Healthcare in Canada: A National Treasure or a System Under Strain?
Canada’s healthcare system, often praised globally for its universal coverage, is a source of pride for many Canadians.
However, it also faces challenges. A recent extensive survey reveals significant frustration with access to primary health care. Many respondents, as reported by researchers from OurCare, feel that the healthcare system has not fulfilled its promise to provide universal, high-quality care promptly.
Canadians are generally dissatisfied with their health care system, and many believe it has failed to deliver on its promise:
- System quality
In 2023, only 26% of Canadians considered the healthcare system to be in excellent or perfect condition, down from 48% in 2015.
- Access
Many people have difficulty accessing the necessary care, especially specialist appointments, emergency care, and surgical procedures.
- Primary care
An estimated 22% of Canadian adults lack a family doctor or nurse practitioner.
- System deterioration
30% of Canadians believe the health care system has deteriorated over the last decade.
- Health worker burnout
Health workers are experiencing record burnout, with some leaving their jobs or reducing their hours.
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Some say the health care system is in crisis, with emergency rooms closing, wait times for surgery increasing, and some procedures being sent to other provinces.
My experiences:
1. In July 2014, just a year after moving to Canada, I woke up one morning with severe pain on my right side that radiated to both my back and front. I immediately recognized the pain as kidney stone pain because I had experienced two similar episodes back in my home country. I didn’t drive, and my husband was away at work, so I left my two kids playing at home and saw my family doctor. There was a long line, and the clinic operated on a first-come, first-served basis with no appointments taken. However, seeing that I was in tremendous pain, the receptionist informed my doctor. He came to see me and advised me to get some tests done. He also suggested that if my pain became unbearable, I should visit the emergency room (ER) at the hospital. My cousin, whose house I was living in at the time, learned about my condition. She and my brother-in-law came to pick me up and took me to the ER.
Upon my arrival at 11:15 a.m., I had to wait in line to register and undergo a basic health check-up. After 15 minutes, my number was called, and I was asked a series of health-related questions. Finally, I was directed to follow a specific-colored marking on the floor to reach the lobby, where I would wait to be called for further tests, including blood work, a doctor’s check-up, and a CT scan. At that point, I was on the floor in excruciating pain and had started to vomit. My cousin went to speak with the head nurse, requesting that she see me first to help relieve my suffering. Instead, the nurse handed my cousin a few cardboard kidney bowls for me to use to vomit in. It was painful to see a few patients wandering the hallway, holding their IV stands as they waited for their turn for appendix surgery. They had no beds to rest in.
Finally, a doctor arrived and called me to sit in the waiting room. He asked what troubled me, patted my back, and left without using a stethoscope. I was then asked to go and wait in the lobby. It was already around 3 pm. Seeing me roll on the floor in pain, my cousin became impatient and looked out for help. The doctor noticed me and instructed the nurse to give me a painkiller. However, the nurse refused, stating that my blood work and CT scan were still pending. After persistent pleading from my cousin, the nurse had my blood work done.
Ironically, she then placed a painkiller on my palate, even though I had already been vomiting. That medication only made me throw up more, including the painkiller. Despite having nothing in my system to eat or drink, I was still violently vomiting, and I had no idea why. My husband arrived at the ER around 5 p.m., and that’s when I was taken for a CT scan. After the scan, I was asked to wait in the lobby for the results. It was 6:30 p.m., and my reports were still pending. The pain I experienced was excruciating because I had vomited the painkiller. I also started to feel famished, and my sugar level was dropping since I was diabetic and had fasted for the tests.
My husband couldn’t stand to see me in pain, so he angrily spoke with the head nurse. As a result, she injected me with a painkiller. I couldn’t help but wonder why she hadn’t given me the injection earlier instead of just placing that medication on my palate, which caused me to vomit it out. He also brought me coffee and a bagel.
Finally, my scan reports arrived. I was informed that I had a 3 mm kidney stone. Since it was small, I was advised that it would likely pass by drinking plenty of fluids. I was prescribed a tablet to help break down the stone and painkillers to manage the discomfort. It was 8:30 PM when I was sent home without any further explanation. The next three days at home were harrowing. Back home in India, I faced a similar issue and was quickly taken to a private clinic. There, I was immediately given pain medication through an IV and admitted for three days of observation. Blood tests and a CT scan were conducted at the clinic. “Of course, all services in India are available at a nominal price. Healthcare is not free.”
