🇨🇦 Canada Is Spending More on Health Care. So Why Does It Feel Worse?

By Dean Brown.

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Good morning,

A reader recently asked me a question I think a lot of Canadians have wondered about:

If governments keep spending more on health care, why does getting care seem harder?

Because Canada certainly isn't spending less.

Health spending was expected to reach almost $399 billion in 2025, or $9,626 per Canadian.

Yet millions still don't have a regular health-care provider, hospitals remain crowded, and waits for several procedures are worse than before the pandemic.

So where is the money going?

A bigger health budget doesn't automatically mean the same increase in actual care.

Hospitals are paying more for workers, drugs, equipment, construction and supplies. Canada also experienced unusually fast population growth in recent years (due to immigration) while the population continued to age.

That means a lot of additional spending is simply required to keep the existing system running.

And the demand keeps increasing.

More Canadians.

More seniors.

More complex patients.

So even if governments add doctors, nurses or surgeries, access can still deteriorate if demand grows faster.

An estimated 5.7 million Canadian adults did not have a regular health-care provider in 2024.

Canada actually has more family doctors than it did a decade ago.

But the number hasn't kept pace with the population and existing demand.

There is also a less obvious capacity problem: Canadian family doctors reported spending a median 20% of their working time on administration.

That's roughly one day every week not spent directly seeing patients.

So simply saying “train more doctors” only answers part of the problem.

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Here's what that adds up to:

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Here's another number that surprised me.

Canadian hospitals added about 87,000 full-time-equivalent workers between 2014 and 2023, an increase of roughly 24%.

But hospital beds increased by only about 4%.

And nearly 17% of hospital days outside Quebec were being used by patients who no longer needed acute hospital care but couldn't leave because appropriate long-term care, rehabilitation or home support wasn't available.

That creates a chain reaction.

A patient can't leave the hospital.

Someone in the ER can't get their bed.

The emergency department backs up.

And everyone behind them waits longer.

This is where the comparison gets difficult to ignore.

Using standardized OECD figures:

Canada isn't a low-spending health system.

But some of the capacity Canadians notice most is relatively scarce.

And that helps explain why increasing the health budget hasn't automatically produced easier access.

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Canada performed 26% more hip replacements and 21% more knee replacements in 2024 than in 2019.

Yet waits for both remained worse.

How?

Because demand grew even faster.

Think of a restaurant adding five tables while ten more families arrive.

Capacity increased.

The lineup still got longer.

And that, more than anything, is the problem Canada keeps running into.

This is where the question gets harder.

Does Canada need:

More doctors?

More hospital beds?

More long-term care?

More private delivery?

Less paperwork?

More money?

Or are we already spending enough but organizing it badly?

I went through those arguments in today's full Plus investigation, including what other countries do differently and which reforms appear most likely to improve access.

I don't think the evidence supports either simple political answer.

“Just spend more.”

Or:

“The public system doesn't work.”

Canada is already spending a lot.

But some of the actual capacity Canadians need to access that system hasn't kept pace.

More money may still be necessary.

The bigger question is what exactly we're buying with it.

Because if Canada eventually spends $450 billion a year but still can't improve access, we'll be asking this same question again.

If you could fix one thing first, what would it be?

Family doctors, hospital beds, long-term care or surgery wait times?

Hit reply and tell me why.

Until Tomorrow,

Dean