Canada’s Healthcare Ranks Second Last Among G20 Despite High Spending [2025 Update] According to recent international comparisons, Canada’s healthcare system now ranks second last among the G20.
This low placement comes despite Canada spending more on healthcare than most peer countries. New findings highlight issues with long waits for regular appointments and surgeries, and inadequate access to timely care.
While more than half of Canadians remain somewhat satisfied with their provincial health systems, growing numbers are expressing support, including a mix of public and private care options. The ongoing debate reflects deep concerns about the efficiency and fairness of care delivery across the country.
Understanding the Global Healthcare Rankings
Recent global reports place Canada near the bottom among G20 nations for healthcare performance, despite significant public investment. Top international indices such as the Healthcare Time Saved Index and the Commonwealth Fund’s Mirror, Mirror report assess national systems using a core set of clear criteria. These benchmarks include access to care, efficiency, quality, equity, and patient outcomes.
How Canada Is Measured
Global healthcare rankings focus on day-to-day realities that affect patient experiences. Canada consistently falls behind on several critical metrics:
- Wait times: Canadians experience some of the longest waits for both family doctor visits and specialist procedures. Data from the Healthcare Time Saved Index 2025 highlights that Canadians spend more hours waiting for appointments and planned surgeries than their peers in most G20 countries. Top-ranked systems, by comparison, deliver faster access to primary and specialist care, which directly impacts outcomes and satisfaction.
- Doctor availability: Canada has fewer physicians per capita than leading G20 nations. This doctor shortage, especially acute in rural and remote regions, drives up wait times and reduces access.
- Technology and infrastructure: While Canada has made some progress, the integration of digital technology, such as electronic health records and telehealth, still trails well behind leaders like Denmark and the Netherlands. Poor investment in these areas slows down both routine and emergency care delivery.
- Care coordination: Fragmented communication between hospitals, clinics, and other care providers remains a problem. This lack of coordination delays treatment and often results in duplicated or missed services.
- Resource allocation: High overall spending doesn’t translate into better outcomes. Unlike top performers, Canada sees gaps between investments and measures of quality, such as reduced hospital re-admissions or improved long-term health.
For readers seeking a deeper understanding of the data behind these metrics, the methodology and breakdown are available in the World’s Best Hospitals 2025 Methodology and the Healthcare Time Saved Index 2025.
Breakdown of G20 Leaders and Laggards
Rankings change, but recent annual reviews help clarify which countries are setting the pace and which fall behind.
Leading the G20
- Denmark and the Netherlands are recognised as front-runners. Both countries offer quick, reliable access to care, driven by heavy investment in health technology and a focus on reducing waits for treatment. Strong primary care networks and smart digital tools allow patients to get help quickly, often in days, not weeks.
- Germany and Australia also perform well. They prioritise timely access, maintain high doctor-to-patient ratios, and invest in patient outcomes rather than just infrastructure. As a result, their residents report high satisfaction alongside better-than-average health indicators.
Laggards in the Group
- Besides Canada, some G20 members like the United States struggle with equity and affordability, even as they excel in other areas such as advanced care and innovation. Gaps in insurance coverage and uneven access keep overall scores lower.
- Brazil and South Africa face challenges due to disparities in health access and outcomes between different population groups and regions. Limited resources, staff shortages, and long wait times persist across much of their health systems.
Canada’s position is shaped by these same measurement standards, capturing a complex picture of strengths and gaps. Full results from the latest Healthcare Time Saved Index and updated system comparisons from the Commonwealth Fund’s Mirror, Mirror report offer more details about the relative positions of each G20 nation, including where reforms have shown results and where setbacks persist.
These reports illustrate a clear gap between investment and outcomes for countries at the lower end of the scale. In many cases, those who rank highest deliver not only efficiency but also more equitable and reliable care across different patient groups.
Key Challenges Facing Canada’s Healthcare System
Canada’s low ranking among G20 healthcare systems is tied to clear challenges that affect both urban and rural residents. These issues run deeper than statistics and reports—they shape the daily realities faced by patients trying to get timely and reliable care.
Chronic Wait Times and Delayed Care
Long waits have become the default for many Canadians. Data points to several areas where wait times stand out:
- Elective surgery: The median wait for procedures such as hip or knee replacements stretches up to 210 days, among the longest in developed countries.
- Specialist appointments: About 60% of Canadians wait more than a month to see a specialist, while only 25% of Swiss patients experience similar delays.
- Emergency room visits: The average in-clinic wait clocks in at 68 minutes, the highest among peer nations and well above international averages.
- Primary care access: Getting a family doctor appointment means waiting over two weeks for roughly 68% of Canadians.
These delays have very real consequences. Waiting for essential procedures can worsen illness, delay recovery, and reduce quality of life. Patients often spend time searching for care instead of receiving timely treatment—a dynamic that has grown all too common.
Delayed care raises stress, increases risks of complications, and can even push simple health issues into emergencies. Chronic bottlenecks in appointments and surgeries pile up, leaving both patients and providers frustrated.