Now comes the worst part: I had an appointment with a nephrologist six months following the incident. When I arrived for the appointment, the nephrologist informed me that he couldn’t assist me because I had no kidney stone to provide for further investigation into why it occurred. He mentioned that I should have collected rocks using a sieve with every urine I passed. Unfortunately, I wasn’t advised to do this. As a result, my visit to the nephrologist felt like a waste.
The problem of recurring kidney stones has stayed with me. Recently, I reviewed all my scan reports from my first episode to date, which strangely indicate that a kidney stone has always been detected in my left kidney. However, I’ve never experienced pain on my left side; my pain has always been on the right. And there is absolutely no problem with my right kidney.
2. In 2016, I developed a spur in my left foot, along with plantar fasciitis. The pain was significant and made it difficult for me to walk. I had experienced similar issues before, but the pain and limping had never lasted more than three months. Initially, I didn’t visit my family doctor, thinking the pain would subside on its own. However, as winter approached, the pain became excruciating. I struggled to limp my way to work and back home.
Finally, I saw my doctor in March. He advised me to exercise, scheduled an appointment with a specialist, and provided a requisition for an x-ray of my left foot. My appointment with the specialist was set for November of that year. However, after calling the specialist’s office multiple times, I managed to get my appointment moved up to September.
I underwent the x-ray, which required me to schedule an appointment with a specific radiologist, as not all facilities offered the same services. I took the x-ray report to the specialist in September. He examined my foot, which was swollen at the time, and the x-ray results were also included. Unfortunately, he informed me that he could not assist me then due to the swelling. He advised me to follow a strict diet and lose as much weight as possible before my next visit and then let me go without any further medication.
During this period, I worked at a diamond store, which required me to be continuously on my feet. Since the store was in liquidation, there were very few employees, often leading to 12-hour shifts or longer. During this time, I developed excruciating sciatica pain in my right foot because I had to put my entire body weight on it while standing in the store to avoid hurting my left foot. The pain was so intense that I struggled to walk, sit, or even lie down in bed. It took two full years for the pain to gradually subside and eventually disappear on its own, without any treatment or weight loss.
3. When I arrived in Toronto, Canada, in 2013, I was aware that my cousin, with whom I would be staying initially, was not in the best health. Our doctor cousin from Mumbai had reviewed her medical history during her visit back home and reported that her kidneys were functioning at only 25% capacity and required attention. However, the endocrinologist attending my cousin in Toronto took this warning lightly because our doctor cousin did not reside in Canada. Unfortunately, he overlooked her deteriorating health to the extent that she eventually needed to undergo surgery for peritoneal dialysis.
She had been living with this condition without receiving proper care from her doctor. Every few months, she would end up in the emergency room due to imbalances in her creatinine, magnesium, and potassium levels. Eventually, she showed me a few knots in her leg, expressing that they hurt. With my limited knowledge, I mentioned that it looked like calcification. A few days later, she experienced significant pain in both feet and visited the emergency rooms of all three hospitals in the Greater Toronto Area (GTA). During her visits, they conducted blood work and kept her in the ER for several hours to treat her potassium, magnesium, and creatinine levels. However, she was discharged without further investigation into the cause of her foot pain.
Finally, during her fourth visit, she returned to the hospital near my house, this time being admitted to the Renal/Nephrology department. We visited her daily, and I noticed that she was always sleepy and often hallucinated. Upon reviewing her medical file, her daughter discovered that she had been administered morphine to keep her in an exhausted state, preventing her from complaining or screaming in pain. The medical staff only weighed her daily and adjusted her dialysis treatment based on that weight.
One day during my visit, she pointed to her feet, covered by a blanket, and mentioned that they hurt when she had to stand on the weighing machine. I lifted the blanket to inspect her feet and saw that the skin on the bottom of both feet had developed a transparent pouch filled with blood. I was shocked. My brother-in-law and I were waiting for her visiting doctor that day, who arrived for his rounds around noon. We lifted her blanket and asked him about the blood we noticed and why no action had been taken. The doctor seemed surprised and said he was just a kidney specialist and hadn’t seen it. We pointed out that she had come in for pain in her feet. The doctor dismissed our concern, saying that since she was a kidney patient, he was only responsible for her kidney issues and that the pain in her feet was outside his expertise. We then asked why he wouldn’t refer her to the appropriate doctor for those concerns.
