Canadian health spending: Managing in a downturn (1990-1999)

NUFFIELD TRUST/CHSRF MASTERCLASS CANADIAN HEALTH SPENDING: MANAGING IN A DOWNTURN (1990-1999) May 17, 2011 – London, England
Terrence Sullivan
Professor, Dept of Health Policy Management and Evaluation
Dalla Lana School of Public Health, University of Toronto

CURRENT PICTURE SASKATCHEWAN ONTARIO U.K. Combined Life expectancy at birth (‘97) 79.5 81 79.7 Population (2011) 1M 13.2M 60.5M Current Debt (2011)
20 million surplus
Net Debt: 7% of provincial GDP
$16.7B deficit
Net Debt: 37.6% of Provincial GDP
£ 163B deficit
Net Debt: 59% of GDP
Per Capita GDP (2009) C$45,718 C$43,847 US$32,798

Sources Figure 1: Canadian Institute for Health Information; United Kingdom Office for National Statistics Figure 2/3: OECD Health Data 2010.

Recession hits North America hard (Black Friday/Gulf War/Oil Shocks)
Significant growth in debt burden by federal/provincial governments
Multiple Premier’s Commissions on Health Reform
Experimentation with regionalization emerges in English Canada
Significant contraction caused decline in public confidence but no evidence of any adverse health outcomes
Significant National Reform Commission Efforts followed in early 2000
Important Context for Canada (1990-2000)

Total health expenditure per capita, US$ PPP Source: Public Accounts and 2000 budgets.

Federal and provincial-territorial surplus/deficit(-) Public Accounts basis Source: Public Accounts and 2000 budgets.

Federal and provincial-territorial net debt Public Accounts basis Source: Public Accounts and 2000 budgets.

Provincial/Territorial Government Revenues Constant Dollar Indices (1993 = 100), Canada, 1993 to 2009 federal revenue as a proportion in the current document Change in Federal Transfers Source: NHEX Database, CIHI.

ONTARIO & SASKATCHEWAN CASES

Per Capita Physician Spending 1981-2010

Hospital beds per 1,000 population Source: OECD Health Data 2010.

Evolution of Assessments of the Quality of the Health Care System
“ Thinking broadly about Canada's health-care system and the quality of medical services it provides, how would you describe it overall? Would you say it is excellent, very good, good, only fair, poor or very poor?”
Source: Department of Finance.

QUESTIONS?

Net Debt-to-GDP Ratio Source: Department of Finance.

Source: 2000 Federal Budget

The provinces and territories recorded an aggregate surplus in 1999-2000 Federal and provincial-territorial budgetary balance Public Accounts basis Source: Public Accounts and 2000 budgets.

Federal and provincial-territorial surplus/deficit(-) Public Accounts basis Source: Public Accounts and 2000 budgets.

Provincial-territorial revenues and program spending National Accounts basis Source: National Income and Expenditure Accounts.

Interprovincial comparison of taxpayer-supported debt as a percentage of GDP Source: Moody’s Investors Service Inc.

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Canadian health spending: Managing in a downturn (1990-1999)

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Canadian health spending: Managing in a downturn (1990-1999) Presentation Transcript