Virtual care will break the Canada Health Act—and that’s a good thing

From the Fraser Institute

The leadership of the Canadian Medical Association (CMA) is facing sharp criticism for its recent proposal to effectively ban private payment for virtual care. In a clear example of putting politics before patients, this would only erect additional barriers for those seeking care.

Moreover, it’s a desperate bid to cling to an outdated—and failed—model of health care while underestimating modern-day innovations.

Virtual care—online video doctor consultations—is a private-sector innovation. In response to our government system’s inability to provide timely care, private companies such as Maple have been offering these services to Canadians for almost a decade. In fact, the public system only pushed meaningfully into the virtual space during COVID when it established partnerships with these private companies alongside setting up new fee codes for virtual consultations.

In return for improving access to physician consultations for thousands of Canadians, these virtual care companies have been rewarded with increased government scrutiny and red tape. The weapon of choice? The Canada Health Act (CHA).

Specifically, sections 18 to 21 of the CHA prohibit user fees and extra billing for “medically necessary” services. Further, the insurance plan of a province must be publicly administered and provide “reasonable access” to 100 per cent of insured services. Provinces found in violation are punished by the federal government, which withholds a portion (or all) of federal health-care transfer payments.

Until recently, there had been no obvious conflict between the CHA and privately paid-for virtual care—primarily because the provinces are free to determine what’s medically necessary. Until recently, many provinces did not even have billing codes for virtual care. As virtual services are increasingly provided by the public sector, however, the ability to innovatively provide care for paying patients (either out-of-pocket or through private insurance) becomes restricted further.

Within this context, the CMA recently recommended formally including virtual care services within the public system, alongside measures to ensure “equitable access.” At the same time, it reiterated its recommendation that private insurance to access medically necessary services covered by the CHA be prohibited.

See where this is going?

The kicker is an additional recommendation banning dual practice (i.e. physicians working in both the public and private sector) except under certain conditions. This means doctors in the public system who could otherwise allocate their spare hours to private appointments online would now have to choose to operate exclusively in either the public or private system.

The combined effect of these policies would ensure that innovative private options for virtual care—whether paid for out-of-pocket or though private insurance—will either be overtaken by bureaucracies or disappear entirely.

But what the CMA report fails to recognize is that virtual care has expanded access to services the government fails to provide—there’s little reason to suspect a government takeover of the virtual-care sector will make things better for patients. And even if governments could somehow prevent Canadian doctors and companies providing these services privately, virtual care is not beholden to Canada’s physical borders. Patients with a little bit of technical knowhow will simply bypass the Canadian system entirely by having virtual consultations with doctors abroad. If Canadians can figure out how to access their favourite show in another country, you can be sure they’ll find a way to get a consultation with a doctor in Mumbai instead of Montreal.

Instead of forcing physicians and patients to operate within the crumbling confines of government-run health care, the CMA’s leadership should be grateful for the pressure valve that the private sector has produced. We should celebrate the private innovators who have provided Canadians better access to health care, not finding ways to shut them down in favour of more government control.

Author:

Bacchus Barua

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Agriculture

Canada’s air quality among the best in the world

Published on December 8, 2025

Todayville

From the Fraser Institute

By Annika Segelhorst and Elmira Aliakbari

Canadians care about the environment and breathing clean air. In 2023, the share of Canadians concerned about the state of outdoor air quality was 7 in 10, according to survey results from Abacus Data. Yet Canada outperforms most comparable high-income countries on air quality, suggesting a gap between public perception and empirical reality. Overall, Canada ranks 8th for air quality among 31 high-income countries, according to our recent study published by the Fraser Institute.

A key determinant of air quality is the presence of tiny solid particles and liquid droplets floating in the air, known as particulates. The smallest of these particles, known as fine particulate matter, are especially hazardous, as they can penetrate deep into a person’s lungs, enter the blood stream and harm our health.

Exposure to fine particulate matter stems from both natural and human sources. Natural events such as wildfires, dust storms and volcanic eruptions can release particles into the air that can travel thousands of kilometres. Other sources of particulate pollution originate from human activities such as the combustion of fossil fuels in automobiles and during industrial processes.

The World Health Organization (WHO) and the Canadian Council of Ministers of the Environment (CCME) publish air quality guidelines related to health, which we used to measure and rank 31 high-income countries on air quality.

Using data from 2022 (the latest year of consistently available data), our study assessed air quality based on three measures related to particulate pollution: (1) average exposure, (2) share of the population at risk, and (3) estimated health impacts.

