Opinion: We need to try doing health care the Swiss way
By Yanick Labrie
Last year marked the 40th anniversary of the Canada Health Act, long considered a pillar of Canadian identity. But today, that symbol is showing signs of strain. Despite record government spending, health-care wait times have reached historic highs — more than 30 weeks on average for planned treatment — and access to care continues to deteriorate. Fewer than one in five Canadians now says the system works well.
While political leaders tinker at the margins, countries such as Switzerland have taken bold steps to build universal health-care systems that are more responsive, more flexible and, above all, more accessible than ours.
Switzerland achieves universal health coverage with a patient-centred model. Instead of relying on a government monopoly, the Swiss system is organized around principles of regulated competition. Forty-four private, non-profit insurers offer standardized basic coverage and, though everyone must enrol, Swiss choose their insurer and are free to switch plans twice a year. This freedom of choice drives insurers to innovate, tailor benefits and ultimately improve service.
Switzerland's universal system is also more comprehensive than Canada's, covering not only hospital and physician services but also prescription drugs, mental-health care and some long-term care services. Patients can manage care based on their own preferences, choosing from a variety of plans with varying deductibles and premiums.
By contrast, the Canadian system offers virtually no choice. The government enrols every citizen in the same plan, with the same benefits, on the same terms. The Canada Health Act, meant to promote equity, prohibits flexibility. It's a lowest-common-denominator model: rigid, bureaucratic and unresponsive to patient needs.
Nowhere is this clearer than in the way we access care through compulsory gatekeeping. To see a specialist, patients must go through a family doctor. But six million Canadians don't have a family doctor. For them, this requirement isn't just inconvenient, it's a dead end. The result is long delays, lost diagnoses and growing public frustration.
The Swiss model, driven by patient choice and regulated competition among insurance providers, prioritizes adaptability. Because residents can switch insurers and choose from among different care models, insurers have an incentive to innovate in response to evolving needs. As a result, patients can opt for: a standard model with no gatekeeping, managed care with family doctors, pharmacy-based co-ordination, telemedicine-first or other models. And they don't have to wait long. According to the latest Commonwealth Fund survey, 76 per cent of Swiss residents can see a doctor or nurse within five days, compared with only 46 per cent of Canadians.
Having different plans not only expands choice but also helps insurers control costs by reducing unnecessary consultations and hospitalizations. Studies show that such models can lower the cost of care by up to 34 per cent without compromising quality. They also encourage providers to focus on prevention and chronic care management, which increases efficiency, improves outcomes and allows insurers to reduce premiums and control long-term spending. In fact, despite the greater choice and broader package of health-care services than in Canada, real per capita health-care spending in Switzerland has grown by less than two per cent a year since the mid-1990s, compared with 2.7 per cent in Canada.
These Swiss facts likely are music to the ears of Canadians. But how much do the Swiss pay out-of-pocket for health care?
Patients do share some costs through deductibles and co-payments, but costs are capped and vulnerable populations (children, pregnant women, low-income people, etc.) are exempt. In 2022, average annual out-of-pocket spending per insured person in Switzerland was 581 Swiss francs, equivalent to $792 at that time. For people who don't require much care, the costs are much lower or even zero. And nearly 28 per cent of the population receives subsidies to cover their premiums.
Many Canadians assume our system is 'free,' forgetting it's funded by taxation. They also tend to overlook significant out-of-pocket costs not covered by the public system (prescription drugs, mental-health care, long-term care, etc.).
The Canada Health Act prohibits co-payments and mandates uniform public insurance so a province could copy-and-paste the Swiss model only at risk of losing federal transfers. But Switzerland's system shows that universality isn't incompatible with choice and competition, which can in fact strengthen each other. When patients are free to choose, providers have to be more efficient and more responsive to their needs and preferences.
Opinion: Hospitals need to be up front about unsafe wait times
Matthew Lau: If health care is a right, why can't we get it when we need it?
Canada's health-care debate has long been framed as rigidly either/or: either a government monopoly or a privately-funded U.S.-style system that abandons universality. This mindset has stifled innovation and made it harder to build a system that is both universal and responsive. The Swiss model, which reconciles equity, choice and adaptability, is a guide Canadian policy-makers can no longer afford to ignore.
Yanick Labrie, senior fellow at the Fraser Institute, is author of the new study Building Responsive and Adaptive Health-Care Systems in Canada: Lessons from Switzerland.
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