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The parallel slowdown in US healthcare group has been debated there as well (more in terms of recession vs Obamacare)...I think John Nyman, Victor Fuchs et al attribute that great majority of the slowdown to the recession. Of course it's different here but I suspect it's largely the recession as well. There hasn't been much in terms of transformative change of any kind in Canada. When I was at the recent CAHSPR conference in Vancouver, Cam Donaldson of the NHS was talking about how dismal Canada's record is at innovation in HC delivery, including the post-Romanow period. Other than regionalization (sort of), there's really been no serious effort in Canada other than the usual low-value hype about electronic medical records.

How much of this is driven by pullback from the big spenders (ON, AB, BC) who had the most rapid increases in spending prior to and during the recession? I agree on the escalator cutback though, and think it's also a broader signal for provinces to have low expectations.

The growth rate seems to spike then gradually slow down in the early 90s as well, in line with the last severe recession.

I'm inclined not to believe any story that doesn't explain why the slowdown would be coincident across both the US and canada. In fact, the slowdown is common to most OECD countries. While unlikely, that doesn't rule out the possibility that a policy change in the US--a giant economy and major exporter of medical sciences--caused a global cost slowdown. But it basically rules out any possibility of being due to Canadian policy.

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