Transcript Health Care Financing in Canada

Health Care Financing in Canada
Pols 321 Lecture 4
Topics
• Federal-Provincial Financial Arrangements
• Distribution of Health Care Expenditures
• Reform Trends
Federal-Provincial Financial
Arrangements
EPF: The beginning of the end...
• effectively ended the 50/50 cost sharing
arrangements
– put hospitals, medical care and post secondary
education under one funding formula
– combination of tax points and cash (tied to
growth in GNP and population)
– federal government reduced cash transfers by
GDP -2 in 1986/87, GDP -3 in 1989/90, and
froze the transfers in 1990/91
Canada Health Act
• Ottawa introduces the Canada Health Act
– retains the five principles
– consolidates the two previous pieces of
legislation
– penalizes the provinces for allowing extrabilling by reducing EPF payments
– came before an election
CHST
• rolls CAP and EPF into a single block fund
• places a ceiling for 1996/97 of $ 26.9 billion
• 1997/98 and beyond to be determined
through negotiations
• CHA principles and CAP residency
requirements continue to apply
CHST ( $ billion)
Year
Total
entitl
Cash
entitl
1995/96 29.7
Tax
point
value
11.2
18.5
Additive
Cash
reductns
-
Cumul.
Cash
reductns
0.0
1996/97 26.9
11.9
15.0
3.5
3.5
1997/98 25.1
12.6
12.5
6.0
9.5
1998/99 25.8
13.3
12.5
6.0
15.5
1999/00 26.5
14.0
12.5
6.0
27.5
2001/02 27.8
15.3
12.5
6.0
33.5
Distribution of Health Care
Expenditures
Percentage
Health Expenditure Percentage GDP, OECD
18
16
14
12
10
8
6
4
2
0
15.3
10.6
10
8.2
US
Germany
Canada
Finland
8.9
OECD
Public Health Expenditures as a Proportion of Total
Health Expenditures
Percentage
100
BC
80
Quebec
60
Alberta
40
NFLD
20
Canada
0
1975
1980
1985
1990
Year
1995
2000
2005
Precentage
Total Health Expenditures as a Percentage of GDP
35
30
25
20
15
10
5
0
Alberta
Quebec
NFLD
BC
PEI
Nunavit
1980
1985
1990
1995
Year
2000
2005
Canada
Health Expenditures in Canada by Public Source
100
Percentage
80
Provincial Government
60
Federal Direct
40
Municipal
Social Security Funds
20
0
1975 1980 1985 1990 1995 2000 2005
Year
Total Health Expenditures as a Proportion of Total
Provincial Government Programs
Percentage
50
Quebec
40
NFLD
30
Alberta
20
BC
10
Canada
0
1975
1980
1985
1990
Year
1995
2000
2005
Public vs. Private
90
80
70
60
50
Public
40
Private
30
20
10
19
75
19
80
19
85
19
90
19
95
20
00
20
05
20
08
0
Private Sector Health Expenditures as a Proportion of
Total Provincial Health Expenditures
Percentage
40
Alberta
30
BC
20
Quebec
10
NFLD
Canada
0
1976
1980
1985
1990
Year
1995
2000
2005
Table 3: Percentage of Total Health Expenditures by Category
Hospital
1975
1985
1992
1996
2003
2006
44
39.8
37.1
34.2
30.0
28.4
Other
Instit.
9.1
10.1
9.7
10.0
9.5
10.3
** includes “administration”
Doctors
15.0
15.1
14.9
14.4
12.9
13.2
Other
Prof.
7.3
8.3
8.5
8.8
11.9
10.7
Drugs
Capital
10.2
10.7
13.3
14.4
16.2
16.7
4.4
4.6
3.2
2.5
4.6
4.8
Public
Health
3.8
4.3
4.6
5.0
6.5
6.1**
Other
6.1
7.1
8.7
10.7
8.4
6.2
Table 4: Public and Private Percentage Share of Health
Expenditures by Category
1975
1985
1992
1996
2003
2006
Hospital
Other
Instit.
Doctors
Other
Prof.
Drugs
Capital
Public
Health
Other
94.1/5.9
90.5/9.5
90.8/9.2
87.7/12.3
91.6/8.4
90.7/9.3
70.8/29.2
74.5/25.5
72.3/27.7
68.1/31.9
72/28
75.2/24.8
98.5/1.5
98.6/1.4
99.1/0.9
99.0/1.0
98.9/1.1
98.5/1.5
15.0/85.0
13.8/81.7
17.1/82.9
14.3/85.7
10/90
7.0/93.0
26.0/74.0
37.2/62.8
39.9/60.1
35.2/64.8
36.7/63.3
38.5/61.5
70.3/29.7
77.5/22.5
75.3/24.7
72.4/27.6
76.5/23.5
71.7/28.3
100.0
100.0
100.0
100.0
100.0
100.0
49.4/50.6
54.6/45.4
56.2/43.8
69.9/30.1
65/35
80.7/19.3
Registered Nursing Workforce,
Canada, 1980 to 2007
Notes
In 1988, the decrease is largely attributed to a substantial increase in the number of employment status
Not Stated records in the Ontario data for that year.
In 2000, the increase is partially attributed to the identification of comparatively fewer duplicates in the
Ontario and Quebec data that year.
