Building Responsive and Adaptive Health Care Systems in Canada: Lessons from Switzerland

By Yanick Labrie of The Fraser Institute.

• Canada’s health-care system is increasingly unable to meet patient needs, with wait times reaching record lengths—over 30 weeks for planned care in 2024—despite significantly rising public spending and growing dissatisfaction among patients and providers nationwide.
• Swiss health care outperforms Canada in nearly all OECD performance indicators: more doctors and nurses per capita, better access to care, shorter wait times, lower unmet needs, and higher patient satisfaction (94% vs. Canada’s 56%).
• Switzerland ensures universal coverage through 44 competing private, not-for-profit insurers. Citizens are required to enroll but have the freedom to choose insurers and tailor coverage to their needs and preferences, promoting both access and autonomy.
• Swiss basic insurance coverage is broader than Canada’s, including outpatient care, mental health, prescribed medications, home care, and long-term care—with modest, capped cost-sharing, and exemptions for vulnerable groups, including children, low-income individuals, and the chronically ill.
• Patient cost participation (deductibles/co-payments) exists, but the system includes robust financial protection: 27.5% of the population receives direct subsidies, ensuring affordability and equity.
• Risk equalization mechanisms prevent risk selection and guarantee insurer fairness, promoting solidarity across demographic and health groups.
• Decentralized governance enhances responsiveness; cantons manage service planning, ensuring care adapts to local realities and population needs.
• Managed competition drives innovation and efficiency: over 75% of the Swiss now choose alternative models (e.g., HMOs, telemedicine, gatekeeping).
• The Swiss model proves that a universal, pluralistic, and competitive system can reconcile efficiency, equity, access, and patient satisfaction—offering powerful insights for Canada’s stalled health reform agenda.