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I can't comment on this question in particular, but some of my work involves cross-provincial healthcare costing statistics.

Anybody out in the comments know if any part of this is driven by accounting differences in how costs are allocated into different Ministry of Health 'buckets'?

(That is to say: no difference in the structure of the healthcare system, only in how it's costs are recorded)

The 2 obvious things that come to mind as points of difference:

1) The OCCI costing statistics that we use do not include the cost of fee for service physician care of in-hospital patients (often including monitoring and/or surgical procedures). Salaried staff, including some physicians are included in the cost statistics.

I imagine this could differ by province. Does the province pay the surgeon, or does the hospital? Are there different rates of salaried physicians in the hospitals in different provinces?

2) In-Hospital drug expenditures: Again, do they come out of the "hospital budget", or the 'drug budget'. Given the relative position of Ontario for drug spending vs. hospital spending "I wouldn't be surprised if" the cost of chemotherapy is being recorded under CCO's drug budget in these statistics, whereas it is a 'hospital expense' in at least some other jurisdictions.

Hello Arrow:
The data is from the Canadian Institute for Health Information (CIHI) and should be relatively standardized across provinces but you might want to query them directly. Chris Kuchiak at CIHI would be able to assist you. As for drug spending, the drug category in the CIHI NHEX data does not include drugs dispensed in hospitals and other institutions and they are included under the spending of the institutions. As well, the physician spending does not include remuneration of physicians on hospital or public sector health agency payrolls. Cheers. Livio.

TLDR: Provincial healthcare systems in Canada are not the same, and the closer you get to source of a lot of data, the less consistent it will appear. I'm sure CIHI does the best they can with the funding they have, but I would definitely look to accounting / funding differences for potential deviations between provinces, especially when it comes to the distribution of spending, and not the overall amount.

I don't want to spend all afternoon on this, so I'll make a couple quick points here:

1) Looking at the CIHI NHEX methedological notes:

"The drugs category does not include drugs dispensed in hospitals and, generally, in other institutions. These are included with the category of hospitals or other institutions."

2) I'm not aware of other CDN provinces having a body analogous to CCO (Cancer Care Ontario), which funds cancer treatments outside of standard hospital funding mechanisms.

A quick look at their 2014 financials suggests that between $300 Million & $1 Billion (depending on how much of 'Cancer Programs' represents drug costs) could plausibly be recorded as hospital spending in other jurisdictions (corresponding to between $220 & $770 per person).

Even if it's at the low end of that range, that eats up almost the entire variance between Ontario & the average above.

3) Lastly, I looked at the OCHU report linked to above, and would caution against taking it as a statistical source. A lot of the data that goes into it is likely valid, but the graphs were clearly constructed with Stats-101 level decisions (ie. no "0" on the Y-axis)... On the whole, I found it very unconvincing.

Population is denser (not accounting for all the completely empty places), so ... scale economies.

Consider that the highest spenders are:

a) a very remote place and

b) a relatively expensive place that, to be honest, people who care about people in a fairly general sense (surely overrepresented in the health profession) might simply not want to live in. I mean, really, who would want to live in Alberta if they could get a pretty OK job somewhere else, unless they already had ties in the province?

Consider that doctors and nurses are demanded internationally. Bad weather (way too cold in winter, too hot in summer), an often hostile culture to newcomers, high cost of living, distant from basically anywhere unless you get on a plane ... obviously, Alberta is going to have to pay a premium to attract an retain talent. At least the geniuses managed to land atop a mountain of black gold, which have been wisely invested over the last 40 years, to the extent that the province can weather an entire couple years before its net fiscal position in a downturn goes into debt.

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