The delivery of healthcare in Canada is shaped by a number of variables – geography, legislation, federal structure, location and culture.

A vast geography

At 10 million km2, Canada is the second largest country in the world but it is sparsely populated – it has only 32 million inhabitants. Canada would cover the whole of Europe and part of Asia but two-thirds of the population live within 300 km of the US border.

A federally monitored Health Act

Since 1967, the country has embarked on the ambitious provision of ‘medically necessary’ healthcare to all its citizens based on five tenets – universality, comprehensiveness, accessibility, portability of coverage and non-profit public administration. These equally apply to mental and addiction disorders. Currently, the main problem is long waiting lists interfering with accessibility.

The dynamics of provincial jurisdiction

Each of the governments of the ten provinces and three territories has the responsibility and control of healthcare within its own boundaries. The national congruence of service delivery remains remarkable.

Location

Canada's contiguity with the USA shapes the public debate concerning healthcare. On the one hand, national pride is readily expressed at the high standards of North American care delivery, while training and publishing in the USA are highly valued; on the other hand, there is widespread public concern about the excesses of US-based managed care and the significant portion of that population without insurance. This results in a determined effort to learn from both US and European influences to create a uniquely Canadian blend (Rae-Grant, 2001).

A cultural mosaic

Canada is a welcoming land of opportunity to a steady stream of immigrants and with a birth rate of 1.5 children per couple the country will continue to depend on migration for its sustenance. With two official languages, English and French, and many unofficial cultures, multiculturalism rather than a ‘melting pot’ policy is one of the prized social characteristics. The healthcare workforce reflects society's mosaic. The first inhabitants of this country, the First Nations, have not fared well so far and this is reflected in higher morbidity and mortality risks.

Canadians in general highly value their healthcare system, known as medicare (which is publicly financed but privately run) and public polls suggest that medicare is considered an essential ingredient of Canadian identity.