The meeting of the federal and provincial/territorial health ministers in Halifax on Thursday will be preoccupied with the sustainability of health expenditures and the coming negotiations over the renewal of the health care accord. Naturally, the provinces want to ensure that federal transfers continue to rise to meet their needs while the federal government will be focused on the rate of increase of its health transfers as well as the need to ensure value for money from those transfers.
The rise in provincial government health spending and the tendency for its growth rate to outstrip revenue growth has been well chronicled. However, another dimension to health spending is its distribution.
The dispersion has been decreasing over time. Figure I plots for each province the ratio of its real per capita provincial government health spending to the provincial average for the period 1975 to 2009 using the CIHI NHEX data and the graph suggests that the range seems to be narrowing. Over time, there does seem to have been a move towards greater “equity” in real per capita health spending but the gap is still large. In 2009, for example, Newfoundland spends 20 percent more than the national average while Quebec spends about 11 percent less. Ontario tended to be a bit above the average until the late 1990s and has since slipped a bit below. To me, these numbers tell me that where you live in Canada invariably will affect the quantity and quality of the public health care you are going to receive.
However, there have also been some very interesting long-term shifts. Quebec has gone from being 10 percent above the average in the 1970s to 10 percent below at present while Newfoundland has gone from 20 percent below to twenty percent above the national average over the same period. The question that arises is if you are spending twenty percent more than the national average, is the quality of your health care twenty percent better? If not, are there substantial savings from adopting the practices of the lower spenders? After all, if every province had its real per capita spending on health match Quebec’s, you would be looking at saving billions of dollars in government health spending. Is Quebec doing something in the public health care field we should emulate? Are the provincial health ministers interested in finding out?