Here is a look at healthcare across Canada as well as how Canada is doing as compare to its peers around the world.

1. HEALTHCARE CRISIS IN
CANADA
BY: PAUL YOUNG, CPA, CGA
DATE: FEBRUARY 25, 2019

2. PAUL YOUNG - BIO
• CPA, CGA
• Financial Solutions
• SME – Risk Management
• SME – Emerging Technology
• SME – Business Process Change
• SME – Close, Consolidate and Reporting
• SME – Public Policy
• SME – Financial Solutions
• SME – Supply Chain Management
Contact information:
Paul_Young_CGA@Hotmail.com

3. OVERVIEW
• Healthcare is a key area for many countries
• Canada spends roughly 10% of GDP on healthcare or about $200B.
Approximately 20% comes from the federal government through the
HST
• The largest expenditures for provinces is healthcare. Ontario for
example spends around $55B or about 40% of their budget on
healthcare
• There is lots of waste within healthcare as many provinces have not
done a very good job when it comes to value for money/healthcare

4. AGENDA
• Who is responsible for Healthcare
• Most Efficient Healthcare Systems
• Federal Government Funding
• Healthcare Dollars Flow
• Ontario Healthcare Transfer Analysis
• Healthcare Ranking
• Letter to local MP
• Liberal Supporter Debate / Blog
• $36B Shortfall / Council for Canadians
• Healthcare forced cuts to frontline services
• Singapore

5. SUMMARY
• This presentation will look
at funding of healthcare
along with the issues facing
the delivery of healthcare
dollars by the provinces and
territories as part of
improving patient care.

6. PROVINCI
AL
POWERS
• The administration and delivery of health care services is
the responsibility of each province or territory, guided by
the provisions of the Canada Health Act. The provinces
and territories fund these services with assistance from
the federal government in the form of fiscal transfers.
• Health care services include insured primary health care
(such as the services of physicians and other health
professionals) and care in hospitals, which account for
the majority of provincial and territorial health
expenditures.
• The provinces and territories also provide some groups
with supplementary health benefits not covered by the
Act, such as prescription drug coverage. The level and
scope of coverage for supplementary benefits varies
between jurisdictions.
Source - http://healthycanadians.gc.ca/health-system-
systeme-sante/cards-cartes-eng.php

7. FEDERAL GOVERNMENT FUNDING
• he Canada Health Transfer, or CHT, is the largest major transfer to provinces and territories. It provides long-term
predictable funding for health care, and supports the principles of the Canada Health Act which are: universality;
comprehensiveness; portability; accessibility; and, public administration.
• CHT transfer payments are made on an equal per capita basis, and include both cash and tax point transfers. Starting in
2014-15, provincial and territorial CHT transfers will be allocated on an equal per capita cash basis only.
• As announced in December 2011, total CHT cash levels are set in legislation to grow at 6 per cent until 2016-17. Starting
in 2017-18, total CHT cash will grow in line with a three-year moving average of nominal Gross Domestic Product, with
funding guaranteed to increase by at least 3 per cent per year.
• The move to an equal capita cash allocation is part of a long-term plan announced by the Government in Budget 2007 to
provide comparable treatment for all Canadians, regardless of where they live. The Government will ensure that the
transition is fiscally responsible by implementing a by-province and territory protection that will ensure that no province
or territory will receive less than its 2013-14 CHT cash allocation in future years as a result of the move to equal per
capita cash.
Source – Government of Canada -
https://www.fin.gc.ca/fedprov/mtp-eng.asp

8. HEALTHCARE RANKING
https://globalnews.ca/news/3599458/canadas-health-care-system-lower-
performing-compared-to-its-peers-study/
• The document makes it clear Canadians
are not getting value for money, spending
the equivalent of 10 per cent of our GDP
on health care in 2014. Meanwhile, many
higher-ranked countries spent less and
still managed to come out on top.
• It’s certainly not all bad news, However.
Canada performed quite well on many
metrics. The country has some of the
lowest mortality rates for patients who end
up in hospital following a heart attack, for
example, and survival rates for certain
types of cancer are also comparatively
high. Unlike their peers abroad, Canadian
doctors were unlikely to say that they
wasted too much time on administrative
tasks.