The doctor then called a varicose veins specialist at another hospital. That specialist promised to visit my cousin soon. After two days, the doctor came and suggested that she be placed in an oxygen chamber to preserve her toes, especially the right toes, which by this point had turned bluish-black and were hanging without any blood or skin. They resembled over-fried okra. The medical file noted that there was no blood flow to her legs because of calcification. Her health only became worse after three or four days in the oxygen chamber, so the doctor decided to amputate all of her right leg toes.
4. I have been seeing my endocrinologist since 2014 when my diabetes was just slightly above the borderline. That September, I received distressing news: my mom was in the ICU back home and was facing a near-death situation. This situation caused me even more stress, especially since I couldn’t leave my young kids behind to travel so far to see her.
During my next appointment with my endocrinologist, I brought my A1C report, which showed my sugar levels were 7.4. He warned me that if my levels reached such a high point again, he would have to put me on insulin. I panicked—becoming insulin-dependent was something I never wanted.
Determined to avoid this, I went on a strict diet, joined a gym, and participated in rigorous group activities for weight loss. I often returned home with aches and pains, but I persisted for 25 days leading up to my next appointment with the endocrinologist. Unfortunately, when I returned, my A1C had risen to 8.4. My doctor immediately prescribed insulin.
The health workers at the clinic who reviewed my case suggested that my spike in sugar levels was due to the stress I was experiencing and that rigorous exercise could also contribute to higher levels, which should be avoided.
I was devastated. During my visit to my home country in January 2015, I underwent a routine check-up and consulted a few doctors and specialists at a renowned hospital to review my health and seek advice. The nephrologist was shocked to learn that I was already on insulin due to an A1C reading of 8.4. He explained that a patient with three consecutive A1C readings of 9 or higher would typically be put on insulin, not for just one reading of 8.4. Nevertheless, I had become insulin-dependent, and all my efforts to lose weight or manage my insulin dependency had not worked. Years passed by, and my diabetes was being controlled with the help of my dietician, my endocrinologist, and my nurse.
Last year was incredibly stressful for me
I quit my job, my dad fell ill, and I had to fly home to take care of him. The sleepless nights, irregular eating, and constant stress resulted in episodes of low blood sugar or spikes in my blood sugar levels. Unfortunately, my dad has passed away, and since then, my blood sugar levels have spiked and haven’t been coming down. I’ve lost my appetite and sleep. I’ve been searching for a job opening but haven’t had any luck. The rising costs of children’s education have added to my stress. All the responsibility has fallen on my husband’s shoulders, and my inability to contribute has disrupted my peace of mind.
Since my return, this was my second visit to my endocrinologist, and my A1C level was a high 12 at both visits. My doctor was truly unhappy with me, and I had a very disappointing experience during the appointment. When I tried to express my concerns as a patient, instead of listening to me about the health issues I was facing, he snapped at me and told me to remain silent. He was insulting, arrogant, and dismissive throughout the entire appointment. I kept repeating my health concern, to which he said I was your endocrinologist. This health issue is not my concern. He lacked basic knowledge about diabetes, which is concerning for a specialist in this field.
The issue I am facing has to do with my kidneys, but he doesn’t want to listen and is unwilling to consider my symptoms or concerns, which are crucial for adequate medical care. His approach was condescending, and he seemed more interested in asserting his authority than helping me manage my condition. He outright told me that I was the problem. (My understanding is that endocrinologists, alongside primary care professionals, are part of the front line of kidney-metabolic care. They play a fundamental role in identifying risk factors and promptly instituting the necessary screening measures. They are also poised to implement effective treatment plans in collaboration with nephrologists.)
But this is how one is treated here by the health professionals, maybe because the health care system is free. This here is another actual incident of improper care, neglect, avoidance, and ignorance by healthcare professionals in Canada.
In India, our family doctor can refer us to a specialist. If we receive a referral from a friend or relative, we can visit the specialist’s office and make an appointment without any wait time. We can also see a radiologist at our convenience and typically get an appointment with just a few hours of wait time, unlike the months of delays often experienced here.
When visiting a hospital, all tests, blood work, and consultations with specialists can be completed on the same day, usually for a nominal fee. If one has insurance, these costs are typically covered. The doctors here refuse to read and accept the reports we get from India as they can’t understand the values printed on it.
