[6] To receive federal funding, provincial and territorial health insurance plans must adhere to the Act’s principles: public administration, comprehensiveness, universality, portability across provinces, and accessibility.[7]

Additionally, provincial government health plans must cover essential medical services and ensure reasonable accessibility for all residents.[8] All citizens are entitled to receive medically necessary hospital or physician services at no cost.[9] The federal government contributes roughly forty percent of the funds towards the healthcare system, while the provincial governments cover the remainder through income tax.[10] Despite these publicly funded services, individuals may need to pay for certain expenses, such as outpatient prescription drugs and dental care.[11] However, about two-thirds of Canadians have private insurance to cover these costs, with employers funding 90% of such plans.[12]However, even with these fees, provinces and territories provide some coverage to groups of individuals in need such as First Nations and Inuit peoples, resettled refugees, and inmates.[13]

While Canada provides universal healthcare services to all of their citizens, approximately ninety-two percent of Canadian physicians practice in urban locations.[14] In theory this is beneficial considering eight-one percent of Canada’s population is in urban locations, but it also creates disparities in access for twenty percent of Canada’s rural population, which tend to be those of Aboriginal descent.[15]

Since the health disparities in Canada are not simply caused by a low socioeconomic status, but rather are influenced by more specific factors such as being an Aboriginal descendant or a woman in combination with other factors, it presents a complex problem to solve.[16] For example, women are more likely than men to experience chronic conditions and long-term activity limitations, highlighting gender as a stronger predictor of health disparities than race, except in the case of Aboriginal individuals, who face the greatest healthcare inequities.[17] Interestingly, while Black individuals have historically been the primary marginalized group in many countries, Black Canadians generally report relative satisfaction with their healthcare. [18] In contrast, those of Aboriginal descent experience the most pronounced disparities.[19] This suggests that while factors such as socioeconomic status, gender, sexuality, income, and education contribute to healthcare inequality, systemic structures may not be inherently designed to support marginalized groups equitably.[20]

To address health disparities, Canada has combined its universal healthcare system with targeted programs, particularly for Aboriginal and Inuit populations, who face the greatest healthcare inequities.[21] While these programs help close the gap, they should be seen as temporary measures rather than long-term solutions, as they risk further stigmatizing vulnerable groups and reinforcing systemic biases.[22] Beyond these programs, the government is investing in research that “(i) advances [their] understanding of the causal mechanisms that result in health disparities (ii) identifies effective interventions for reducing health disparities and (iii) measures the cost-effectiveness of different types of initiatives over time.”[23]

Unfortunately, it is crucial for Canada to address healthcare disparities to ensure all citizens receive equal and adequate medical care, especially since the country's malpractice system provides limited options for individuals seeking legal remedies when they experience inadequate treatment.[24] Canada’s legal malpractice system creates significant barriers for patients seeking compensation for inadequate care, ultimately favoring physicians.[25] Patients must pursue claims through the courts, facing high legal costs, a heavy burden of proof, and lengthy delays.[26] With a success rate of only thirty-eight percent and less than one percent of medical injuries resulting in lawsuits, few harmed patients receive compensation.[27] Meanwhile, most physicians have legal representation through the Canadian Medical Protective Association (CMPA), while patients struggle to secure counsel.[28] These obstacles discourage malpractice claims, limiting accountability for healthcare providers and allowing medical disparities to persist.[29]

While Canada’s healthcare system serves as a strong foundation for providing medical care to its citizens, persistent disparities highlight the need for further systemic improvements. Although Canada has taken steps to address healthcare disparities through targeted programs and research initiatives, systemic inequities persist, particularly for Aboriginal communities and rural populations. While universal healthcare provides a foundation for accessible medical services, additional efforts are needed to create long-term, sustainable solutions that do not reinforce stigma or temporary fixes.   Furthermore, Canada’s legal malpractice system offers little recourse for patients who receive inadequate care, further limiting accountability within the healthcare system. With legal and financial barriers discouraging malpractice claims, systemic inequities persist without sufficient corrective measures. To create a truly equitable healthcare system, Canada must go beyond short-term solutions and work toward structural changes that improve accessibility, accountability, and quality of care for all citizens. Addressing these disparities requires a multifaceted approach that considers the broader social determinants of health, ensuring that Canada’s healthcare system truly serves all citizens equitably.

[1] Sara Allin et. al., International Health Care System Profiles: Canada, Commonwealth Fund (Jun. 5, 2020), https://www.commonwealthfund.org/international-health-policy-center/countries/canada.

[2] Health Disparities Task Group, Reducing Health Disparities – Roles of the Health Sector: Discussion Paper (2004), https://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_discussion_paper_e.pdf.

[3] Jennifer R. Weinman, A Deterioration of Health: A Critical Analysis of Health Care Systems, Medical Malpractice, and No-Fault Insurance in Canada, Great Britain, and the United States, 14 Hous. J. Int’l L. 425, 428  (1992).

[4] Sara Allin et. al., supra note 13.

[5] Sara Allin et. al., supra note 13.

[6] Weinman, supra note 31.

[7]  Sara Allin et. al., supra note 13.

[8] Weinman, supra note 31.

[9] Sara Allin et. al., supra note 13.

[10] Weinman, supra note 31.

[11] Id.

[12]  Id.

[13]  Id.

[14]  Id.

[15] Canada Population (Live), WorldoMeter https://www.worldometers.info/world-population/canada-population/ (last visited Feb. 28, 2024).

[16] Health Disparities Task Group, supra note 14.

[17] Id.

[18] Lebrun & LaVeist, supra note 136.

[19] Health Disparities Task Group, supra note 14.

[20] Id. (explaining that the world's historical obsession with racial differences has instilled a perpetuating society that has been programmed to see minority groups as lesser than, which inherently creates a society that is not designed to treat all individuals the same, but rather is designed to always have a lesser group).

[21] Trends in Income-Related Health Inequalities in Canada, supra note 127.

[22] Id.

[23] Id.

[24] Shoo K. Lee et al., Canada’s System of Liability Coverage in the Event of Medical Harm: Is It Time for No-Fault Reform?, National Library of Medicine (Aug. 17, 2021), https://pubmed.ncbi.nlm.nih.gov/34543174/.

[25] Id.

[26] Id.

[27] Id.

[28] Weinman, supra note 31.

[29] Id.