9. MOST EFFICIENT
HEALTHCARE
SYSTEMS /
WORLD
Source -
https://www.bloomberg.com/
news/articles/2018-09-19/u-
s-near-bottom-of-health-
index-hong-kong-and-
singapore-at-top

10. HEALTHCARE FUNDING FLOW
Federal Government (Canadian Health Transfers)
Provinces (Canadian Health Transfer and taxation from general revenue)
Doctors/Clinics
(OHIP/Provincial Plan Billing)
Hospitals
Transfers of funding
Other Programs
• Homecare
• Mental Health Programs
• Substance Abuse Programs
• Assisting Living

11. HEALTHCARE TRANSFERS
6% growth
year over
year
Federal Transfers to Ontario Ontario
Healthcare
Funding
Hospital Example
/Royal Victoria
Hospital Barrie

12. HEALTHCARE
RANKING

13. LETTER TO
MP /
HEALTHCAR
E
• Here are facts about healthcare including the government commitments.
• http://globalnews.ca/news/2042725/health-ministers-urging-pharmacare-program-to-pay-
for-prescription-drugs/
• It is all about money and not looking at cost to serve models, right? It seems to me that there are
deep issues with delivery of healthcare dollars, but that is never discussed. I guess when we have
governments like NDP/LP across Canada at the provincial level it is all about handouts!
• During the past two elections the nursing association called out Harper for not funding healthcare
to extent was required as part of the service level. Yet, the nursing association received money for
training that never made it to training.
• Videos
• https://www.youtube.com/watch?v=hS4_VLc59kM
• https://www.youtube.com/watch?v=p0ijr_Gp2os
• Here are comments on Healthcare
• Mr. Harper has funded healthcare on average 6% per year. (Please refer to the government F/S -
http://www.fin.gc.ca/afr-rfa/2014/index-eng.asp )
• The new accord ties healthcare to GDP growth that will ensure that healthcare spending not below
3% (link: http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending
or
• http://www.fin.gc.ca/access/fedprov-eng.asp.
• The provincial governments need to take some responsibilities when it comes to delivery:
http://www.thestar.com/opinion/commentary/2014/02/26/kathleen_wynne_must_clean_up_hom
ecare_mess_hepburn.html"
• Or
• Spending Issues:
• http://www.procurementoffice.ca/2015/02/12/post-ehealth-audit-uncovered-more-health-
sector-spending-abuses/
• Pharma Options
• http://www.cbc.ca/news/health/pharmacare-is-not-unaffordable-drug-policy-experts-find-
1.2994857

14. LETTER TO
MP /
HEALTHCA
RE
• Source:
• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-
spending
• http://www.bloomberg.com/visual-data/best-and-worst//most-efficient-health-
care-2014-countries
• http://www.theglobeandmail.com/globe-debate/apples-to-apples-canadas-health-
system-underperforms/article19351870/
• http://www.ctvnews.ca/health/canada-ranked-last-among-oecd-countries-in-
health-care-wait-times-1.1647061
• http://www.huffingtonpost.ca/michael-bolen/canadian-health-care-
ranking_b_5503898.html
• http://www.thestar.com/news/ontario/2009/10/07/ehealth_squandered_1b_auditor
_says.html
• http://www.progressive-economics.ca/2014/12/12/the-ontario-auditors-damning-
report-on-p3s/,
• Where are government on Retirement Living:
https://www.sfu.ca/uploads/page/10/GRC_030.pdf

