Canada has a predominantly publicly financed, privately delivered healthcare system, based on ten provincial and three territorial health insurance plans.
Healthcare ? Canada
Valerie Strand, Trade Officer
British Consulate-General, Toronto
Last revised: October 2009
Whereas every effort has been made to ensure that the information given in this document is accurate,
neither UK Trade & Investment nor its parent Departments (the Department for Business, Innovation
and Skills, and the Foreign & Commonwealth Office), accept liability for any errors, omissions or
misleading statements, and no warranty is given or responsibility accepted as to the standing of any
individual, firm, company or other organisation mentioned.
Published October 2009 by UK Trade & Investment.
Crown Copyright ©
Healthcare - Canada
Table of Contents
CHARACTERISTICS OF MARKET 5
KEY METHODS OF DOING BUSINESS 8
MORE DETAILED SECTOR REPORTS 9
CONTACT LISTS 10
ASSOCIATIONS AND GOVERNMENT DEPARTMENTS, IN CANADA: 10
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Healthcare - Canada
Canada has a predominantly publicly financed, privately delivered healthcare
system, based on ten provincial and three territorial health insurance plans . The
system includes universal, comprehensive coverage for medically necessary
hospital, in-patient and out-patient physician services . Under the Canada Health
Act , to receive federal support from Health Canada, provincial/territorial plans
must meet five criteria; comprehensiveness, universality, portability, accessibility
and public administration.
The healthcare industry is composed of companies involved in the design,
establishment, operation, maintenance and improvement of healthcare systems and
institutions; telehealth/health telematics; contract research organisations; health
administration and consultants; facilities management; continuing medical, nursing
and allied health education and training; architectural and design services; clinical
services; health insurance. Over 1.6 million people are employed in the healthcare
and social services sector, the third largest employer in Canada with nurses
constituting the largest group of health care providers .
Source: Francine Anne Roy, Director, Health Services Information at CIHI ?Each province has it?s own
unique environment that will influence decisions around health spending. Variations in models of care,
salary and benefit levels, health needs and the geographic distribution of a province?s population are all
factors that can effect health system expenditures?
Source: Health Canada www.hc-sc.gc.ca
Source: Canada Health Act http://laws.justice.gc.ca/en/C-6
Source: Health Canada www.hc-sc.gc.ca
Source: Nurses Union www.nursesunion.ca
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Healthcare - Canada
Public sector funding represents about 79% of healthcare expenditure with the
remaining 21% percent financed privately through supplementary insurance and
employer-sponsored benefits, or directly through out-of-pocket spending . In 2008
healthcare spending reached C$172 billion (a 60% increase in 10 years). The
healthcare sector contributed significant economic growth amounting to C$79.3
billion or 10% percent of Canada?s Gross Domestic Product (GDP) in 2008 .
Currently Canada?s health care system lists almost 400,000 general practitioners,
more than 700 hospitals, and 1,600 long-term care facilities, servicing the
population of 33 million.
As the provinces and territories aim to reduce the cost of healthcare, there is
demand for equipment and services that reduce the length of hospital stays and
recovery times. This includes technology and equipment for non-invasive
treatments using sensors, lasers, ultra-sound and nuclear medicine, plus faster and
more accurate diagnostic methods and tests.
There is a need for compatibility with existing equipment and long term
compatibility, especially with equipment involving PC-linked monitors and
telehealth. The use of ICT to deliver healthcare services and information over
distances is a growing segment.
Demand is increasing for supplies and equipment for home care, including
management of chronic conditions, aids for daily living, and natural, alternative and
preventative healthcare products, which help the aging to remain active and
independent. The Canadian Institute for Health Information (CIHI) reports that
the home care market in Canada is currently worth about C$6.6-billion, a year. This
amount is less than 4% of all the money spent on healthcare. Drastic changes will
have to be adopted and additional support given to this segment of the market to
meet the demands of Canada?s aging population. Currently 13% of the population
is aged 65 or older with a forecasted growth to 25% in the next 20 years.
Overall, Canada remains dependant on imports of medicines, medical devices,
imaging equipment and related technology, maintaining a trade deficit of over
CAD$10 billion (£0.48 billion) .
The UK?s reputation as a source of high quality, innovative products, makes it an
ideal supplier to the market. This can be leveraged as an entry point to the US and
Mexico, for example, manufacturing in Canada to supply the NAFTA market.
Health Canada is the federal government department that oversees the regulation
of healthcare components such as pharmaceuticals and medical devices.
Exploring the 70/30 Split: How Canada's Health Care System is Financed
Source: Ivey Business Journal www.iveybusinessjournal.com This figure includes expenditure on
hospitals and other institutions, physicians and other professionals, drugs, capital, public health,
administration and other healthcare spending.
