Time to finally change the Canada Health Act for the sake of patients

Back in 1984, the Canada Health Act (CHA) received royal assent and has since reached near iconic status. At the same time, under its purview, the Canadian health-care system has become one of the least accessible—and most expensive—universal health-care systems in the developed world.

Clearly, policymakers should reform the CHA to reflect a more contemporary understanding of how to structure a truly world-class universal health-care system.

Consider for a moment the remarkably poor state of access to health care in Canada today. According to international comparisons of universal health-care systems, we endure some of the lowest access to physicians, medical technologies and hospital beds in the developed world. Wait times for health care in Canada also routinely rank among the longest in the developed world.

None of this is new. Canada’s poor ranking in the availability of services reaches back at least two decades. And wait times for health care have nearly tripled since the early 1990s. Back then, in 1993, Canadians could expect to wait 9.3 weeks for medical treatment after GP referral compared to 30 weeks in 2024.

This is all happening despite Canadians paying for one of the world’s most expensive universal-access health-care systems. And this brings us back to the CHA, which contains the federal government’s requirements for provincial policymaking. To receive their full federal cash transfers for health care from Ottawa, provinces must abide by CHA rules and regulations. And therein lies the rub.

We can find the solutions to our health-care woes in other countries such as Germany, Switzerland, the Netherlands and Australia, which all provide more timely access to quality care. Every one of these countries requires patient cost-sharing for physician and hospital services, and private competition in the delivery of universally accessible services with money following patients to hospitals and surgical clinics. And all these countries allow private purchases of health care, as this reduces the burden on the publicly-funded system and creates a valuable pressure valve for it.

Unfortunately for Canadians, the CHA expressly disallows requiring patients to share the cost of treatment while the CHA’s often vaguely defined terms and conditions have been used by federal governments to discourage a larger role for the private sector in the delivery of health-care services. At the same time, every new federal commitment to fix health care means increased provincial reliance on Ottawa. In 2024-25, federal cash transfers for health care are expected to total $52 billion, which means there’s $52 billion on the line for perceived non-compliance with the CHA. In short, this is why the provinces beholden to a policy approach that’s clearly failing Canadians.

So, what to do?

For starters, Ottawa should learn from its own welfare reforms in the 1990s, which reduced federal transfers and allowed provinces more flexibility with policymaking. The resulting period of provincial policy innovation reduced welfare dependency and government spending on social assistance (i.e. savings for taxpayers). When Ottawa stepped back and allowed the provinces to vary policy to their unique circumstances, Canadians got improved outcomes for fewer dollars.

We need that same approach for health care today, and it begins with the federal government reforming the CHA to expressly allow provinces the ability to explore alternate policy approaches, while maintaining the foundational principles of universality.

Next, the federal government should either hold cash transfers for health care constant (in nominal terms), reduce them or eliminate them entirely with a concordant reduction in federal taxes. By reducing (or eliminating) the pool of cash tied to the strings of the CHA, provinces would have greater freedom to pursue reform policies they consider to be in the best interests of their residents without federal intervention.

After 40 years, it’s high time to remove ambiguity and minimize uncertainty—and the potential for politically motivated interpretations—of the CHA. If federal policymakers want Canadians to finally have access to world-class health care, they should allow the provinces to choose their own set of universal health-care policies. The first step is to fix the 40-year-old legislation that has held the provinces back.

Nadeem Esmail

Senior Fellow, Fraser Institute

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Charitable giving on the decline in Canada

Published on December 20, 2025

Todayville

From the Fraser Institute

By Jake Fuss and Grady Munro

There would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior

According to recent polling, approximately one in five Canadians have skipped paying a bill over the past year so they can buy groceries. As families are increasingly hard-pressed to make ends meet, this undoubtedly means more and more people must seek out food banks, shelters and other charitable organizations to meet their basic necessities.

And each year, Canadians across the country donate their time and money to charities to help those in need—particularly around the holiday season. Yet at a time when the relatively high cost of living means these organizations need more resources, new data published by the Fraser Institute shows that the level of charitable giving in Canada is actually falling.

Specifically, over the last 10 years (2013 to 2023, the latest year of available data) the share of tax-filers who reported donating to charity fell from 21.9 per cent to 16.8 per cent. And while fewer Canadians are donating to charity, they’re also donating a smaller share of their income—during the same 10-year period, the share of aggregate income donated to charity fell from 0.55 per cent to 0.52 per cent.

To put this decline into perspective, consider this: there would have been 1.5 million more Canadians who donated to charity in 2023—and $755.5 million more in donations—had Canadians given to the same extent they did 10 years prior. Simply put, this long-standing decline in charitable giving in Canada ultimately limits the resources available for charities to help those in need.

On the bright side, despite the worrying long-term trends, the share of aggregate income donated to charity recently increased from 0.50 per cent in 2022 to 0.52 per cent in 2023. While this may seem like a marginal improvement, 0.02 per cent of aggregate income for all Canadians in 2023 was $255.7 million.

