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Tuesday, 8 November 2011

Health care spending in Canada - Lets face the real facts.

“Health care spending cannot continue to rise faster than the rate of growth”. 
“We need to reverse the upward trend of health care spending”. 
“Time to turn down the curve”
“Health care spending cannot be let rise above 30% of the provincial budget”
“Health care spending cannot be let rise above 40% of the provincial budget”
“Health care spending is almost at 50% and we can’t let it eat up more of the provincial budget”

I’ve heard enough quotes by senior system administrators over the years to fill a book.  If they had been successful we would not be consistently facing crisis mode for the past multiple decades, during which it has never gone away. They also would not have announced the plethora of CT scanners, then MRI scanners, then new hospitals, expanded in-patient units, dialysis units, ICUs, CCUs, NICUs  etc.  The flagships that buy the public votes.
CIHI released its annual spending report to the sounds of $200 Billion chinking through the till for 2011. CIHI health care spending report .  Good luck finding the information, but it is there.  We now spend nearly $3800 public dollars per person on health care annually in the country, with the territories being hit with expenditures that are over twice this level.  Add in private payments and that number increases to $5800, a gap that continues to widen as a higher proportion of health costs are being borne by consumers.
To surpise many, hospital spending has proportionately decreased over the past 35 years from 55% to 37% of the dollars.  Physician costs have remains proportionately at 18-20% with minor fluctuations. Drugs have over quadrupled to almost 9%.  Public health has supposedly doubled from 4.4 to 8.9% - though one has to wonder if that includes all community based services, or truly public health/preventative services, and is down from a peak of 9.4% in 2007.  Administrative costs have declined to a 35 year low of 1.8%.  

More questions are burried in the detailed provincial data.  The health status of Canadians does not vary to the same extent as public expenditures.  Ranging from a low of 3400 in Quebec, to a high of 5300 in Newfoundland, expenditures don't correlate well with health status.  Public health investments vary from a low in Newfoundland of 3.1%, to a high in Saskatchwan of 9.2% - again raising questions on definitions, however a 300% variance across the country undermines the value of the data and the universality of our current Canada Health system.
There is much to the report, including placing Canada middle to bottom of the OECD pack for many public expenditures, and debunking many of the political propaganda on the dire and imminent demise of the health care system.  The facts by CIHI is perhaps the one document worth reading unless you enjoy pouring over the detailed data tables accessible on the site.   
Kudos to CIHI, but given the future rests in home care, community based services and public health in the pure sense of prevention, perhaps these could be detailed out in the future.  Phooey on those that continue to engender a sense of imminent failure and collapse, fear is not a good motivator for change.

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