In 2003, the increase is partially attributed to methodological changes in the submission of data that
year.
Source
Regulated Nursing Database, Canadian Institute for Health Information
Registered Nursing Workforce, by Jurisdiction and
Canada, 2003 to 2007
2003
2004
2005
2006
%
2007 Change20032007
N.L.
P.E.I.
N.S.
N.B.
5,430
1,373
8,498
7,186
5,452
1,377
8,602
7,375
5,496
1,443
8,733
7,526
5,515
1,428
8,790
7,680
5,574
1,435
8,843
7,726
2.7%
4.5%
4.1%
7.5%
Que.
62,494
63,455
63,827
64,014
64,955
3.9%
Ont.
85,187
86,099
89,429
90,061
90,978
6.8%
Man.
10,034
10,628
10,811
10,902
10,825
7.9%
Sask.
8,503
8,481
8,549
8,480
8,669
2.0%
Alta.
24,037
25,600
26,355
26,752
27,527
14.5%
B.C.
27,711
28,289
27,814
28,840
30,059
8.5%
Y.T.
290
283
302
324
322
11.0%
N.W.T./Nun.
672
930
957
1,033
1,048
56.0%
241,415
246,571
251,242
253,819
257,961
6.9%
Canada
Licensed Practical Nursing Workforce, by Jurisdiction and Canada,
2003 to 2007
%
2007 Change20032007
2,598
-4.5%
623
0.6%
3,160
4.6%
2,734
12.6%
2003
2004
2005
2006
N.L.
P.E.I.
N.S.
N.B.
2,719
619
3,022
2,429
2,710
628
3,058
2,556
2,698
606
3,127
2,633
2,639
599
3,174
2,646
Que.
14,831
15,472
16,293
17,104
17,492
17.9%
Ont.
25,730
24,467
24,458
25,084
26,126
1.5%
Man.
2,417
2,415
2,590
2,652
2,671
10.5%
Sask.
2,056
2,131
2,194
2,224
2,381
15.8%
Alta.
4,766
5,051
5,313
5,614
5,986
25.6%
B.C.
Y.T.
4,391
60
4,811
53
4,884
56
5,412
60
5,791
59
31.9%
-1.7%
N.W.T.
98
91
101
92
88
-10.2%
Canada
63,138
63,443
64,953
67,300
69,709
10.4%
Nurse Practitioner Workforce, by Jurisdiction and Canada, 2003
to 2007
N.L.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Y.T.
2003
55
23
6
494
73
-
2004
61
30
14
536
42
106
-
2005
66
37
19
590
*
74
130
*
-
2006
89
61
24
1†
639
*
88
156
35
-
2007
96
*
72
29
1†
731
31
99
176
50
-
N.W.T./Nun.
5
12
19
16
42
Canada
656
801
943
1,129
1,346
Reform Trends
Trends: Hospitals (1984-91)
• Total number of beds declined from 7.0 to
6.5/1000 (2.9 in 2007)
• Alberta - government targeted 2.4/100.
Capital Health actually achieved
1.4(1.6)/1000.
Trends: Hospitals (cont.)
• Nationally (1986/87-1994-95)
– 1994/95 - 901 public, 22 private and 55 federal
– total approved beds: 156,547 (98% public)
– Number of hospitals fell by 14 % or from 6.6
4.1 beds/1000 (11%). (actually a 30% declined
in staffed beds) – 2.9 in 2007
– Average annual growth in operating expenses
was 8 % (-2.4 % between 1991/92 and
1994/95)
Trends: Hospitals (cont.)
• Outpatient vs. Inpatient (1986/87,1993/94)
–
–
–
–
outpatient days: increased by 15%
inpatient days declined by 17%
day surgery increased by 37%
visits to emergency wards increased by 1%
– Alberta: ratio of outpatient visits to inpatient
days increased by 130%
Trends: Hospitals (cont.)
• Factors contributing to growth in costs:
– wage and price inflation (national and sector
specific
– economic downturn
– unionization
– professionalism
– increasing population aging
– rising costs per admission (intensity of
servicing/technology, decreasing productivity)
Trends: Physicians (1984-1991)
• # increased at at annual rate of 2%
• cost of services/patient increased by 10%
annually (1979/80, 1990/91)
• 10% reduction in medical school enrollment
• increasing service intensity
• declining utilization
• cost per patient increased at 10%/annum
(50% attributable to GPs)
Trends: Pharmaceuticals
(1987/91)
• Total expenditures increased by 55.(%>
10%/annum (not including drugs dispensed
in hospitals)
• new drugs are more costly than existing
drugs
• cost or volume?
• Price, volume and quantity have all
increased
Summary
• Cost drivers:
– economy-wide wage and price inflation
accounts for 50%
– population growth 10%
– aging 5 %
– wage and prices (health) 20%
– inpatient/outpatient
– higher service intensity 5%
– lower productivity 10%
Summary
• Proportion of private vs. public has been
relatively stable over time although there is
a definite downward trend in percentage of
public expenditures
• Definite upward trend in percentage of total
public expenditures devoted to health care
• Upward trend in health expenditures as a
percentage of GDP
Internet Sources
• http://secure.cihi.ca/cihiweb/dispPage.jsp?c
w_page=home_e
• http://www.fin.gc.ca/access/fedproveng.asp