The first measure, average exposure, reflects the average level of outdoor particle pollution people are exposed to over a year. Among 31 high-income countries, Canadians had the 5th-lowest average exposure to particulate pollution.

Next, the study considered the proportion of each country’s population that experienced an annual average level of fine particle pollution greater than the WHO’s air quality guideline. Only 2 per cent of Canadians were exposed to fine particle pollution levels exceeding the WHO guideline for annual exposure, ranking 9th of 31 countries. In other words, 98 per cent of Canadians were not exposed to fine particulate pollution levels exceeding health guidelines.

Finally, the study reviewed estimates of illness and mortality associated with fine particle pollution in each country. Canada had the fifth-lowest estimated death and illness burden due to fine particle pollution.

Taken together, the results show that Canada stands out as a global leader on clean air, ranking 8th overall for air quality among high-income countries.

Canada’s record underscores both the progress made in achieving cleaner air and the quality of life our clean air supports.

Annika Segelhorst

Junior Economist

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute

Banks

To increase competition in Canadian banking, mandate and mindset of bank regulators must change

Published on December 7, 2025

Todayville

From the Fraser Institute

By Lawrence L. Schembri and Andrew Spence

Canada’s weak productivity performance is directly related to the lack of competition across many concentrated industries. The high cost of financial services is a key contributor to our lagging living standards because services, such as payments, are essential input to the rest of our economy.

It’s well known that Canada’s banks are expensive and the services that they provide are outdated, especially compared to the banking systems of the United Kingdom and Australia that have better balanced the objectives of stability, competition and efficiency.

Canada’s banks are increasingly being called out by senior federal officials for not embracing new technology that would lower costs and improve productivity and living standards. Peter Rutledge, the Superintendent of Financial Institutions and senior officials at the Bank of Canada, notably Senior Deputy Governor Carolyn Rogers and Deputy Governor Nicolas Vincent, have called for measures to increase competition in the banking system to promote innovation, efficiency and lower prices for financial services.

The recent federal budget proposed several new measures to increase competition in the Canadian banking sector, which are long overdue. As a marker of how uncompetitive the market for financial services has become, the budget proposed direct interventions to reduce and even eliminate some bank service fees. In addition, the budget outlined a requirement to improve price and fee transparency for many transactions so consumers can make informed choices.

In an effort to reduce barriers to new entrants and to growth by smaller banks, the budget also proposed to ease the requirement that small banks include more public ownership in their capital structure.

At long last, the federal government signalled a commitment to (finally) introduce open banking by enacting the long-delayed Consumer Driven Banking Act. Open banking gives consumers full control over who they want to provide them with their financial services needs efficiently and safely. Consumers can then move beyond banks, utilizing technology to access cheaper and more efficient alternative financial service providers.

Open banking has been up and running in many countries around the world to great success. Canada lags far behind the U.K., Australia and Brazil where the presence of open banking has introduced lower prices, better service quality and faster transactions. It has also brought financing to small and medium-sized business who are often shut out of bank lending.

Realizing open banking and its gains requires a new payment mechanism called real time rail. This payment system delivers low-cost and immediate access to nonbank as well as bank financial service providers. Real time rail has been in the works in Canada for over a decade, but progress has been glacial and lags far behind the world’s leaders.

Despite the budget’s welcome backing for open banking, Canada should address the legislative mandates of its most important regulators, requiring them to weigh equally the twin objectives of financial system stability as well as competition and efficiency.

To better balance these objectives, Canada needs to reform its institutional framework to enhance the resilience of the overall banking system so it can absorb an individual bank failure at acceptable cost. This would encourage bank regulators to move away from a rigid “fear of failure” cultural mindset that suppresses competition and efficiency and has held back innovation and progress.

Canada should also reduce the compliance burden imposed on banks by the many and varied regulators to reduce barriers to entry and expansion by domestic and foreign banks. These agencies, including the Office of the Superintendent of Financial Institutions, Financial Consumer Agency of Canada, Financial Transactions and Reports Analysis Centre of Canada, the Canada Deposit Insurance Corporation plus several others, act in largely uncoordinated manner and their duplicative effort greatly increases compliance and reporting costs. While Canada’s large banks are able, because of their market power, to pass those costs through to their customers via higher prices and fees, they also benefit because the heavy compliance burden represents a significant barrier to entry that shelters them from competition.

More fundamental reforms are needed, beyond the measures included in the federal budget, to strengthen the institutional framework and change the regulatory mindset. Such reforms would meaningfully increase competition, efficiency and innovation in the Canadian banking system, simultaneously improving the quality and lowering the cost of financial services, and thus raising productivity and the living standards of Canadians.