Canada's Provinces likely to spend half of all revenues on health care by 2034, warns think-tank

Provincial spending on health care in Canada continues to grow faster than provincial revenues, with six out of 10 provinces projected to be spending half of all available revenue on health care by 2034, according to a new report from the Fraser Institute, one of Canada's leading economic think-tanks.

Ontario and New Brunswick face the biggest crunch, where health expenditures are on pace to consume half of total provincial revenues by 2014 or earlier. The study suggests that Prince Edward Island will likely reach the 50% point within 10 years, followed by Nova Scotia in 15, Manitoba in 17 and Quebec in 25 years.

'Health spending has increased at an unsustainable rate in the majority of provinces over the past decade,' said Brett Skinner, Fraser Institute director of bio-pharma, health, and insurance policy and lead author of its Paying More, Getting Less: 2009 Report.

'Unless provincial governments can devise a better way to finance health care, they will be forced to either hike taxes, expand rationing of medical goods and services, or make extensive cut backs in other government programs,' he added.

Mr Skinner points out that while the 10-year trend confirms the urgency of the sustainability problem, more recent one-year trends are even more concerning. 'Over the past year, health spending in Ontario is on pace to consume 50 per cent of total available revenue in the province by the end of next year,' he said.

Sustainability being addressed with tax burdens, which is 'misguided'

The report points out that some provinces have tried to address the sustainability problem by raising tax burdens. Mr Skinner argues that this approach is misguided. 'Tax hikes reduce economic growth in the long run, resulting in job losses and increased demand for government spending on employment insurance and social assistance programs. Attempting to drive long-term revenue growth through tax increases is futile, and if introduced at this time, would only further delay economic recovery from the recession,' he said.

The report also chronicles how provinces have tried to cut health spending using blunt, centrally imposed rationing. Provincial governments are increasingly forcing Canadians to accept less from public health insurance by reducing the supply of physicians and nurses, allowing hospital infrastructure to deteriorate, and refusing to cover new medical technologies. All of which contributes to long wait times for health care services, Mr Skinner notes, saying that, 'despite these misguided efforts, health spending is still growing faster than the ability of government to pay for it.'

The report concludes that Canada's current public health insurance system is simply not financially sustainable through public means alone and recommends several changes:

' encourage the efficient use of health care by requiring patients to make co-payments for all publicly funded medical goods and services they use;
' relieve cost pressures facing the public health insurance system by legally recognizing the moral right of patients to pay privately (out of pocket or through private insurance) for all types of medical goods and services, including hospitals and physician services, as is currently allowed for access to prescription drugs;
' allow health providers to receive reimbursement for their services from any insurer, whether government or private;
' shift the burden of medical price inflation onto the private sector by allowing providers to charge patients fees in addition to the government health insurance reimbursement level; and
' create incentives for cost and quality improvements by permitting both for-profit and non-profit health providers to compete for the delivery of publicly insured health services.

Mr Skinner suggests that Canada should follow the example of Switzerland or the Netherlands, where the government is not responsible for providing health or drug insurance. Instead, individuals in those countries are required by law to purchase comprehensive health insurance in a regulated, pluralistic private-sector market, and the government provides low-income subsidies so that everyone can afford coverage.

'Sustainable, high-quality health care is possible, but not under Canada's current system. Canadians will continue to pay more and get less from their health care system unless major health policy changes are introduced,' he concludes.

In a recent book (The Pharma Letter September 22), Dr Skinner detailed how Canada tends to be in the lowest ranks among all 30 Organization for Economic Cooperation and Development (OECD) countries for availability of medical resources including physicians, diagnostic technologies and new medicines per population, despite having one of the most expensive health care systems and, at the time, also proposed Switzerland and the Netherlands as models.