A new analysis by the Fraser Institute concludes that Canada ranks among the highest spenders on health care yet lags behind peer nations on several measures of access to services and medical resources.
The report, "Comparing Performance of Universal Health Care Countries," examined 32 high-income economies that provide universal or near-universal coverage and met a minimum gross national income per capita. Using the most recent comparable data for 2024, it found Canada was the second-highest spender on health care as a share of gross domestic product — surpassed only by Chile.
High spending, weak return on key resources
Despite large outlays, Canada scored poorly across a range of indicators the Fraser Institute used to measure the availability of medical resources and timely access to services. The country ranked near the bottom on the supply of physicians and several types of diagnostic and hospital resources.
Key findings highlighted in the report include:
- Doctors: Canada ranked 30th of 32 countries for the number of physicians. It had 2.8 doctors per 1,000 people, compared with an OECD average of 4.1.
- Nurses: The country recorded 10.5 nurses per 1,000 people, slightly above the average of 10.1, placing it around the middle of countries assessed.
- Hospital beds and imaging: Canada was 26th of 31 for physical-care hospital beds, and ranked 28th of 31 for both MRI and CT scanner availability. The nation had 10.7 MRIs per million residents, compared with the OECD average of 20.6 per million.
| Indicator | Canada | OECD average / rank |
|---|---|---|
| Doctors per 1,000 people | 2.8 | Average 4.1; ranked 30/32 |
| Nurses per 1,000 people | 10.5 | Average 10.1; mid-ranking |
| MRIs per million people | 10.7 | Average 20.6; ranked 28/31 |
Context and implications
The Fraser Institute study covers mostly Organisation for Economic Co-operation and Development members that meet the institute's income threshold. It excludes nations without universal health coverage or those below the income cutoff, which narrows the comparison to broadly similar health systems. The authors, Mackenzie Moir and Nadeem Esmail, use a set of 13 indicators to compare availability and timeliness.
The findings raise questions about whether Canada’s high level of spending is yielding commensurate benefits in access and capacity. For example, several European countries with lower health-care spending per GDP have considerably greater numbers of physicians and diagnostic machines per capita. The report notes top-performing countries in the physician category — Greece, Austria, Iceland and Norway — all have more than five doctors per 1,000 people.
Policy discussions prompted by the analysis are likely to focus on workforce planning, capital investment in diagnostic equipment and hospital capacity, and how funds are allocated across federal and provincial responsibilities. The report illustrates a persistent policy challenge: high national spending does not automatically translate to stronger on-the-ground access for patients.
Health-policy experts and provincial health ministries have for years debated causes for wait times and uneven access, pointing to factors such as physician distribution across regions, hospital funding models, and the availability of specialists and diagnostic services. The Fraser Institute’s rankings add a comparative international layer to those domestic considerations.
Provinces and territories, which administer most front-line health services in Canada, will likely face renewed scrutiny of strategies to increase capacity — from training and retaining more physicians to expanding access to imaging and inpatient care. The report provides a snapshot that may shape public and political debate ahead of budget and health-system planning cycles.
While the analysis does not prescribe specific policy solutions, it underscores a gap between what Canada spends and the relative supply of certain health resources compared with peer nations — a gap that officials and health system planners will need to address if the country hopes to improve measured access and outcomes.