The provinces also reflect the national trends. From 2013 to 2023, every province saw a decline in the share of tax-filers donating to charity. These declines ranged from 15.4 per cent in Quebec to 31.4 per cent in Prince Edward Island.

Similarly, almost every province recorded a drop in the share of aggregate income donated to charity, with the largest being the 24.7 per cent decline seen in P.E.I. The only province to buck this trend was Alberta, which saw a 3.9 per cent increase in the share of aggregate income donated over the decade.

Just as Canada as a whole saw a recent improvement in the share of aggregate income donated, so too did many of the provinces. Indeed, seven provinces (except Manitoba, Nova Scotia and Newfoundland and Labrador) saw an increase in the share of aggregate income donated to charity from 2022 to 2023, with the largest increases occurring in Saskatchewan (7.9 per cent) and Alberta (6.7 per cent).

Canadians also volunteer their time to help those in need, yet the latest data show that volunteerism is also on the wane. According to Statistics Canada, the share of Canadians who volunteered (both formally and informally) fell by 8 per cent from 2018 to 2023. And the total numbers of hours volunteered (again, both formal and informal) fell by 18 per cent over that same period.

With many Canadians struggling to make ends meet, food banks, shelters and other charitable organizations play a critical role in providing basic necessities to those in need. Yet charitable giving—which provides resources for these charities—has long been on the decline. Hopefully, we’ll see this trend turn around swiftly.

Alberta

Schools should go back to basics to mitigate effects of AI

Published on December 20, 2025

Todayville

From the Fraser Institute

By Paige MacPherson

Odds are, you can’t tell whether this sentence was written by AI. Schools across Canada face the same problem. And happily, some are finding simple solutions.

Manitoba’s Division Scolaire Franco-Manitobaine recently issued new guidelines for teachers, to only assign optional homework and reading in grades Kindergarten to six, and limit homework in grades seven to 12. The reason? The proliferation of generative artificial intelligence (AI) chatbots such as ChatGPT make it very difficult for teachers, juggling a heavy workload, to discern genuine student work from AI-generated text. In fact, according to Division superintendent Alain Laberge, “Most of the [after-school assignment] submissions, we find, are coming from AI, to be quite honest.”

This problem isn’t limited to Manitoba, of course.

Two provincial doors down, in Alberta, new data analysis revealed that high school report card grades are rising while scores on provincewide assessments are not—particularly since 2022, the year ChatGPT was released. Report cards account for take-home work, while standardized tests are written in person, in the presence of teaching staff.

Specifically, from 2016 to 2019, the average standardized test score in Alberta across a range of subjects was 64 while the report card grade was 73.3—or 9.3 percentage points higher). From 2022 and 2024, the gap increased to 12.5 percentage points. (Data for 2020 and 2021 are unavailable due to COVID school closures.)

In lieu of take-home work, the Division Scolaire Franco-Manitobaine recommends nightly reading for students, which is a great idea. Having students read nightly doesn’t cost schools a dime but it’s strongly associated with improving academic outcomes.

According to a Programme for International Student Assessment (PISA) analysis of 174,000 student scores across 32 countries, the connection between daily reading and literacy was “moderately strong and meaningful,” and reading engagement affects reading achievement more than the socioeconomic status, gender or family structure of students.

All of this points to an undeniable shift in education—that is, teachers are losing a once-valuable tool (homework) and shifting more work back into the classroom. And while new technologies will continue to change the education landscape in heretofore unknown ways, one time-tested winning strategy is to go back to basics.

And some of “the basics” have slipped rapidly away. Some college students in elite universities arrive on campus never having read an entire book. Many university professors bemoan the newfound inability of students to write essays or deconstruct basic story components. Canada’s average PISA scores—a test of 15-year-olds in math, reading and science—have plummeted. In math, student test scores have dropped 35 points—the PISA equivalent of nearly two years of lost learning—in the last two decades. In reading, students have fallen about one year behind while science scores dropped moderately.

The decline in Canadian student achievement predates the widespread access of generative AI, but AI complicates the problem. Again, the solution needn’t be costly or complicated. There’s a reason why many tech CEOs famously send their children to screen-free schools. If technology is too tempting, in or outside of class, students should write with a pencil and paper. If ChatGPT is too hard to detect (and we know it is, because even AI often can’t accurately detect AI), in-class essays and assignments make sense.

And crucially, standardized tests provide the most reliable equitable measure of student progress, and if properly monitored, they’re AI-proof. Yet standardized testing is on the wane in Canada, thanks to long-standing attacks from teacher unions and other opponents, and despite broad support from parents. Now more than ever, parents and educators require reliable data to access the ability of students. Standardized testing varies widely among the provinces, but parents in every province should demand a strong standardized testing regime.

AI may be here to stay and it may play a large role in the future of education. But if schools deprive students of the ability to read books, structure clear sentences, correspond organically with other humans and complete their own work, they will do students no favours. The best way to ensure kids are “future ready”—to borrow a phrase oft-used to justify seesawing educational tech trends—is to school them in the basics.