Medication itself is costly in Canada. Insulin is double the price we pay in India. Also, the specialists don’t give us the prescription; they send it directly to the pharmacy near our house. As ordinary individuals, we often understand the causes of our pain based on our experiences. However, doctors typically won’t acknowledge or confirm these causes until tests such as blood work, X-rays, or ultrasounds provide evidence. They fear getting sued by their patients.
Researchers from OurCare also found evidence of what it calls an “attachment crisis” — an estimated 22 percent of Canadian adults (about 6.5 million people) do not have a family doctor or nurse practitioner they can see regularly.
I want to share an actual incident that happened to me. We moved from my cousin’s place to a new area. Shortly after the move, my husband visited a clinic across the plaza from our house and enrolled himself with a family doctor there. He also provided our daughter’s health card and transferred her medical file to this new doctor.
I also needed to change my family doctor because my previous doctor’s office was too far from our new home, and the long wait times and commuting were becoming quite exhausting.
Soon, I registered my son and me with this doctor across from our home. When she asked if I had any health issues, I told her that I was diabetic. She then inquired if I had ever been referred to a specialist, and I confirmed that I had. However, she refused to accept my file, stating she no longer takes new patients. At that moment, I noticed a family sitting in her office. They had just arrived in Canada, did not have a health card, and spoke her mother tongue. Without hesitation, the doctor accepted them as new patients. This experience left me frustrated with how some family doctors behave here.
I also learned from some of my work colleagues that after COVID, their family doctors quit their practice here and moved out to their home country.
Healthcare in Canada: A National Treasure or a System Under Strain
The advantages:
1) Universal Coverage:
The public healthcare system ensures that all Canadian citizens and permanent residents can access medically necessary services without out-of-pocket expenses.
This system is funded through taxes, reducing financial barriers to essential care and eliminating the need for expensive private insurance plans for primary care.
2) Quality of Care & Comprehensive Services:
Canadian healthcare professionals are highly trained, and hospitals are equipped with modern technologies.
Essential health services are widely available, reducing disparities in access across socioeconomic groups.
Includes hospital care, physician services, and diagnostic tests. Some provinces also cover additional services like mental health care and prescription drugs.
The focus on equitable access ensures fair treatment irrespective of income or status.
3) Health Outcomes:
Canada boasts high life expectancy and low infant mortality rates compared to many other nations, reflecting good healthcare delivery.
4) Preventative Care Focus:
Many provinces emphasize public health initiatives, including vaccinations, screenings, and education, helping to reduce long-term health costs.
5) No Medical Bankruptcy:
Canadians are protected from financial ruin due to medical expenses, a common issue in other countries with privatized healthcare systems.
The disadvantages/strain:
1) Long Wait Times:
One of the most criticized aspects is the waiting period for non-emergency services such as elective surgeries and specialist appointments.
Delays can cause stress and affect the quality of life for patients needing timely care.
2) Limited Coverage for Certain Services:
While essential healthcare is covered, services like dental, vision, and prescription drugs often require private insurance or out-of-pocket payments.
Mental health support, though improving, remains underfunded in many regions.
3) Geographical Disparities:
Rural and remote areas face a shortage of healthcare providers, leading to inequities in access and quality.
Indigenous communities often experience poorer health outcomes due to systemic barriers.
4) Strain on Resources:
An aging population and increased demand for services put significant pressure on the system, leading to resource constraints.
Healthcare spending consumes a large portion of provincial budgets, sometimes at the expense of other public services.
5) Lack of Innovation:
The focus on universal access sometimes stifles innovation in treatment or the adoption of new technologies compared to countries with competitive systems.
6) Tax Burden:
Funding the healthcare system through taxes means higher tax rates for individuals and businesses.
7) Doctor Shortages:
A shortage of healthcare professionals, particularly family doctors, can make accessing primary care challenging.
8) Limited Mental Health Support:
While improving, mental health services are often not fully integrated into the healthcare system, leading to gaps in care.
The Canadian government is working with provinces and territories to make health care more accessible and affordable. Some of the initiatives include:
- The Pharmacare Act, which will improve access to contraception and diabetes medications
- The CDCP, which provides care for eligible Canadians between the ages of 18 and 64
Final Verdict
Canada’s healthcare system is undeniably a boon for its universal access and equitable care principles. However, systemic issues like wait times, coverage gaps, and resource limitations reveal areas needing urgent reform. Strengthening healthcare delivery, particularly in underserved areas and non-covered services, could help Canada live up to its healthcare ideals. Whether seen as a boon or a burden depends mainly on individual experiences and expectations.