Canadian health system may have its flaws, but its structure is sound

By Lindsay Advocate

By Dr. Michael Moreton

After years of practicing medicine in Canada and the United States I left for China to work for 10 years there, and then another seven years in Thailand and Cambodia. Just four years ago I returned to Canada. There are significant differences in the structure of how health care is provided in different countries, and I am now more appreciative of the Canadian system.

The structure of medicine, as pioneered in Britain and adopted in other countries of the Commonwealth (Canada, Australia, New Zealand, Malaysia, the Caribbean countries) and much of Europe, is the pattern that I have experienced, and for me seems ideal. 

Dr. Michael Moreton.

It is pyramidal, with three elements. First is primary care, a network of family doctors living in the community and delivering everyday advice and treatment of everyday complaints. If the problem needs more expert advice, they refer the patient to their specialist colleague who is able to provide secondary care.

This specialist may refer the patient on to a super-specialist — neurosurgeon, cardiac surgeon or cancer specialist, for example, for tertiary care. The primary care doctor, family doctor or pediatrician, has an essential role in this system. In ideal situations they have known the patient for years and have guided them through various misfortunes. They know the family and understand the patient’s attitudes to treatment and compliance with recommended treatment.

The primary care doctor is also the quarterback, coordinating care by more than one specialist that might conflict. The specialist doctors communicate with the primary care doctor and inform them of any investigations or procedures performed. The primary care doctors are the foundation on which the specialists stand. They are ably assisted by well-trained nurse practitioners who provide a similar service. When the system works well it is excellent for both doctor and patient. Each doctor is providing the level of service they are best capable of offering.

The striking thing when I went to China in the 1990s was that there were essentially no primary care professionals outside the hospitals. Everybody went to the hospital for everything. Patients choose which kind of doctor they wished to see, thus self-diagnosing their condition, which can lead to unfortunate results. It was enormously inefficient; a visit for a minor complaint such as a sore throat or urinary tract infection could take all day.

In my area of medicine, obstetrics, cultural traditions established over centuries were present and compromises had to be made for me to fit in and not offend. I also helped arrange visits for Chinese health professionals to Canada, the U.S. and Australia. They were not exposed to family doctors and could not see how useful a system this could be in their own country. In recent years efforts have been made to provide primary care in community clinics, but in a country with a population 38 times that of Canada this is a formidable task and historical and cultural barriers must be overcome. 

The Canadian health care system is not perfect but by comparison, it is excellent. Waiting times are sometimes longer than they should be. Overworked staff can be brusque and apparently uncaring but in the main it is a system that we have many reasons to be proud of. I cringe when I hear Canadians criticize the system.

It is also natural to dread illness, but to feel it may be a financial — in addition to a medical — disaster is unconscionable. Canadians are luckily free from this concern unlike some nearby neighbours we know.

–Dr. Michael Moreton is a retired physician living in Lindsay.


  1. Blair Morris says:

    I commend Dr Moreton for standing up for the Canadian Health care system. Too often we hear from those critics who have not lived with health care elsewhere. I wish that he had spoken about the US for-profit system which is often compared to the Canadian system. In the US millions are without the basic health care that all Canadians take for granted. The rich in America have the best health care perhaps in the world while too many others suffer. The US spends more on healthcare per capita than we spend in Canada and end up with poorer outcomes. Canadians have longer life expediencies than do our free enterprise neighbors to our south. We should work on improving those areas deemed problematic in our system , not adopt more of an inferior American system.
    Thank you Dr. Moreton.

  2. Cristian Toma says:

    “We should work on improving those areas deemed problematic in our system , not adopt more of an inferior American system.”

    You forget, intentionally or not, that there are also other options, such as the ones offered in many European countries and in some Asian ones: a blend of public and private.
    I live in Portugal now, and my daughters have been referred to Ophthalmology for a follow-up as recommended by their previous ophthalmologist in Canada. After 5 months, we still do not have an appointment. The good thing is that, realizing that this may take a while and knowing that they should have an eye exam sooner rather than later, we chose to go private. For 30 Euros each, I had my daughters’ vision examined in a private clinic across the road from where we live in Porto within about 10 days after asking for the appointments there. And we had to pay only because I chose not to purchase comprehensive private health insurance for about 50 euros/month for a family of 4, given the fact that we are generally healthy and I am trying to assess first how much we spend for healthcare in an average year before deciding on whether to buy health insurance.
    Want to talk medication? Medication here in Portugal costs me about 4-5 times less than what it used to be in Canada, partly because it is partially covered by the government. Dental care? How about 180 euros for a root canal, 750 euros for an implant + crown, 40 euros for cleaning?
    My wife has been referred to a physical medicine specialist for further physio and massage treatments for back and hips, and these are done in private clinics and covered by the government with referral from the family doctor.
    After living in Canada for over 15 years I know that Canadian healthcare is not something to be too proud of, smug as Canadians may feel about it. Yeah, I get it, it’s easy to feel smug when comparing yourself with something worse (the dreaded US). But let’s compare Canada to something better for a change, shall we?
    While working in Canada I had many patients telling me that they didn’t understand how bad Canadian healthcare system was until they got really ill and the wait and suffering started. And for me personally it was one of the main reasons to leave Canada as soon as I was able to retire. I now feel much safer here in Portugal when it comes to my health and the health of my family. I am not saying that everything is perfect here, but it’s definitely much better than in Canada, and it is something Canada could learn from.

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