What can Canada learn from one of the world’s top health-care systems?
That question has animated our reporting over the past several months. Reporter Alexandra Keeler spoke with 13 experts to understand Australia’s health-care model and why it consistently ranks at or near the top of the Commonwealth Fund’s report on leading health systems.
Our series has not been driving at any particular conclusions. We began this project with little knowledge of Australia’s health-care model and its key features.
But through our reporting, we have come away with several takeaways:
First, we should scrap the universal-versus-private binary. Framing Canada’s health-care choice as a stark choice between our existing, predominantly single-payer model and American-style private care is unhelpful and costly. It blinds us to promising ideas for reform.
Most of the world’s leading health systems are hybrid models, where public care is strong and private care performs an essential role.
In Australia’s case, that means a system of publicly funded hospitals and primary care, but also a private system of hospitals and clinics funded through private insurance, out-of-pocket payments and government subsidies.
Under this system, Australia leads the world in health outcomes and health equity, meaning it shows the smallest differences in health access and experiences based on a resident’s income. This high level of equity challenges the popular narrative that two-tier systems necessarily leave lower-income residents worse off.
Australia achieves these top outcomes while spending the least on health care as a percentage of GDP, a measure that includes all public and private spending.
Second, private where necessary, but not necessarily private. The option of private care can function like a “release valve” for strained public systems, one expert said. But private options are not optimal in all circumstances.
Take Canada’s approach to drug coverage. Currently, Canada funds drugs through a messy patchwork of public and private schemes: we have a tiny national pharmacare program that only funds a few drugs in a few provinces; provincial schemes that fund select groups; employer-sponsored insurance; and out-of-pocket payments.
Australia, by contrast, runs a universal, national pharmacare scheme that ensures drug coverage for all. As the single purchaser of drugs, the country is able to drive down drug prices. Australians pay about 30 per cent less for brand name drugs than Canadians.
Third, mental health is health. Mental health is essential to overall health and should be an integral part of health system design.
Currently, both Australia and Canada treat mental health care as peripheral. Care is funded through a mix of public funding, private insurance and out-of-pocket payments that leave a “missing middle” without effective care.
Some European countries highlight the possibilities of another model. These countries mandate residents to hold private health insurance, and they mandate that that insurance cover mental health care. These countries’ spending on mental health is more in line with the overall disease burden of mental health conditions.
Fourth, the doctor deficit is self-inflicted and solvable. Canada’s massive doctor shortage is a function of government decisions. This includes decisions to severely limit the number of doctors we train, and to make it difficult for foreign-trained doctors to qualify to practice.
When faced with similar constraints, Australia chose reform. It increased the number of doctors it trains domestically and recruited internationally-trained doctors, while making it easier for those doctors to practice.
These decisions have consequences. In 2024, Canada had one of the lowest physician-to-population ratios among high-income countries, with about 2.4 physicians per 1,000 people. By comparison, Australia has about four physicians per 1,000 people, right around the OECD average of 3.9.
Fifth, health-care reform takes political will. Canadians need to be clear eyed about our current system and its limitations. If the Canada Health Act is holding us back from a better system, we need to be fearless about jettisoning ideological attachments, debating alternatives, and demanding change. Politicians will act when enough people demand it.
This is where greater public awareness of alternative models comes in. This series has sought to play a small role by heightening public awareness of one leading alternative.
The Canadian system is in a crisis. We must be calm and rational while demanding better. Our lives quite literally depend on it.