Source: Innovating Health June/July 2006
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Healthcare - Canada
Provincial/territorial governments are responsible for delivering healthcare,
including licensing of doctors, and building and operating hospitals.
The Therapeutic Products Directorate (TPD) , a division of Health Canada, is made
up of several Bureau's and is responsible for regulating pharmaceuticals, blood,
biologics, disinfectants and medical devices. The Medical Devices Bureau is
responsible for processing license applications, reviewing safety and effectiveness
data, and establishing standards and policies. Medical devices are classified based
on risk Class I-V; Class I being the least risky, Class V being most risky .
UKTI publishes international business opportunities gathered by our network of British
Embassies, High Commissions and Consulates worldwide. These opportunities appear in
the Opportunities portlet on the relevant sector and country pages on the UKTI website. By
setting up a profile you can be alerted by email when relevant new opportunities are
published. New or updated alert profiles can be set in My Account on the website.
CHARACTERISTICS OF MARKET
Medical devices manufactured in Canada include those used for diagnosis and
treatment of ailments including medical, surgical and dental equipment, furniture
and consumables, orthopaedic appliances, prosthetics and electro-medical
equipment, diagnostic kits, reagents and equipment. Following is a snapshot
(most recent figures) of the Devices segment:
? 35,000 employees, representing almost 25% of the total national sector
? 1,500 corporate facilities across Canada, but primarily based in Ontario, Quebec
and BC with over 80% of the device industry based in Ontario and Quebec
? Device sector is comprised of small, medium and large facilities with the
majority of companies in the small to mid-sized area, however, large companies
represent 43% of employment.
? Over 600 related importers/distributors.
The industry generates approximately CAD$6 billion (£3 billion) in national sales.
Of this, Ontario and Quebec are the largest purchasers; CAD$3 billion (£1.5 billion)
and CAD$2 billion (£1 billion) respectively .
In 2008 , Canada exported CAD$554 million (£277 million) worth of medical
devices (Harmonised System Codes 9022 and 9018) to the USA and CAD$18
million (£9 million) to the UK. In the same year, Canada imported CAD$1.5 billion
(£750 million) of medical devices from the US and CAD$46 million (£23 million)
from the UK.
Expenditure shifts: Since the mid-1970?s, the share of total healthcare
expenditure devoted to hospitals, has declined, however, hospitals remain the
The Therapeutic Products Directorate (TPD) www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/aboutus_e.html,
contains downloads including the Medical Devices Regulations, Guidance Documents, Policy Documents,
Information Letters, Alerts, License Applications and other regulatory information for manufacturers.
Medical device regulation http://laws.justice.gc.ca/en/F-27
Medical device regulation http://laws.justice.gc.ca/en/F-27/SOR-98-282/index.html
Source: Medec http://www.medec.org/about_our_industry
Source: MEDEC www.medec.org
Source: Industry Canada http://strategis.ic.gc.ca, includes top 10 medical device imports and
A slight increase each year for the past 5 years.
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Healthcare - Canada
largest single user of healthcare funds. In 2008, hospitals made up the largest
component of health care spending, drugs accounted for the second-largest share
with an estimated annual growth rate of 8.3%, an increase that exceeds other
major health-spending categories and Physicians account for the third largest
share, a category that has remained stable since 2000 .
Expenditure breakdown 2008 (figures rounded):
Use of Funds Expenditure (billions) Percentage of total
Hospitals C$45.5 28.0
Pharmaceuticals C$30.0 17.4
Physicians C$21.5 13.4
In its annual report (October 2009) on healthcare spending in Canada, the
Canadian Institute for Health Information reports that the country?s healthcare
spending continues to rise, reaching C$172 billion in 2008 representing 10.1% of
GDP. This equates to C$5,170 per person annually.
Delivery: Factors influencing delivery of treatment include expenditure reductions,
aging population and new technology. Use of clinics, home care and treatment with
medical equipment and drugs, are increasingly incorporated into the system.
Long-term services and follow-up care: These services are now also provided
through publicly funded rehabilitation facilities, home care, chronic care institutions
and other programmes. Over 270,000 seniors live in healthcare institutions. The
majority of these were newly diagnosed with conditions that often require higher
levels of regular care, such as incontinence, stroke, Alzheimer disease or other
dementia. Currently, 1 in 7 Canadians are 65 or older; this number will increase
and it is estimated by 2031, 25% of the population will be 65+ accounting for 60%
of all hospital costs .
E-Health: Federal and provincial/territorial governments are undertaking electronic
health record initiatives related to personalised medical assistance, administration
and addressing issues such as wait times, healthcare in remote locations and
proactive management of health issues by individuals, with the provinces of Alberta
leading the way, followed by Ontario, British Columbia and the Atlantic provinces.
