Canada Health and Medical Insurance Market

The market is segmented by Product Type (Private, Public), Term of Coverage (Short, Long), and Channel of Distribution (Brokers/Agents, Banks, Direct Purchases, Companies, Other Channels of Distribution) - Growth, Trends, and Forecast (2019-2024).

Market Snapshot

Canada Market snapshot
Study Period:

2015-2024

Base Year:

2018

CAGR:

7.5 %

Key Players:

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Market Overview

The Canadian health insurance market is expected to register an effective CAGR of 7.5% over the forecast period (2019-2024). It had been valued at USD 41 billion in 2017. However, it is facing challenges in terms of the delivery of health services in the rightful time, due to certain operational discrepancies.

While Medicare provides all the required health services free of cost to all the residents, and some of the employers offer private supplemental health insurance as a benefit cover to attract quality employees. Each province holds responsibility to raise the revenue, plan, regulate, and ensure the rightful delivery of the healthcare services, although the federal government regulates certain aspects of prescription drugs, and subsidizes the provinces coverage of services to vulnerable populations.

Public private partnerships in the health system delivery.

Drivers

  • Growing geriatric population.
  • Rising income and preference for better health benefits, to meet emergency health needs.
  • Increasing medical care costs across different healthcare services offered.

Restraints

  • Lack of awareness of the policy changes or the appropriate health plan details.
  • Lack of knowledge to choose the rightful provider.
  • Stronger competitor activity pressurizing the consumer health spending habits.

Scope of the Report

A complete background analysis of the Canadian health insurance industry, which includes an assessment of the National Health Accounts, economy, and emerging market trends by segments, significant changes in market dynamics, and market overview, is covered in the report.

By Product Type
Private Health Insurance (PMI)
Individual Policy Coverage
Group Policy Coverage
Public/Social Security Schemes
By Term of Coverage
Short-term
Long-term
By Channel of Distribution
Brokers/Agents
Banks
Direct
Companies
Other Channels of Distribution

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Key Market Trends

Private Health Insurance in Canada and Its Implications on the Health Coverage

Private health spending in Canada accounted to about 31% of the total health spending (includes private insurance, OOPs and others) in Canada, in 2018. In 2018, about 25 million Canadians had supplementary health insurance to achieve their health security needs. About 12% of the total health expenditure, in 2018, was derived from private insurance. Employment-based supplementary health insurance is the status quo among large employers and covers services, such as optometry, dental, and extended prescription drug coverage. In Canada, majority of the population is publicly financed, while the private healthcare delivery is achieved through 10 provincial and two territorial health insurance schemes. Three provinces, namely, British Colombia, Alberta, and Ontario, remain the core for Medicare services with the receival of the national health premiums.

Prior to 1940, the healthcare was essentially financed privately. However, with the advent of the 1984 act on Medicare and its principles, public had wide scope to receive a lot health benefits. Canada’s national public health insurance is characterized by local control, doctor autonomy, and consumer choice, i.e., patients can choose for themselves which physician and hospital to attend to receive services within their province. Healthcare providers are mostly private funded by public monies via provincial budgets. Hospitals are largely privately owned not for profit organizations who receive an annual global operating budgets from the provinces. Physicians practice privately, with their remunerations on fee for service basis received through the provincial health plans.

Health insurance

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Spotlight on the Popular Channels Used to Distribute Health Insurance in Canada

Canada is home to more than 130 health insurers serving the healthcare needs of its people. Group sales through the medium- and large-sized employers is the dominant channel of distribution in health insurance, which is best utilized by the Canadian population. Together with the traditional career agent or exclusive sales force, health insurers may as well use any combination of independent agents, Managing General Agencies (MGAs), and national accounts, to distribute their products. Each of these channels is further divided into sub-categories. So independent agents may be either individuals working on their own or Personal Producing Groups of Agents (PPGAs), MGAs include Associate General Agencies, and national accounts include both IIROC dealers and MFDA dealers.

  • MGA’s: Managing General Agencies – This is supposedly the largest channel of distribution for life, as well as health insurance in Canada, which contributes about 30% of all the new premiums. The MGA channel utilizes a wide variety of business models large, national organizations to small, local operations. Though there is no clear and consistent description of how the channel operates, there is no evidence of any systemic problems in the channel.

