Canadian Medical Association

It's time to talk consultations on public and private care in Canada

Millions of Canadians aren't getting the health care they need, when they need it.

Some provinces are filling gaps in the health system by expanding private delivery of care, while others are pulling back

Understanding what this all means is critical. The Canadian Medical Association (CMA) believes it’s a pivotal moment to speak up for the health system we want, grounded in a shared understanding of the system we already have and key issues of access, equity, quality and system capacity.

Through 2023 and 2024, we’ll be holding focused dialogues on the balance of public and private care in Canada with patients and physicians, as well as wider public discussions hosted by The Globe and Mail. Our goal is to educate and engage Canadians, and what we hear will help shape CMA policy and advocacy at a national level. We also invite physicians to join us online at CMA Community to engage on issues—like this one—that matter most to the profession. 

Uniting physicians from urban, rural and remote communities across Canada, the CMA is uniquely positioned to lead informed, constructive discussions focused on the right priorities: patients getting equitable access to the care they need and providers thriving in healthy work environments.

Public-private primer

What we mean when we talk about public and private health care in Canada

Video Transcript

Canada has an aging population, more complex health needs than ever, and NOT enough health workers. Many patients aren’t getting access to the care they need. And some governments are turning to the private sector for help. Do we need a new balance of public and private health care in Canada? The Canadian Medical Association believes it’s time to talk.

Regardless of their ability to pay, every Canadian is guaranteed access to: Hospital care, physicians, and diagnostic services like X-rays and blood tests. But every province and territory can determine how services are provided and what is or isn’t covered by public health insurance.

Private health care can refer to services that are not covered by any level of government. The physiotherapy you pay for through employee health insurance.

Cosmetic surgery you cover out of pocket. Private health care can also refer to public health services delivered by private facilities or providers.

For example: Some governments outsource specialized procedures, like cataract surgeries, to private facilities. You can also get a flu shot at many for-profit pharmacies.

Let’s look at how access to an MRI scan varies across the country. Remember that diagnostic services are guaranteed for every Canadian regardless of the ability to pay. But unless you need emergency care, there can be long – very long – wait lists.

In provinces including Alberta, Quebec and New Brunswick, paying a private clinic to get ahead of the line for an MRI scan is permitted. Full stop.

In Saskatchewan, patients can pay for faster access to MRIs at private clinics but clinics must match every privately funded MRI with a spot for someone on the public waiting list.

Where paying for an MRI scan out of pocket is not an option at all, patients will have to travel to another part of Canada – or another country.

As of 2022, 72% of all health care was paid for by governments, 15% by private health insurance, 11% by patients themselves, and 2% came from other sources, like donations. On average, Canadians spend more than $1,000 out of pocket per year on health care.

In February 2023, the Angus Reid Institute surveyed Canadians on the possibility of increased private funding and delivery of care: 28% think privatization is a necessary evolution of care, 33% acknowledge the benefits of both public and private care, and 39% are public health care proponents.

The CMA is listening to patients, physicians and other health workers to hear their perspectives on the balance of public and private care in Canada.


Common terms of reference in discussions about public and private care

Opting out

Rules around private medical practice across the country

How other countries do it

Comparing Canada to the mix of public and private care in five other OECD countries

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“We want to understand what’s most important to all Canadians, and to ensure that urgently needed solutions to the health care crisis are grounded in the lived experiences of the people who actually use, and work in, our health systems.”

– Dr. Kathleen Ross, CMA president

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