? Alberta Netcare Portal ? www.albertanetcare.ca
? Canada Health Infoway - collates patient records, which can be retrieved by
healthcare professionals across the country.
? Telehealth Ontario ? free and confidential telephone service, providing health
advice from registered nurses.
Waiting times: Wait times continue to be a barrier to accessing medical care across
all Provinces. A shortage of medically trained personnel, timely access to
emergency beds, availability of diagnostic equipment and a general system
overload continues to contribute to this on-going problem. Despite the Federal and
Provincial governments attempts to reduce wait times there continues to be
Source: Canadian Institute for Health Information www.cihi.ca
Source: Statistics Canada www.statcan.ca
Canada Health Infoway www.infoway-inforoute.ca
Telehealth Ontario www.health.gov.on.ca/english/public/program/telehealth/telehealth_mn.html
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Healthcare - Canada
Accessing family physicians: Family doctors are estimated to be in the 98:100,000
population ratio (2007 figure), while the number has increased from 95:100,000
(2001) it is estimated that 5 million of the population are without a family doctor.
This ranks Canada last amongst the G8 countries. The Canadian Medical Association
(CMA) estimates it will take 26,000 more doctors to bring Canada up to the OECD
Nurse Shortages: In 2007, despite the 217,000 registered nurses delivering care; it
was estimated that a further 11,000 full time nursing staff are required to enable
full service delivery. At the current rate of patient growth, it is estimated that a
further 60,000 nurses will be required by 2022.
To counteract some of the shortfall in medical personnel Canada has adopted a plan
to ?fast track? medically trained new immigrants through the various compliances
and examinations to meet the federal and/or provincial standards to enable quicker
introduction into the healthcare sector. Several Provinces have organized proactive
outreach programmes, including fully financed visits for medical professionals,
overseas advertising campaigns, and recruitment drives to generate interest in
working in Canada.
Private Healthcare : Private-sector (individual) expenditure was forecast to reach
C$51.6 billion in 2008 with prescribed drugs and dental care making up the
largest components of total private health spending. Private healthcare is a
growing segment and differs in each province:
? In Quebec, British Columbia, Alberta, Prince Edward Island, doctors can set fees
and practice outside the public system. Does not allow private insurance to
cover services provided through private healthcare, which are covered under
? Manitoba and Ontario do not allow private insurance, but reimburse doctors who
practice outside public healthcare.
? Nova Scotia permits private insurance and healthcare.
? In New Brunswick, doctors can set fees.
? In Saskatchewan, doctors can set fees if they do not practice within public
? In Newfoundland, patients can be reimbursed if they utilise private healthcare
and use private insurance to cover the difference.
Wait times are the primary reason for private healthcare demand.
Natural Health and Organic Products: A 2005 Health Canada baseline report
reported that 7 in 10 Canadians use Natural Health Products (vitamins/minerals,
herbal remedies and teas, additive-free foods and organics). By 2010 they project
that retail sales will be worth CAD$2.75 billion (£1,375,000). The Canadian Health
Food Association (www.chfa.ca) recognize NHP is a key component in a healthy
lifestyle and as a niche within the Healthcare industry, has growth potential. The
CHFA are working with the Health Products and Food Branch Inspectorate to speed
up the tremendous backlog of unprocessed requests for DIN or NPS certification.
The Canadian industry has developed strengths including in:
Source: Breaking the Taboo, MacLean?s, 20 June 2006
Source: CIHI www.cihi.ca
Source: Invest in Canada www.investincanada.gc.ca
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Healthcare - Canada
? Cardiovascular - heart valves, pacemakers and catheters
? In-vitro diagnostics - cancer, hepatitis and sexually transmitted diseases
? Radiation therapy and therapy-planning software
? Medical imaging - 3-D imaging, imaging archiving systems and ultrasound
scanners and related software
? Dental - high-speed sterilises, dental materials including implants and related
equipment and sundries
? Orthopaedics/prosthetics/orthotics - artificial limbs, including myoelectric hands
? Health research - Diabetes Islet Transplant Programme and Human Genome
In addition, Canada maintains strengths in related industries such as biotechnology,
advanced materials, microelectronics, photonics, robotics, software and infomatics,
Science/Technology: Many medical device manufacturers collaborate on R&D with
universities, hospitals, and government. About 10% of medical device firms are
spin-offs from these collaborations . Developments in science/technology are an
ongoing process it is near impossible to determine those projects that are most
important or when a project will come to fruition.
KEY METHODS OF DOING BUSINESS
The management and delivery of publicly insured medical services in Canada is the
responsibility of each provincial and territorial government. Provinces and
territories therefore individually control the planning, management, and financing of
hospital care, physician and allied health care services, and some aspects of
prescription care and public health.
