|OVERVIEW OF CANADA||HEALTHCARE IN CANADA||DOING BUSINESS IN CANADA|
Canada, a country consisting of 10 provinces and 3 territories, achieved its independence in 1867 but still retains close ties with the British Crown. The country functions as a federal parliamentary democracy, but is also a constitutional monarchy with Queen Elizabeth II as the head of state. Canada is the second largest country worldwide, after Russia, extending from the Atlantic to the Arctic and the Pacific oceans. Benefiting from abundant natural resources and a well-developed trade network, Canada is one of the richest countries in the world, with the highest highest GDP per capita globally. It is also globally recognized for having one of the highest scores on the Human Development Index and for having one of the healthiest economies in the world. 
35% of Canada’s population lives in Toronto, Vancouver and Montreal, while 27 million Canadians (81%) live in urban areas. The 2011 census shows that almost 7 in 10 people live in one of the country’s 33 census metro areas. The highest increases in population were noted in Calgary (12.6%) and Edmonton (12.1%). 
According to the latest 2011 census, Canada’s population grew from 31.6 million from 2006. The population growth rate has shown little variation in the past 30 years, ranging from 0.8% to 1.2%. International migration has been the main source of population growth in the past three decades, being responsible for around two thirds of population growth. In the past 5 years, Canada’s growth rate of 5.9% exceeded that of countries such as the USA, Germany or France. 
According to World Bank data from 2012, the number of children represented 16% of the population, down 5.8 points from 1982, while the number of seniors increased by 5.2 points to 15%. The population aging process is set to accelerate in the next decades, with the baby-boom generation growing older. Canada has an older population than Mexico (6%), China (9%), Brazil (7%) and the USA (14%) but younger than Germany (21%), France (17%) or the United Kingdom (17%). 
Canada has the highest life expediencies in North America, close to that of Australia, Sweden or France. Canadian men saw an increase of 5 years to 79 in terms of life expectancy from 1990 to 2012, while women moved from 80 to 83 years. The gap in life expectancy between Canada and the USA continues to increase, with Canadians living, on average, three years more than Americans.
Canada’s economy is dominated by the service industry, with the logging and oil industries being among the country’s most important. Canada’s GDP showed a growth rate of 1.7% in 2012, showing a comeback after the 2009 recession, when it contracted by 2.8%. According to The Bank of Canada, the outlook for economic growth is set at 2.3% in 2014 and 2.6% in 2015. 
Canada’s per capita GDP was US$ 52,219 in 2012, surpassing the USA for the first time in history. This value is also higher than the USA (US$ 49,965) or Japan (US$ 46,720) but lower than Australia’s (US$ 67,036). The per capita GDP has increased by 122% in the past 10 years, benefiting from an increasing demand from developing countries and high commodity prices.  
Canada’s medical sector is composed of over 1,500 companies that employ more than 35,000 people. Medical device exports amounted to US$ 1.72 billion in 2012, up from US$ 1.62 billion in 2007, while imports increased to US$ 6.7 billion from US$ 5.1 in 2007. Canada’s largest trading partner for medical devices is the United States, responsible for 50.9% of total medical device imports, followed by China (7%), Germany (6.3%) and Mexico (4.7%). In 2012, the main destinations for medical devices made in Canada were the USA (64.7%), Germany (4.5% of total) and China (3.1%). 
75% of Canada’s total trade is done with countries part of the country’s free trade agreements (FTAs), the most important one being North American Free Trade Agreement (between Canada, Mexico and the USA). Other FTAs in force exist with Panama, Jordan, Colombia, Peru, Costa Rica, Chile, Israel and EFTA (Iceland, Liechtenstein, Norway and Switzerland). An FTA has been signed with Honduras while there are ongoing negotiations for agreements with the Caribbean Community (CARICOM), the Central American Four (Guatemala, Nicaragua and El Salvador), the Dominican Republic, the European Union, India, Japan, South Korea, Morocco, Singapore and Ukraine. 
Healthcare for Canadians is delivered through a publicly funded system, put in place by the provisions of the Canada Health Act of 1984. The system is financed by funds from both the federal government, as well as the provincial and territorial governments. Often referred to as Medicare, the system provides universal coverage for physician and hospital services, with a statewide health insurance program that handles additional benefits such as home care, drug coverage or ambulance services. Each doctor handles insurance claims against the insurer taking away the responsibility from the patient. About two thirds of Canadians take out a supplemental insurance or have one from their employer to cover these additional services.  
11.2% of Canada’s GDP is allocated for healthcare spending, a much lower percentage than in the neighboring United States (11.7%), Netherlands (11.9%), Germany (11.3%) and France (11.6%). This percentage has slowly decreased, from 11.4% in 2009, due to budgetary deficits and modest economic growth. The health expenditure per capita in 2011 was higher than Brazil ($1,120), Japan ($3,958) or Mexico ($619) but lower than the US ($8,607) or Australia ($5,938).  