15. DEBATE WITH LIBERAL SUPPORTER
• Healthcare accord:
• http://www.fin.gc.ca/fedprov/his-eng.asp (the health accord was change to GDP growth)
• The growth will be at least 3%. The previous deal replaced the 6% growth rate. Transfers could be higher depending on GDP
• The based amount of transfers to the provinces is at 34B Billion.
• If you use 3% growth rate then the transfers will be $401B as compare to 414 using 6% growth rate. The difference would be $13B
• If you use 12% growth rate then the transfers will 437B as compare to 401B.
• Provinces are combining their drug procurement process to reduce costs: http://www.cbc.ca/news/politics/provinces-reach-deal-to-save-on-6-generic-
drugs-1.1331370
• Provinces have added levels of management: http://www.thespec.com/news-story/2155849-if-lhins-are-disbanded-what-then-/
• Provinces need to cap executive salaries: http://news.nationalpost.com/2014/10/29/ontario-looks-to-cap-executive-salaries-at-scandal-plagued-ornge-
ehealth-and-the-broader-public-sector/
• Provinces need to look at compensation growth - http://www.cihi.ca/cihi-ext-
portal/internet/en/document/spending+and+health+workforce/workforce/physicians/release_22jan13
• Healthcare needs to undertake value for money: http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/value-for-
money-in-health-care.pdf
• I am all for debate, but it is like you want me to do the work for you on different aspect of funding, delivery, etc. If there was detail report
then I can do more analysis. There are assumptions built into their models that I am not privy to the details!
• Source:
• http://www.fin.gc.ca/fedprov/mtp-eng.asp
• http://www.fin.gc.ca/fedprov/mtp-eng.asp
• http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/value-for-money-in-health-care.pdf
• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending
•

16. NDP AND HEALTHCARE
• http://www.thestar.com/news/federal-election/2015/09/14/ndp-prescribes-500m-for-health-care-system.html
• NDP needs to take a deep look at the issues driving the cuts and stop throwing money at the symptoms. NDP seems
to think the whole issue is money when there are issues with delivery including bloated levels of administration. I
cannot believe people buy the comments from the NDP as they do nothing but throw money at the symptoms and
that never fixes the root causes to a policy
• https://www.youtube.com/watch?v=p0ijr_Gp2os
• http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-spending
• http://www.lfpress.com/2014/04/25/only-paltry-sum-was-used-for-retraining
• I am all for solutions, but unless accountability/transparency are part of the solution including tying the following to
funding them nothing will be done for healthcare
• Access to family physician or specialist
• Wait Times – Reduction
• Access to homecare spaces
• CEO salaries/Compensation
• Other productivity/efficiency improvements
• *** NDP has never been known to fix healthcare at the provincial level -
http://www.cbc.ca/news/canada/manitoba/manitoba-gets-poor-grade-in-canadian-health-report-1.2954500

17. COUNCIL
FOR
CANADIANS
– 36B
HEALTHCAR
E FUNDING
GAP
• PBO - http://cupe.ca/canadas-health-
care-system-about-lose-36-billion. Yet
nothing is said on the waste with
healthcare, why?
http://www.nugget.ca/2015/03/31/worker
s-rally-for-new-health-accord. It seems
like unions are complaining at funding
from the Feds, but say nothing on the
LHINs or CCAC -
http://blogs.windsorstar.com/opinion/the-
stars-view-time-to-audit-ccacs-and-the-
lhins or revenue like Ontario Health
Premium that does not go to healthcare -
http://www.fin.gov.on.ca/en/budget/pacct
s/2014/14_cfs.html#operations

18. ONTARIO HEALTHCARE FORCED CUTS
• Quote “The Ontario Nurses' Association is sounding the alarm about layoffs of
Registered Nurses by cash-strapped hospitals, and warns patients will pay the
price.
• The union, which represents 60,000 registered nurses, says there were 770 RN
positions cut across Ontario last year, and hospitals in Windsor and Kitchener
have already announced more RN layoffs this month.
• The hospitals decided to "risk the health outcomes of patients by cutting RNs
to balance the budget," said ONA president Linda Haslam-Stroud.”
Source - http://toronto.ctvnews.ca/patients-will-pay-the-price-for-ont-nurse-
layoffs-association-warns-1.2737697