The Functions of an MGA include:

  • Back office support between advisor and insurer for sales transactions
  • Sales and marketing support for the advisor
  • Market conduct compliance support for the insurer

AGA’s Associate General Agencies – They too support independent financial advisors on a smaller scale, compared to the MGAs. It is mostly a sub to one or more MGAs.

Canada health and medical insurance market distribution channel share

Competitive Landscape

It is a fragmented market, with the leading players, such as SunLife, ManuLife, Great Westlife, contributing about 25-30% of the total health insurance market, in 2018. The competition is, however, tightening up, based on the consumer awareness about having an additional private health cover. The consumers are resorting to additional health benefits offered by the private players, besides receiving Medicare benefits free of costs. Sunlife, in 2018, had acquired MaxWell Health, a digital platform that makes it easy for plan members to make good benefit plan enrolment decisions, along with administration tools for employers and brokers.

Major Players

  1. Manulife
  2. Sun life Financial
  3. GreatWest Life
  4. Ontario Blue Cross
  5. Blue Cross Canada

* Complete list of players covered available in the table of contents below

Canada CL

Table of Contents

  1. 1. INTRODUCTION

    1. 1.1 Scope of the Study

    2. 1.2 Key Deliverables of the Study

    3. 1.3 Study Assumptions

  2. 2. RESEARCH METHODOLOGY

    1. 2.1 Analysis Methodology

    2. 2.2 Research Phases

  3. 3. EXECUTIVE SUMMARY

  4. 4. GOVERNMENT REGULATIONS AND INITIATIVES

    1. 4.1 Canada Health Act and Its Implications on the Overall Healthcare Coverage in Canadian Population

    2. 4.2 Insights on the Public or Social Security Health Insurance Coverage in Canada

    3. 4.3 Latest Government Rules Pertaining to Health Insurance Plans in Canada

  5. 5. INDUSTRY DYNAMICS AND INSIGHTS

    1. 5.1 Current Market Scenario

    2. 5.2 Market Dynamics

      1. 5.2.1 Drivers

      2. 5.2.2 Restraints

      3. 5.2.3 Opportunities

    3. 5.3 Brief on Health Insurance Premiums and Study on the Effect of Medical Trend Rate on Health Plans

    4. 5.4 Role of Private Health Insurance Service Providers in Serving the Healthcare Needs of Canadians

    5. 5.5 Insights on the Private Health Insurance Premiums Growth by Type of Coverage and Duration of Plans

    6. 5.6 Industry Attractiveness - Porter's Five Forces Analysis

    7. 5.7 Value Chain/Supply Chain Analysis

  6. 6. MARKET SEGMENTATION

    1. 6.1 By Product Type

      1. 6.1.1 Private Health Insurance (PMI)

        1. 6.1.1.1 Individual Policy Coverage

        2. 6.1.1.2 Group Policy Coverage

      2. 6.1.2 Public/Social Security Schemes

    2. 6.2 By Term of Coverage

      1. 6.2.1 Short-term

      2. 6.2.2 Long-term

    3. 6.3 By Channel of Distribution

      1. 6.3.1 Brokers/Agents

      2. 6.3.2 Banks

      3. 6.3.3 Direct

      4. 6.3.4 Companies

      5. 6.3.5 Other Channels of Distribution

  7. 7. COMPETITIVE LANDSCAPE

    1. 7.1 Overview (Market Concentration and Major Players)

    2. 7.2 Company Profiles

      1. 7.2.1 Manulife

      2. 7.2.2 Sun life Financial

      3. 7.2.3 GreatWest Life

      4. 7.2.4 Ontario Blue Cross

      5. 7.2.5 Blue Cross Canada

      6. 7.2.6 Green Shield Canada

      7. 7.2.7 Ivari

    3. *List Not Exhaustive
  8. 8. FUTURE GROWTH PROSPECTS OF THE CANADA HEALTH INSURANCE INDUSTRY

  9. 9. APPENDIX

    1. 9.1 Canada Public Health Insurance Statistics

    2. 9.2 Trend Analysis of Per Capita Health Expenditure in Canada

    3. 9.3 Statistics on Age-wise Health Insurance Coverage

    4. 9.4 Key Statistics on the Direct Written Premiums across Top Domestic and International Insurance Players in Canada

  10. 10. DISCLAIMER AND ABOUT US

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