70.41% of health expenditures were covered by the Canadian government in 2011, according to data from the World Health Organization, down from 71.05% in 2010. This percentage is close only to Japan, with 80% government expenditure on health and far above such countries as Australia (55.89%), Brazil (45.74%) or USA (45.94%). 
The remaining 29.59% of healthcare costs are covered by private sources, represented by health insurances or out-of-pocket expenses. Patients may pay privately for some drugs, physiotherapy and other services. The private share of expenses is smaller in Japan, with 19.99% and at a similar level in Australia (31.49%).
48.61% of private expenses are paid out-of-pocket by Canadians. The highest out-of-pocket costs come from dental services, eye care and prescription drugs. The USA (20.89%) has smaller out-of-pocket expenses, while the highest were recorded for Japan (82.01%) and Mexico (92.02%). 
Canada’s medical device market is estimated at US$ 6.4 billion in 2012, being expected to grow to US$ 7.3 billion in 2013. It accounts for 2% of the global market with 80% of the market being made up of imported medical devices. The key expenditure areas are diagnostic apparatus, consumables, patient aids and orthopedic and prosthetic. Although the industry is distributed across Canada, many of the companies are concentrated around Ontario and Quebec. Canada had a trade gap of US$ 5.4 billion in 2012, with exports estimated at US$ 1.7 billion and imports – US$ 7 billion. The most imported medical devices in 2012 were laboratory reagents (7.4% of total imports), instruments & appliances parts (7.1%) and bougies, catheters, drains and parts (4.2%), while the most exported were composite diagnostic or laboratory reagents (21.5%), medical, surgical or dental furniture (7.5) and instruments & appliances (6.8%). 
2 physicians and 10 nurses attend to every 1,000 Canadians, according to WHO data from 2009. Canada has more nurses than Brazil, USA, Mexico, Australia or Japan and roughly the same number of doctors as Mexico and Japan. These numbers are above the world average (1.3 physicians and 3 nurses per 1,000 people) and below the EU average (3.3 and 8 respectively). 
Canada has 3.2 hospital beds per 1,000 people, ahead of countries such as Brazil (2.3 beds), the USA (3) but behind the European Union average (5.8).
Doing business in Canada
Canada is the eleventh largest economy and one of the world’s richest countries, with a market-oriented economy that resembles that of the USA. The country reported solid economic growth from 1993 to 2007, dropping into recession at the end of 2008. Growth, albeit minimal, has been achieved from 2010 to 2012 and plans or under way to balance its budget by 2015. Canada ranks 14th in the Global Competitiveness Index 2013-2014, ahead of countries such as France or Australia. This stable ranking is influenced by Canada’s transparent institutions, efficient goods, labor and financial markets as well as excellent infrastructure. Doing Business puts Canada on the 19th position out of 189 countries surveyed on the ease of doing business, above the OECD high income countries but below the USA or Australia.  
There are 3 documents required to import into Canada, 1 less than the OECD high income countries average. The number is also below the USA average and the EU, which both require 5 types of documents to import.
- Bill of Lading
- Commercial invoice
- Customs import declaration
Importing products into Canada takes an average of 10 days, the same amount of time as the OECD high income average (10 days), but longer than Australia (8 days) or the USA (5 days). This number has remained fairly consistent in recent years and is not projected to change in 2014.
Health Canada is the state agency that regulates the manufacturing, sales and importation of medical and IVD devices. To import a product into Canada, a duty is paid, varying from 0 to 35%, depending on the type of product<. The amount of duty is entirely dependent on the place in Canada where the importer resides, rather than the country where the product comes from. 
The Logistics Performance Index (LPI) is the average score for a country reflected by the efficiency of custom procedures, trade and transport related infrastructure, ease of arranging competitively priced shipments, quality of logistics services, ability to track and trace consignments and timeliness of shipments in reaching their destination. With an LPI of 3.84, Canada is ranked 14th, behind Germany, the USA and Japan but ahead of Australia or China. 
1 = Low; 5 = High
When it comes to enforcing contracts, Canada is ranked 58th out of 189 countries surveyed. It takes 570 days to enforce a contract in Canada, involves a cost of 22.3% of the claim and 36 procedures. Compared to other countries, Canada ranks below the USA, Germany, France or Australia and even below the OECD average for high income countries. 
For a detailed overview on how the the Canadian dollar has moved in recent years, please see the graphic below. 
A company located in Canada will have to pay 23.4% of its profit to tax authorities. Firms make 8 tax payments a year that require a total of 131 hours of filling. This numbers put Canada in the 8th spot in terms of the ease of paying taxes, outranking the USA, Australia or Germany.
Data compiled November 2013. Updated yearly
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