Hospital and Workforce Constraints
Shortages in hospital resources and trained nursing staff have become a significant roadblock. Canadian hospitals have among the lowest rates of beds, specialist equipment, and physicians per capita across the G20. This resource gap is especially pronounced outside major cities.
Key challenges include:
- Bed shortages: Hospitals in many provinces operate close to capacity, limiting flexibility during flu season or health crises.
- Physician-to-patient ratios: Canada’s physician pool is stretched thin. Many family doctors carry large patient loads, leaving less time for individual care.
- Regional inequities: Rural and northern communities face greater shortages. Patients sometimes travel hours—or even days—for routine procedures due to the lack of local medical staff and facilities. Provincial programs, such as those outlined here, aim to bring more physicians and nurses to underserved areas, but shortages persist.
- Workforce burnout: Heightened workloads have fueled staff burnout across the country. Canada’s unions recently raised concerns about labour shortages reaching a “dangerous tipping point,” as highlighted in a recent statement.
While the federal government has invested in efforts to attract and retain healthcare professionals, including recent funding to address shortages as reported by Canada’s Employment and Social Development department, recruitment continues to lag behind the growing demand.
Administrative Inefficiencies and Coverage Gaps
Canada’s system faces ongoing administrative hurdles that affect both patients and providers alike.
- Lack of coordinated care: Disjointed communication between hospitals, clinics, and specialists slows care and leads to repeated or missed treatments.
- Outdated infrastructure: Many healthcare facilities have not kept pace with the demands of a modern population. Investments in technology have lagged what’s seen in top-performing countries.
- Coverage gaps: Basic healthcare remains publicly funded, but Canadians continue to pay out of pocket for prescription medications, dental care, and vision services. For many, this results in financial strain or delays in seeking needed care.
- Electronic health record (EHR) integration: Progress on fully digitising health records is slow. Limited EHR adoption across provinces makes it harder to coordinate care and ensure that patient histories are easily accessible to all providers.
The combined effect of these inefficiencies slows down the system, increases administrative burdens, and frustrates both frontline staff and those waiting for help. These gaps reveal why higher spending does not always yield better outcomes for Canadians compared to other G20 nations.
Canada’s health system continues to face mounting pressures. With demand growing and resources stretched, the ability to respond to patient needs remains a top concern.
Learning From International Success Stories
Looking at leading G20 healthcare systems reveals common themes behind their success. Countries like Switzerland and the Netherlands have gained recognition for combining public and private sector strengths, maintaining universal coverage, and investing in technology that puts patients first. These systems show that purposeful change, not just higher spending, leads to better health outcomes and experiences.
The Decentralised and Mixed Model Advantage
Top-ranked healthcare systems often use a decentralised model with both private and public care providers, giving patients more choice while maintaining strong public oversight. This approach is seen in Switzerland, the Netherlands, and the United Kingdom, where public funding supports universal access and competition among providers drives up standards.
Key features of these systems include:
- Public and private sector mix: Public funding covers everyone, but private providers also participate. Patients can choose between providers, encouraging higher quality and shorter wait times.
- Strong government oversight: While competition stimulates improvement, regulation ensures no one is left behind. Universal insurance means costs are manageable for all patients.
- Regional autonomy: Decentralisation management to respond to community health needs more effectively, avoiding a one-size-fits-all approach.
For example, Switzerland blends private insurance options with a public guarantee that all residents receive care. This structure keeps out-of-pocket costs low for patients and ensures no one is denied treatment. In the Netherlands, insurers compete on service quality, but are required to accept everyone, which keeps standards high across the board.
Academic reviews and G20 policy documents highlight how public-private partnerships can boost access without undermining equity. The G20 has urged more countries to explore these models, as outlined in its report on universal health coverage and public-private collaboration and the broader summary from the Digital Economy Working Group.
Unlike Canada, where most care is publicly delivered, these countries use competition to address bottlenecks, helping reduce wait times, improve outcomes, and relieve health system pressure. Their experience shows that private involvement need not threaten equal access when public funding and regulation are strong. Targeted partnerships help clear surgical backlogs and introduce service innovations, all while maintaining broad access.
Digital Health and Patient Engagement Innovations
Alongside funding and structure, leading healthcare systems invest in digital tools to widen access and improve care coordination. Digital health innovations—like virtual consultations and integrated electronic records—have helped reduce waits and support better health outcomes in countries at the top of international rankings.
Several real-world examples stand out:
- Telemedicine and virtual care: Denmark and the UK expanded telehealth services, letting patients consult physicians online for common issues. This saves time for both patients and doctors, helping more people get care quickly and safely.
- Integrated electronic records: Top performers use shared digital records to ensure test results and medical histories travel with the patient, cutting down redundant tests and wasted appointments.
- Smart care coordination tools: Digital apps and portals help patients schedule appointments, receive reminders, and track progress on referral lists. These tools put the patient in control and streamline communication between providers.
A review from the G20’s health working group highlights the value of tech adoption in lowering barriers across fragmented systems. Countries that have embraced digital innovation, as discussed in this overview of top healthcare innovations in 2024, saw direct gains in reduced delays and higher satisfaction.
