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«Spending and Health Workforce Our Vision Better data. Better decisions. Healthier Canadians. Our Mandate To lead the development and maintenance of ...»

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National Health Expenditure Trends, 1975 to 2014

Report October 2014

Spending and Health Workforce

Our Vision

Better data. Better decisions.

Healthier Canadians.

Our Mandate

To lead the development and

maintenance of comprehensive

and integrated health information

that enables sound policy and

effective health system management

that improve health and health care.

Our Values

Respect, Integrity, Collaboration,

Excellence, Innovation Table of Contents Acknowledgements

Key Findings

Executive Summary

Introduction

1.0 Overview of Health Spending in Canada

1.1 Total Health Expenditure

1.2 Total Health Expenditure per Capita

1.3 Total Health Expenditure and Economic Growth

2.0 Total Health Expenditure by Source of Finance

2.1 Public and Private Sectors Fund Canada’s Health Care System

2.2 Public-Sector Health Expenditure by Source of Finance

2.3 Private-Sector Health Expenditure by Source of Finance

3.0 Total Health Expenditure by Use of Funds

3.1 Where Health Dollars Are Spent

3.2 Hospitals

3.3 Drugs

3.4 Physicians

3.5 Other Professionals

3.6 Other Institutions

3.7 Administration

3.8 Public Health

3.9 Other Health Spending

4.0 Health Expenditure in the Provinces and Territories

4.1 Provincial/Territorial Health Spending Differs

4.2 Trends in the Provinces and Territories

5.0 Provincial and Territorial Government Health Expenditure by Age and Sex

5.1 Standardization for Age and Sex

5.2 Population Aging

5.3 Issues to Monitor in Future

6.0 Provincial and Territorial Government Fiscal Position and Health Expenditures................. 80

6.1 Provincial and Territorial Government Financial Trends

6.2 Issues to Monitor in Future

National Health Expenditure Trends, 1975 to 2014

7.0 International Comparisons

7.1 Comparability of Health Expenditure Across Countries

7.2 OECD Definition of Total Health Expenditure

7.3 Total Health Expenditure as a Percentage of GDP—2012

7.4 Total Health Expenditure per Capita—2012

7.5 Health Expenditure Growth

7.6 Total Health Expenditure by Source of Finance—2012

7.7 Health Expenditure by Use of Funds—2012

7.8 Canada’s Position Among the OECD Member Countries

Appendix A—Methodological Notes

A.1 Concepts and Definitions

A.2 Major Data Limitations

A.3 Collection and Non-Response

A.4 Major Changes From Previous Years

A.5 Sources of Data

Appendix B—Data Tables

References

Comprehensive versions of data tables, series A to G, are available on the CD-ROM at the back of this report. They are also available online at www.cihi.ca/nhex.

–  –  –

List of Figures Figure 1: Total Health Expenditure, Canada, 1975 to 2014

Figure 2: Total Health Expenditure, Annual Growth Rates in Constant 1997 Dollars, Canada, 1976 to 2014

Figure 3: Average Annual Growth in Total Health Expenditures per Capita and GDP per Capita, 2000 to 2012

Figure 4: Cost Driver Shares of Average Annual Growth in Public-Sector Health Spending, 2000 to 2012, Compared With Annual Growth in 2013 and 2014............ 25 Figure 5: Total Health Expenditure per Capita, Canada, 1975 to 2014

Figure 6: Total Health Expenditure per Capita, Annual Growth Rates in Constant 1997 Dollars, Canada, 1976 to 2014

Figure 7: Total Health Expenditure as a Percentage of Gross Domestic Product, Canada, 1975 to 2014

Figure 8: Total Health Expenditure and Nominal GDP, Annual Growth, Canada, 1976 to 2014

Figure 9: Total Health Expenditure by Source of Finance, 2014 (Percentage Share and Billions of Dollars)

Figure 10: Health Expenditure by Source of Finance, Canada, 1975 to 2014

Figure 11: Public- and Private-Sector Shares of Total Health Expenditure, 1975 to 2014......... 33 Figure 12: Distribution of Private-Sector Health Expenditure by Source of Finance, Canada, 1988 and 2012 (Percentage Share and Millions of Dollars)

Figure 13: Share of Private-Sector Health Expenditure by Source of Finance, Canada, 1988 to 2012

Figure 14: Private-Sector Health Expenditure per Capita, Source of Finance, Canada, 1988, 1998 and 2012

Figure 15: Total Health Expenditure by Use of Funds, Canada, 2014 (Percentage Share and Billions of Dollars)

Figure 16: Public and Private Shares of Total Health Expenditure, by Use of Funds, Canada, 2014

Figure 17: Total Health Expenditure, Share of Selected Use of Funds, Canada, 1975 to 2014

Figure 18: Total Expenditure per Capita, Selected Use of Funds, Canada, 1975 to 2014......... 45 Figure 19: Hospital Share of Public-Sector Health Expenditure