19. HEALTHCARE
• I assess policies both on cost as well results (ou
• Wait times have worsen over the years -

20. GOVERNMEN
T WASTE
• Harris spent more government % on healthcare than Wynne/McGuinty. Harris was
slowly putting money back into healthcare due to new health accord. Harris was not
adding management, but front line workers.
• Transfers http://www.slideshare.net/paulyoungcga/provincial-transfers-and-
program-spending
• Ontario Spending - http://www.slideshare.net/paulyoungcga/ontario-government-
spending?related=1
• Ontario spending - http://www.slideshare.net/paulyoungcga/ontario-tax-and-
spend-analysis
• Moodys - http://www.thestar.com/business/economy/2015/02/23/moodys-says-
ontario-has-a-spending-problem.html
• Hydro Rates - http://www.slideshare.net/paulyoungcga/power-generation-canada
• Education, Healthcare and Infrastructure -
http://www.slideshare.net/paulyoungcga/provincial-transfers-and-program-
spending
• 2015 Planned audit - http://www.auditor.on.ca/en/plannedaudits_en.htm
• LHINs - http://www.procurementoffice.ca/2015/02/12/post-ehealth-audit-
uncovered-more-health-sector-spending-abuses/
• Nursing -
http://www.ona.org/presidents_message/RN_Cuts_devastate_Patient_Care_20150324
.html
• Homecare - http://www.thestar.com/opinion/commentary/2015/03/14/a-golden-
chance-to-fix-home-care-mess-hepburn.html
•

21. GOVERNMEN
T WASTE
• Here are examples of waste:
• P3 Costs $8B (source:
http://www.thestar.com/news/queenspark/2014/12/09/publicprivate_financing_cost_ontario_taxpayers_8_
billion_auditor_says.html)
• Equalization $10B (http://www.fin.gc.ca/fedprov/mtp-eng.asp#Ontario)
• Gas Plant Cancellation $1.1B
(http://www.thestar.com/news/canada/2013/10/08/liberals_power_plant_cancellations_cost_11b_auditor_g
eneral.html)
• eHealth $1B (http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640)
• Selling excess power $1B/year http://kitchener.ctvnews.ca/ontario-paid-1-billion-to-export-surplus-
power-in-2013-ndp-say-1.1647299 - 2013 amount only)
• Wind Subsidies $1B/year (http://www.netnewsledger.com/2014/03/05/ontario-wind-energy-plans-
costing-1-billion-annually/)
• Ontario capital Expenditures $11.8B (http://www.fin.gov.on.ca/en/budget/paccts/2014/)
• Ontario shares of gas tax $750M (http://www.infrastructure.gc.ca/alt-format/pdf/GTF-FTE-20140905-
eng.pdf)
• Municipalities Capital spending $6B
(http://www.amo.on.ca/Advocacy.aspx?searchtext=capital&searchmode=exactphrase&date=0;&issue=0;&ca
tegory=0;)
• Wynne’s AIT Issues - http://www.cbc.ca/news/canada/saskatchewan/saskatchewan-premier-brad-wall-
concerned-about-ontario-quebec-position-on-energy-east-1.2848930
•
• The government of Ontario as at least wasted $30B via failed projects. Ontario also has spent about
$11B/year on capital with the municipalities spending about $6B. So, why does Wynne not mention that in
her speech?

22. SINGAPORE
• https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-
bottom-of-health-index-hong-kong-and-singapore-at-top or
https://sbr.com.sg/healthcare/news/singapore-dethroned-hong-
kong-worlds-most-efficient-healthcare-system-bloomberg or
https://www.nytimes.com/2017/10/02/upshot/what-makes-
singapores-health-care-so-cheap.html
• “Singapore's health system also has a mix of public and private health
care delivery organizations”

23. PRESCRIPTIO
N DRUG
COSTS /
CANADA
Source -
http://www.cmaj.ca/content/1
89/23/E794.full?sid=16adbec
d-39db-4d77-9474-
87d351a777da

24. WHAT’S
NEXT
• Healthcare needs to endorse co-payments -
https://www.monster.ca/career-
advice/article/how-much-are-health-benefits-
canada
• Liberals need to reverse their small business
taxation policies -
http://www.cmaj.ca/content/190/2/E62
• Provincial govt need removed the waste by
eliminating the levels of duplicate management
• Drug procurement process needs to be fixed to
ensure drug costs are control along with
accessibility to new drugs and treatment.
• Mix of public and privatization when it comes to
healthcare
• More use of technology, i.e. remote surgery, AI,
etc.