From the Fraser Institute

By Yanick Labrie

Switzerland’s universal health-care system delivers significantly better results than Canada’s in terms of wait times, access to health professionals like doctors and nurses, and patient satisfaction finds a new study published by the Fraser Institute, an independent, non-partisan Canadian policy think-tank.

“Despite its massive price tag, Canada’s health-care system lags behind many other countries with universal health care,” said Yanick Labrie, senior fellow at the Fraser Institute and author of Building Responsive and Adaptive Health-Care Systems in Canada: Lessons from Switzerland.

The study highlights how Switzerland’s universal health-care system consistently outperforms Canada on most metrics tracked by the OECD.

In 2022, the latest year of available data, despite Canada (11.5 per cent of GDP) and Switzerland (11.9 per cent) spending close to the same amount on health care, Switzerland had 4.6 doctors per thousand people compared to 2.8 in Canada. In other words, Switzerland had 64.3 per cent more doctors than Canada (on a per-thousand people basis).

Switzerland also had 4.4 hospital beds per thousand people compared to 2.5 for Canada—Switzerland (8th) outranked Canada (36th) on this metric out of 38 OECD countries with universal health care.

Likewise, 85.3 per cent of Swiss people surveyed by the CWF (Commonwealth Fund) reported being able to obtain a consultation with a specialist within 2 months. By comparison, only 48.3 per cent of Canadians experienced a similar wait time. Beyond medical resources and workforce, patient satisfaction diverges sharply between the two countries, as 94 per cent of Swiss patients report being satisfied with their health-care system compared to just 56 per cent in Canada.

“Switzerland shows that a universal health care system can reconcile efficiency and equity – all while being more accessible and responsive to patients’ needs and preferences,” Labrie said.

“Policymakers in Canada who hope to improve Canada’s broken health-care system should look to more successful universal health-care countries like Switzerland.”

Building Responsive and Adaptive Health Care Systems in Canada: Lessons from Switzerland

• Canada’s health-care system is increasingly unable to meet patient needs, with wait times reaching record lengths—over 30 weeks for planned care in 2024—despite significantly rising public spending and growing dissatisfaction among patients and providers nationwide.
• Swiss health care outperforms Canada in nearly all OECD performance indicators: more doctors and nurses per capita, better access to care, shorter wait times, lower unmet needs, and higher patient satisfaction (94% vs. Canada’s 56%).
• Switzerland ensures universal coverage through 44 competing private, not-for-profit insurers. Citizens are required to enroll but have the freedom to choose insurers and tailor coverage to their needs and preferences, promoting both access and autonomy.
• Swiss basic insurance coverage is broader than Canada’s, including outpatient care, mental health, prescribed medications, home care, and long-term care—with modest, capped cost-sharing, and exemptions for vulnerable groups, including children, low-income individuals, and the chronically ill.
• Patient cost participation (deductibles/co-payments) exists, but the system includes robust financial protection: 27.5% of the population receives direct subsidies, ensuring affordability and equity.
• Risk equalization mechanisms prevent risk selection and guarantee insurer fairness, promoting solidarity across demographic and health groups.
• Decentralized governance enhances responsiveness; cantons manage service planning, ensuring care adapts to local realities and population needs.
• Managed competition drives innovation and efficiency: over 75% of the Swiss now choose alternative models (e.g., HMOs, telemedicine, gatekeeping).
• The Swiss model proves that a universal, pluralistic, and competitive system can reconcile efficiency, equity, access, and patient satisfaction—offering powerful insights for Canada’s stalled health reform agenda.

Yanick Labrie

Senior Fellow, Fraser Institute

From the Fraser Institute

By Tegan Hill

Amid a growing separatist movement in Alberta, a recent poll commissioned by the Smith government found that 55 per cent of Albertans would vote to replace the “Canada Pension Plan (CPP) with an Alberta Pension Plan that guaranteed all Alberta seniors the same or better benefits.” That’s a massive surge in support since last year when support for a provincial plan was approximately 22 per cent. And while there are costs and benefits to leaving the CPP, one thing is clear—Albertans could see savings under a provincial pension plan.

First, some context.

From 1981 to 2022 (the latest year of available data) Alberta workers contributed 14.4 per cent (on average) of total CPP payments while retirees in the province received only 10.0 per cent of the payments, due mainly to the province’s relatively high rates of employment, higher average incomes and younger population (i.e. fewer retirees).

Over that same period, Albertans’ net contribution to the CPP—the amount Albertans paid into the program over and above what retirees in Alberta received in CPP payments—was $53.6 billion. That’s more than six times more than British Columbia, the only other province that paid more into the CPP than retirees in the province received in benefits.

Some analysts argue that the surge in support for a provincial pension plan in Alberta is a result of strategic wording by the Smith government, specifying that seniors would be guaranteed the same or better benefits than under the current CPP.

It’s true, the wording of a poll question can impact the results. But according to the federal legislation that governs the CPP, any province that wishes to withdraw from the CPP in favour of a provincial plan must provide comparable benefits.

And in fact, several analyses show that due to Alberta’s demographic and economic factors, Alberta workers would receive the same retirement benefits under a provincial pension plan but pay lower contribution rates compared to what they currently pay, while contributions rates would have to increase for Canadians outside Alberta (excluding Quebec) to maintain the same benefits under the CPP.

More specifically, according to a report commissioned by the Smith government, Alberta’s contribution rate, which is effectively a tax taken off paycheques, would fall from the base CPP contribution rate (9.9 per cent) to an estimated 5.85 per cent under a provincial pension plan. That would save each Albertan up to $2,850 in 2027 (the first year of the hypothetical Alberta plan). Again, this lower contribution rate (i.e. tax) would deliver the same benefit levels in Alberta as the current CPP.

Even under more conservative assumptions, Albertans would still pay a lower contribution rate while receiving the same benefits. According to economist Trevor Tombe’s estimate, Alberta’s contribution rate would drop to 8.2 per cent and save Albertan workers approximately $836 annually.

Support for a separate provincial pension plan is on the rise. And Albertans should know that under an Alberta plan, due to demographic and economic factors, they could pay a lower contribution rate yet receive the same level of benefits.