National Health Expenditure Trends, 1975 to 2014

Figure 20: Drugs by Source of Finance and Type, Canada, 2012 (Percentage Share and Billions of Dollars)





Figure 21: Prescribed Drug Expenditure, Private-Sector Share, Canada, 1975 to 2014........... 50 Figure 22: Private Prescribed Drug Expenditure, Share by Source of Finance, Canada, 1988 to 2012

Figure 23: Public-Sector Physician Expenditure per Capita, Share of Total Health Expenditure, Canada, 1975 to 2014

Figure 24: Dental and Vision Care Services Expenditure, Total per Capita, Canada, 1975 to 2014

Figure 25: Professionals Expenditure by Source of Finance and Type, Canada, 2012 (Percentage Share and Billions of Dollars)

Figure 26: Other Professionals Expenditure, Share of Total Private Spending, by Type, Canada, 1975 to 2014

Figure 27: Private Dental Expenditures, Share by Source of Finance, Canada, 1988 to 2012

Figure 28: Other Institutions Health Expenditure per Capita, Canada, 1975 to 2014................ 59 Figure 29: Public-Sector Other Institutions Expenditure as a Percentage of Total Other Institutions Expenditure, Canada, 2000 to 2014

Figure 30: Public Health Spending as a Percentage of Total Health Expenditure, Canada, 1975 to 2014

Figure 31: Public- and Private-Sector Health Expenditure per Capita, 1988 to 2014, by Province and Territory, Constant 1997 Dollars

Figure 32: Age Distribution, Canada, 2000 and 2012

Figure 33: Total Provincial/Territorial Government Health Expenditure, by Age and Sex, Canada, 2012

Figure 34: Provincial/Territorial Government Health Expenditure per Capita, by Age Group, Canada, 2012

Figure 35: Share of Provincial/Territorial Government Health Expenditure, by Age Group, Canada, 2000 and 2012

Figure 36: Contribution of Aging to Average Annual Growth for Hospitals, Physicians, Drugs and Other Institutions, Canada, 2000 to 2012

Figure 37: Contribution of Population Growth and Aging to Average Annual Growth in Provincial/Territorial Government Health Spending, by Province/Territory and Canada, 2000 to 2012

Figure 38: Provincial/Territorial Government Revenue, Constant Dollar Indices (1993 = 100), Canada, 1993 to 2013

National Health Expenditure Trends, 1975 to 2014

Figure 39: Provincial/Territorial Government Health Expenditure per Capita in Constant 1997 Dollars, Canada, Three Distinct Periods, 1975 to 2014

Figure 40: Provincial/Territorial Government Health Expenditure as a Proportion of Total Provincial/Territorial Government Expenditure and Programs, Canada, 1993 to 2013

Figure 41: Provincial/Territorial Government Spending Growth (Health, Transportation/ Communications, Education and Social Services) Compared With Revenue and Debt Charges, Average Annual Real per Capita Expenditure Growth, Canada, 1998 to 2009

Figure 42: Total Health Expenditure as a Percentage of GDP, 30 Selected OECD Countries, 2012

Figure 43: Total Health Expenditure per Capita, US$ Purchasing Power Parity, 30 Selected OECD Countries, 2012

Figure 44: Annual Growth in Total Health Expenditure per Capita, in Current National Currency Units, Canada and OECD Average, 2001 to 2012

Figure 45: Total Health Expenditure, Public and Private Shares, 30 Selected OECD Countries, 2012

Figure 46: Expenditure on Services Provided by Hospitals, per Capita US$ Purchasing Power Parity, 29 Selected OECD Countries, 2012

Figure 47: Total Expenditure on Drugs, per Capita US$ Purchasing Power Parity, 29 Selected OECD Countries, 2012

Figure 48: Expenditure on Services Provided by Offices of Physicians, per Capita US$ Purchasing Power Parity, 26 Selected OECD Countries, 2012

Figure A1: Composition of Total Health Expenditures, by Source of Finance

National Health Expenditure Trends, 1975 to 2014

List of Tables Table 1: Distribution of Public-Sector Health Expenditure by Source of Finance, Canada, 1975 and 2012

Table 2: Quebec Drug Insurance Fund, 1997 to 2014 (Millions of Dollars)

Table 3: Private-Sector Health Expenditure by Source of Finance and Use of Funds, Canada, 2012 (Millions of Dollars and Percentage Share)

Table 4: Hospital Expenditure Summary by Sector of Finance, Canada, 2012

Table 5: Health Expenditure Summary, by Province/Territory and Canada, 2014.................. 65 Table 6: Total Health Expenditure per Capita and Share, Selected Use of Funds, by Province/Territory and Canada, 2014

