NUFFIELD TRUST/CHSRF MASTERCLASSCANADIAN HEALTH SPENDING: MANAGING IN ADOWNTURN (1990-1999)May 17, 2011 – London, England ...
CURRENT PICTURE          SASKATCHEWAN           ONTARIO              U.K.Combined Lifeexpectancy at birth            79.5 ...
SourcesFigure 1:   Canadian Institute for Health Information; United            Kingdom Office for National StatisticsFigu...
Important Context for Canada (1990-2000)• Recession hits North America hard (Black Friday/Gulf War/Oil  Shocks)• Significa...
Total health expenditure per capita, US$ PPPSource: Public Accounts and 2000 budgets.                                     ...
Federal and provincial-territorial surplus/deficit(-)Public Accounts basisSource: Public Accounts and 2000 budgets.       ...
Federal and provincial-territorial net debtPublic Accounts basisSource: Public Accounts and 2000 budgets.                 ...
REAL PER CAPITA GDP, CANADA:before, during and after the recession (1985 to 2000)$50,000$45,000$40,000$35,000$30,000$25,00...
REAL PER CAPITAPUBLIC SECTOR HEALTH EXPENDITURE:  Canada, 1980 to 2010(f)  $4,500  $4,000                                 ...
Provincial/Territorial Government RevenuesConstant Dollar Indices (1993 = 100), Canada, 1993 to 2009          federal reve...
ONTARIO & SASKATCHEWAN         CASES         11
REAL PER CAPITA SPENDING GROWTH ONHOSPITALS AND OTHER INSTITUTIONS:Ontario, 1990 to 200010% 5%                            ...
REAL PER CAPITA SPENDING GROWTH ONHOSPITALS AND OTHER INSTITUTIONS:Saskatchewan, 1990 to 200010% 5%                       ...
Per Capita Physician Spending 1981-2010                  14
Hospital beds per 1,000 population876543210    1980           1982                  1984                         1986     ...
Evolution of Assessments of the Quality of theHealth Care System“Thinking broadly about Canadas health-care system and the...
QUESTIONS?    17
18
Net Debt-to-GDP RatioSource: Department of Finance.                                 19
Source: 2000 Federal Budget                              20
21
The provinces and territories recorded an aggregatesurplus in 1999-2000Federal and provincial-territorial budgetary balanc...
Federal andprovincial-territorialsurplus/deficit(-)Public Accounts basisSource: Public Accounts and 2000budgets.          ...
Provincial-territorial revenues and program spendingNational Accounts basisSource: National Income and Expenditure Account...
Interprovincial comparison of taxpayer-supported debt as a percentage of GDPSource: Moody’s Investors Service Inc.        ...
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Terrence Sullivan: Canadian health spending

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Terrence Sullivan: Canadian health spending

  1. 1. NUFFIELD TRUST/CHSRF MASTERCLASSCANADIAN HEALTH SPENDING: MANAGING IN ADOWNTURN (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
  2. 2. CURRENT PICTURE SASKATCHEWAN ONTARIO U.K.Combined Lifeexpectancy at birth 79.5 81 79.7(‘97)Population (2011) 1M 13.2M 60.5MCurrent Debt (2011) • 20 million • $16.7B deficit • £ 163B deficit surplus • Net Debt: 37.6% • Net Debt: 59% of • Net Debt: 7% of of Provincial GDP provincial GDP GDPPer Capita GDP (2009) C$45,718 C$43,847 US$32,798 2
  3. 3. SourcesFigure 1: Canadian Institute for Health Information; United Kingdom Office for National StatisticsFigure 2/3: OECD Health Data 2010. 3
  4. 4. Important Context for Canada (1990-2000)• Recession hits North America hard (Black Friday/Gulf War/Oil Shocks)• Significant growth in debt burden by federal/provincial governments• Multiple Premier’s Commissions on Health Reform• Experimentation with regionalization emerges in English Canada• Significant contraction caused decline in public confidence but no evidence of any adverse health outcomes• Significant National Reform Commission Efforts followed in early 2000 4
  5. 5. Total health expenditure per capita, US$ PPPSource: Public Accounts and 2000 budgets. 5
  6. 6. Federal and provincial-territorial surplus/deficit(-)Public Accounts basisSource: Public Accounts and 2000 budgets. 6
  7. 7. Federal and provincial-territorial net debtPublic Accounts basisSource: Public Accounts and 2000 budgets. 7
  8. 8. REAL PER CAPITA GDP, CANADA:before, during and after the recession (1985 to 2000)$50,000$45,000$40,000$35,000$30,000$25,000 8
  9. 9. REAL PER CAPITAPUBLIC SECTOR HEALTH EXPENDITURE: Canada, 1980 to 2010(f) $4,500 $4,000 Trend (1980 to 1991) $3,500 Trend (1992 to 1996) $3,000 Trend (1997 to 2010) $2,500 Actual $2,000 $1,500Source: Canadian Institute for Health Information 9
  10. 10. Provincial/Territorial Government RevenuesConstant Dollar Indices (1993 = 100), Canada, 1993 to 2009 federal revenue as a proportion in the current document Change in Federal TransfersSource: NHEX Database, CIHI. 10
  11. 11. ONTARIO & SASKATCHEWAN CASES 11
  12. 12. REAL PER CAPITA SPENDING GROWTH ONHOSPITALS AND OTHER INSTITUTIONS:Ontario, 1990 to 200010% 5% Hospitals 0% Other Institutions -5%-10%Source: OECD Health Data 2010 12
  13. 13. REAL PER CAPITA SPENDING GROWTH ONHOSPITALS AND OTHER INSTITUTIONS:Saskatchewan, 1990 to 200010% 5% Hospitals 0% Other Institutions -5%-10%Source: OECD Health Data 2010 13
  14. 14. Per Capita Physician Spending 1981-2010 14
  15. 15. Hospital beds per 1,000 population876543210 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 Source: OECD Health Data 2010. 15
  16. 16. Evolution of Assessments of the Quality of theHealth Care System“Thinking broadly about Canadas health-care system and the quality of medicalservices 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. 16
  17. 17. QUESTIONS? 17
  18. 18. 18
  19. 19. Net Debt-to-GDP RatioSource: Department of Finance. 19
  20. 20. Source: 2000 Federal Budget 20
  21. 21. 21
  22. 22. The provinces and territories recorded an aggregatesurplus in 1999-2000Federal and provincial-territorial budgetary balancePublic Accounts basisSource: Public Accounts and 2000 budgets. 22
  23. 23. Federal andprovincial-territorialsurplus/deficit(-)Public Accounts basisSource: Public Accounts and 2000budgets. 23
  24. 24. Provincial-territorial revenues and program spendingNational Accounts basisSource: National Income and Expenditure Accounts. 24
  25. 25. Interprovincial comparison of taxpayer-supported debt as a percentage of GDPSource: Moody’s Investors Service Inc. 25

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