Emerging solutions such as artificial intelligence for triage, remote monitoring for chronic conditions, and automated prescription renewals further speed up care. Leading private and public systems deploy these tools to connect rural patients, reduce unnecessary hospital visits, and ease the burden on frontline staff. Stanford experts point out how digital health innovation boosts access in underserved communities, narrowing gaps for people far from city centres.
Canada’s relatively slow integration of these tools leaves patients behind their peers in other G20 countries. International experience indicates that smart investment in digital health does not just modernise systems—it removes long waits and puts timely, reliable care within reach for more people.
Paths Forward: Reforming Canada’s Healthcare for the Future
Canada’s healthcare system ranks low among G20 nations despite heavy investment. Provinces have started to experiment with new policy tools and collaborations to tackle core issues like surgery backlogs, long wait times, and uneven access. These efforts raise important questions about how reform can scale across the country and what it takes to gain consensus for real change.
Policy Innovations and Pilot Programs at Home
Several provinces have launched pilot programs to speed up access and cut waiting times. Quebec leads in this area through a partnership with private clinics, allowing patients the choice to pay for certain procedures if public waitlists are too long. This approach emerged after the 2005 Supreme Court decision in Chaoulli v. Quebec, which ruled that excessive wait times can violate patients’ rights to timely care. The Supreme Court’s findings set a precedent, supporting the idea that private alternatives can run alongside public care where access falls short. Details on the ruling are available in the official court summary of Chaoulli v. Quebec.
Quebec’s model enables private clinics to perform surgeries like hip replacements or cataract removal, which traditionally saw long public waitlists. This shift did not eliminate the public option; instead, it offered relief to those who could not afford to wait months for surgery. According to an analysis by the Journal of Ethics, the decision sparked debate across Canada about whether other provinces should follow Quebec in adapting single-payer rules to improve access (Chaoulli v. Quebec: Testing the Single-Payer System).
Other provinces have also tried new programs:
- British Columbia tested contract partnerships with private surgical centres to address waitlists for minor procedures.
- Ontario expanded its use of Independent Health Facilities to deliver diagnostics and day surgeries, reducing pressure on hospitals.
- Saskatchewan launched targeted funding for private orthopaedic and cataract surgeries, which helped clear some backlog and shortened wait times in targeted communities.
These initiatives are not yet the norm nationwide, but they show that targeted private sector involvement can offer relief without undermining universal coverage.
Scaling Successful Reforms and Building Consensus
Wider adoption of reforms depends on coordination among provinces, firm political will, and public agreement. Canadian healthcare remains a provincial responsibility under federal funding rules, making national reforms complex. Provinces must agree not only on new programs but also on common standards to avoid a patchwork of care quality.
Several steps are needed to bring local successes to scale:
- Political support: Elected leaders must prioritise outcome-based reforms over traditional process-driven approaches. Safe experimentation with new delivery models depends on sustained political commitment, even when facing public scepticism or organised opposition.
- Provincial collaboration: Regions should share data on what works, harmonise rules for private participation, and maintain strict public funding rules to ensure fairness.
- Stakeholder engagement: Building consensus means providers, unions, and patient groups need to be involved from the start, making sure reforms address workforce needs and protect equitable access.
The 2005 Supreme Court ruling gave provinces legal cover to try new approaches (A Victory for Freedom: The Canadian Supreme Court’s Ruling on Private Health Care). Since then, public appetite for reform has risen in step with growing frustration over wait times. However, official changes remain slow, held back by concerns about privatisation and institutional inertia.
Evidence from recent pilot programs suggests:
- Patient wait times drop when there is an option to pay for procedures privately if the public queue is too long.
- Backlog-targeted funding and public-private partnerships can clear bottlenecks without reducing access for lower-income patients when managed under strict oversight.
- Clear communication, transparency, and ongoing measurement are critical to keep reforms on track and maintain trust.
Getting lasting improvements will require more than local pilot projects. It calls for a coordinated effort to update laws, train staff for new care models, invest in digital systems, and ensure provinces work together on standards and evaluation.
As new policy tools take shape across Canada, success will depend on the courage to try new ideas, learn from both wins and losses, and build the consensus needed to reshape the system for future needs.
Summary
Canada consistently ranks near the bottom among G20 nations in healthcare, despite high public spending. Persistent delays, underused digital tools, and uneven access are keeping the system from meeting the needs of many Canadians.
Examples from countries like the Netherlands and Switzerland show there are tested ways to offer better, faster care while protecting fairness. Provinces that have piloted targeted reforms, including partnerships with the private sector and investments in digital health, have seen measurable improvements in wait times and access.
Addressing workforce shortages, streamlining administration, and adopting practical technology solutions can help close the gap. The urgency to act is clear. Learning from proven models at home and abroad can drive a system that works for all Canadians.
The path forward depends on political will, coordinated reforms, and openness to new ideas. The future of Canadian healthcare rests on making these choices now.