Table 7: Total Provincial/Territorial Government Health Expenditure per Capita, Standardized for Age and Sex, by Province/Territory and Canada, 2009 to 2012..... 73 Table A1: Differences From Previously Reported Provincial Government–Sector Data by Province/Territory and Canada, 2009 to 2011 ($ Millions)

Table A2: Differences From Previously Reported Private-Sector Data, by Province/Territory and Canada, 2010 and 2011 ($ Millions)

Table A3: Differences From Previously Reported Federal Direct–Sector Data, by Province/Territory and Canada, 2011 ($ Millions)

National Health Expenditure Trends, 1975 to 2014

List of Data Tables Series A—Summary Data, Canada 1 Total Health Expenditure, Canada, 1975 to 2014—Summary

2.1–2.3 Total Health Expenditure by Source of Finance, Canada, 1975 to 2014—Current Dollars

2.4–2.5 Total Health Expenditure by Source of Finance, Canada, 1975 to 2014—Constant Dollars

3.1.1–3.1.3 Total Health Expenditure by Use of Funds, Canada, 1975 to 2014—Current Dollars

3.2.1–3.2.3 Private-Sector Health Expenditure by Use of Funds, Canada, 1975 to 2014—Current Dollars

3.3.1–3.3.3 Public-Sector Health Expenditure by Use of Funds, Canada, 1975 to 2014—Current Dollars

Series B—Total Health Expenditure by Source of Finance, by Province/Territory and Canada (Selected Tables) 1.1–1.2 Total Health Expenditure, by Province/Territory and Canada, 1975 to 2014—Current Dollars

1.3 Total Health Expenditure as a Percentage of (Provincial/Territorial) GDP, by Province/Territory and Canada, 1975 to 2014—Current Dollars........... 158 2.1–2.2 Private-Sector Health Expenditure, by Province/Territory and Canada, 1975 to 2014—Current Dollars

2.3 Private-Sector Health Expenditure as a Proportion of Total Health Expenditure, by Province/Territory and Canada, 1975 to 2014— Current Dollars

3.1–3.2 Public-Sector Health Expenditure, by Province/Territory and Canada, 1975 to 2014—Current Dollars

3.3 Public-Sector Health Expenditure as a Proportion of Total Health Expenditure, by Province/Territory and Canada, 1975 to 2014— Current Dollars

4.1–4.2 Provincial/Territorial Government Sector Health Expenditure, by Province/Territory and Canada, 1975 to 2014—Current Dollars

4.3 Provincial/Territorial Government Sector Health Expenditure as a Proportion of Total Health Expenditure, by Province/Territory and Canada, 1975 to 2014—Current Dollars

Series E—Provincial Government Health Expenditure, by Age and Sex, by Province/Territory and Canada (Selected Tables) 1.1 Estimate of Total Provincial and Territorial Government Health Expenditures, by Age and Sex, by Province/Territory and Canada, 2012—Current Dollars

National Health Expenditure Trends, 1975 to 2014

List of Data Tables on CD-ROM and Online Series A—Summary Data, Canada Series B—Total Health Expenditure by Source of Finance, by Province/Territory and Canada Series C—Health Expenditure by Use of Funds, by Source of Finance, Canada Series D—Health Expenditure by Use of Funds, by Source of Finance, by Province/Territory Series D1—Total Health Expenditure by Use of Funds, by Province/Territory Series D2—Private-Sector Health Expenditure by Use of Funds, by Province/Territory Series D3—Public-Sector Health Expenditure by Use of Funds, by Province/Territory Series D4—Provincial/Territorial Government Health Expenditure by Use of Funds, by Province/Territory Series E—Provincial Government Health Expenditure, by Age and Sex, by Province/Territory and Canada Series F—Provincial/Territorial Government Health Expenditure, by Province/Territory and Canada Series G—Drug Expenditure by Type, by Source of Finance and as a Share of Public, Private and Total Health Expenditures, by Province/Territory and Canada, 1985 to 2014 Appendix A—Gross Domestic Product at Market Prices Appendix B—Price Indices, by Province/Territory and Canada Appendix C—Population, Population by Age and Sex, by Province/Territory and Canada Appendix D—Total Provincial/Territorial Government Programs and Expenditures, by Province/Territory and Canada

National Health Expenditure Trends, 1975 to 2014

Acknowledgements The Canadian Institute for Health Information (CIHI) wishes to acknowledge the following

individuals for their contribution to National Health Expenditure Trends, 1975 to 2014:

• Christopher Kuchciak, Manager, Health Expenditures, CIHI

• Gilles Fortin, Program Consultant, CIHI

• Ruolz Ariste, Program Consultant, CIHI

• Jean He, Program Lead, CIHI

• Yiqun Yang, Senior Analyst, CIHI

• Jian Gao, Senior Analyst, CIHI

• Amie Chant, Analyst, CIHI

• Vicky Wang, Analyst, CIHI



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