The 700 publicly financed hospitals account for 75% of medical equipment
purchases. The majority of hospitals are part of regional or national not-for-profit
buying groups or Group Purchasing Organisations (GPOs). Most hospital goods are
either sold direct to GPOs by the manufacturer or through one of the larger
importing distributors, mainly based in the provinces of Quebec and Ontario.
Smaller regional distributors tend to supply niche segments and deal with smaller
accounts including clinics, smaller hospitals, care homes and doctors? offices. To
supply directly to private healthcare is likely to involve sales to each clinic/doctor
rather than wholesale distributors.
Factors enabling access to the market include:
? Canada's Mutual Recognition Agreements (MRAs) with the EU, facilitating
? Provincial funding initiatives to encourage global partnerships
? R&D tax treatments make it an attractive location for companies to leverage
? Joint ventures and strategic partnerships, such as manufacture under private
? Canada is considered the lowest cost country to establish a medical device firm,
with a 4.1 % cost advantage over the US
? Canada is part of the North American Free Trade Agreement (NAFTA). NB: UK
suppliers opting to serve Canadian customers via US distributors or sales agents
Source: Industry Canada www.strategis.ic.gc.ca
Source: Competitive Alternatives: KPMG?s Guide to International Business Costs, 2006 Edition
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Healthcare - Canada
should be aware of possible double duties applied to shipments originating from
the UK. Direct UK export to Canada is usually the best route to entry.
Other background information on doing business in Canada can be found on UKTI?s
website. Simply go to to the Canada page where you will find information on:
Economic background and geography, Customs and regulations, selling and
communications, contacts and setting up, visiting and social hints and tips.
MORE DETAILED SECTOR REPORTS
The Canadian Institute for Health Information www.icis.ca (CIHI) produces very
comprehensive reports on a regular basis that are referenced throughout this
Research is critical when considering new markets. UKTI provides market research
services which can help UK companies doing business overseas including:
? Overseas Market Introduction Service (OMIS). Bespoke research into potential
markets, contacts and support during your visits overseas.
? Export Marketing Research Scheme. Advice on market research and help to
contact subsidised market research administered by the British Chambers of
Commerce on behalf of UKTI.
Contact your local International Trade Advisor if you are interested in accessing
these services, or for general advice in developing your export strategy.
The Medical Post
wWwhwen.m considering doing business in Canada, it is essential to obtai egal, financiedicalpost.com The Canadian Journal of Medical
and taxation advice. For further details, please contact:
Canadian Healthcare Technology www.csmls.org
wVawlewr.icea Snthreaanldth, .Tcroamde Office
UK Trade & Investment/British Consulate-GenHeoraslpital News Canada
C77an7a Bday Str et, Suite 2800ian Medical Association Journal www.hospitalnews.com
wTowrwon.ctom OajN.c aM5G 2G2
T: 011 44 416 593 1290 + 1 ext + 2229
Long Term Care Magazine
GF:e r0i1at1r i4cs4 416 593 1229 and Aging www.oltca.com
Due to the provincial fragmentation of the market there are no national Healthcare
trade shows in Canada. Canadian buyers and industry professionals will regularly
visit international trade shows in other parts of the world, e.g. Medica. The
following shows are, however, currently notable:
e-Health Conference & Exhibition www.e-healthconference.com
Ontario Hospital Association-Health Achieve Convention and Exhibition
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Healthcare - Canada
UK Trade & Investment?s Tradeshow Access Programme (TAP) can help eligible UK
businesses take part in overseas exhibitions. Attendance at TAP events offers significant
? possibilities for business opportunities both at the show and in the future
? a chance to assess new markets and develop useful contacts
? grants are available if you meet the criteria
? UKTI staff overseas will be available to assist delegates
Find out if you are eligible to apply to attend this event, and more about the support UKTI
can offer, on the UKTI Market Entry web page.
Details of TAP events can be found in the Events portlet on the Canada page.
ASSOCIATIONS AND GOVERNMENT DEPARTMENTS, IN CANADA:
Canadian Healthcare Association
www.canadian-healthcare.org Canadian Council on Health Services
Standards Council of Canada
Medbuy Corporation www.scc.ca
Canadian Standards Association
Canadian Co-ordinating Office for www.csa.ca
Health Technology Assessment Health Canada
Therapeutics Products Directorate,
Health Canada Strategis Canada
UKTI?s International Trade Advisers can provide you with essential and impartial advice on all
aspects of international trade. Every UK region also has dedicated sector specialists who can
provide advice tailored to your industry. You can trace your nearest advisor by entering your
postcode into the Local Office Database on the homepage of our website.
For new and inexperienced exporters, our Passport to Export process will take you through
the mechanics of exporting. An International Trade Adviser will provide professional advice on
a range of services, including financial subsidies, export documentation, contacts in overseas
markets, overseas visits, translating marketing material, e-commerce, subsidised export
training and market research.
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