The decades-long trend of disinvestment in healthcare infrastructure has led to unacceptable barriers to access and serious challenges to the quality of care Canadians receive. Addressing these issues can seem dauntingly complex; before adopting new policies, it’s important to make sure remedies are well designed to achieve a return on investment. In determining the most impactful ways to move forward, the government and other key players in Canada’s healthcare system can look to other countries whose healthcare systems are particularly effective on a given measure and take a page from those countries’ playbook.
Prioritizing primary care that is patient-centered
When a patient has an ongoing relationship with a primary care provider, this greatly increases the likelihood the patient will receive the recommended screenings, vaccinations, and other preventive care. On average, regular visits with a primary care provider reduce all-cause mortality risk and decrease healthcare costs for a given patient. Yet, Canada ranked last in a survey of 10 high-income countries in terms of the percentage of the population that said they have a physician they commonly see for medical care. Just 86% of Canadian respondents said this was true for them in 2023—down from 93% in 2016.
The leading country in that survey was the Netherlands, where 99% of respondents reported having a doctor they visit on a regular basis. The Netherlands requires citizens to purchase health insurance and subsidizes premiums for low-income persons; primary care visits are then free (that is, 100% covered by insurance. The Dutch government has undertaken targeted efforts to emphasize primary care and strengthen care networks; the National Prevention Agreement, signed in 2018, enlists the help of organizations representing healthcare providers and insurers, as well as sports associations, local government, and business leaders, to focus on preventive measures such as reducing alcohol and tobacco use.
Another reason many countries look to the Dutch healthcare system as a model to emulate is its focus on patient-centered care. As the name indicates, this approach places the patient at the center, aligning the care plan around the needs of the patient rather than the needs of the provider or the healthcare system. In addition, this approach emphasizes that the patient and not the provider is the one in charge. This shift in perspective empowers patients to ask questions and make their own decisions, providing an added level of accountability for health providers and systems—and, in the process, leading patients to take on a greater sense of agency and responsibility in managing their own health. Patient-centered care doesn’t just lead to greater patient satisfaction and better health outcomes; it also tends to improve morale for healthcare workers. Among the countries with the highest primary care uptake, Norway and Sweden are also known for their adoption of patient-centered care.
Leveraging technology and innovation to improve care
The same bureaucracy that plays a crucial role in patient safety can sometimes act as a barrier, preventing innovations with lifesaving potential from actually reaching patients in a timely manner. Canada recently took a positive step in this area with the creation of a temporary access process for medications with promising early results that haven’t yet had time to go through the clinical trial process for full authorization. In general, it takes too long for scientific and technological innovation to reach a mass market when people’s health is at stake. Governments should continue to look for ways to increase access to innovative drugs, devices, and treatments while continuing to prioritize patient safety.
Some of the same countries that have shown flexibility in adopting patient-centered care are also known for their openness to innovation in the healthcare space. Denmark is a leader in healthcare digitization; Sweden is also a model in adoption of healthcare technology, including as a way to increase access to care in remote areas.
Among other nations, South Korea is known for its widespread adoption of digital health and for demonstrating the possibilities of using big data to generate insights and drive decisions at the system level. Singapore has one of the world’s highest adoption rates for artificial intelligence, and this technology is already yielding impressive results for disease detection and personalized medicine.
Pursuing efficient allocation of resources and sustainability of funding
While it is true that Canada spends less on healthcare per capita than most other highly developed nations, simply spending more does not guarantee better results. Increasing spending may not have the desired outcome without a well-designed strategy. Countries whose healthcare systems rank highly in terms of efficiency tend to tie funding to evidence-based treatments and emphasize long-term planning, system-level integration, and sustainable funding models.
In contrast to the Dutch model, in which citizens are required to buy insurance but have a choice about which insurer to enroll with, in Australia enrollment in the universal public health insurance program is mandatory and automatic. The government also subsidizes the purchase of supplemental private health insurance, which about half of Australians add on to the publicly funded coverage. This collaboration with the private sector is a key feature of Australia’s brand of universal healthcare and has been instrumental in helping to rein in the cost to taxpayers while also delivering a high quality of care.
Germany has a long history of socialized healthcare, with the world’s first such system having been introduced there in 1883, and holds equity as a core value of its healthcare system. Compared to Canada, Germany has higher ratios of physicians per capita and hospital beds per capita—metrics that translate to increased access. Germany also has several systems in place for measuring quality and efficiency of drugs and treatments to ensure that evidence-based care is delivered and that healthcare spending is matched with tangible results. Nationwide disease registries help to ensure consistency of care according to established best practices and emerging changes in guidance.
Addressing health inequities and disparities in access
Universal coverage goes a long way in promoting access to care, and in this sense Canada performs well. However, if long wait times for care in the public system drive people to pursue their treatment in a separate, private system, this leads to a stratified healthcare system in which your socioeconomic status determines what kind of care you receive and how long it takes to get it. Other countries well known for their universal coverage, such as the United Kingdom and Norway, have also grappled with the challenge of long wait times for patients. Among developed countries with universal coverage, those with the shortest wait times according to the OECD include the Netherlands, Germany, and Switzerland.
As part of an effort to close the gap in life expectancy and other health measures that separated it from other Nordic countries, in the last four decades, Finland has undertaken three national health policy programs aimed at addressing health disparities. One major focus has been providing comprehensive access to care at the level of local communities rather than forcing people to travel to urban areas for specialized care. The latest campaign encourages communities to consider the social determinants of health as a lens to inform policies, priorities, and program offerings.
Countries with a significant rural population commonly face challenges in eliminating disparities in access, given the difficulty of attracting physicians to remote areas and the economies of scale that cities present. For disadvantaged groups, distrust of the medical system can compound these inequities. Notably, New Zealand has invested considerable effort into reducing disparities across its geography, including a focus on improving life expectancy for the indigenous Maori and Pacific Islander populations. This holistic approach considers the structural factors—whether social, economic, cultural, or historical—that contribute to disparities with a goal of addressing the source, not just the downstream effects. Crucially, it involves the indigenous and disabled communities in program creation and delivery. It recognizes the role of mental and behavioral health services to support mainstream medical care, as well as supports to minimize the impact of illness and disability on socioeconomic status. Routine collection and reporting of data on health disparities encourages accountability for the results of these efforts.
In charting a path forward for its own healthcare system, Canada can learn from these examples and take the best from each of them. Improving health outcomes for Canadians will require increasing access to primary care and boosting the effectiveness of that care with a focus on public health education about health-promoting behaviors and preventive measures.
Moving to a patient-centered approach to care can lead to improved outcomes and greater satisfaction on both sides of the patient-provider equation. Efforts to evaluate effectiveness and efficiency can ensure alignment of initiatives with broader goals. Any feasible plan must include attention to health inequities and disparities in access. Innovative technologies are one tool that can help reduce disparities; a relatively simple technology-based solution such as an electronic patient portal or a virtual visit can help improve coordination and elevate overall quality of care.