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Managing the Cost of Healthcare for an
Aging Population: How Do the Provinces
Compare?
Colin Busby
Senior Policy Analyst
C.D. Howe Institute
2
xx
2
Public Healthcare Budgets In Canada – Three Major Eras
body
Bullet 1
Bullet 2
Source: Author’s calculations
3
xx
3
An Aging Population
20
66
14
19
58
23
18
56
26
16
57
27
0
10
20
30
40
50
60
70
Youth (17 and under) Working Age (18-64) Old Age (65 and up)
Shar
e o
f th
e t
ota
l po
ula
tio
n (
pe
rce
nt)
2010 2030 2050 2050 - BCSource: Author’s calculations
4
xx
4
Canada - Average Per Capita Public Health Spending
By Age Group, 1998 and 2010
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
22,000
24,000
26,000
28,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
<1 1-4
5-9
10
-14
15
-19
20
-24
25
-29
30
-34
35
-39
40
-44
45
-49
50
-54
55
-59
60
-64
65
-69
70
-74
75
-79
80
-84
85
-89
90
+
20
10
Ave
rage
Per
Cap
ita
Spen
din
g ($
no
min
al)
19
98
Ave
rage
Per
Cap
ital
Sp
end
ing
($n
om
inal
)
Age Group
1998 (left axis) 2010 (right axis)Source: CIHI and Author’s calculations
5
xx
5
British Columbia - Average Per Capita Public Health
Spending By Age Group, 1998 and 2010
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
22,000
24,000
26,000
28,000
30,000
32,000
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20
10
Ave
rage
Per
Cap
ita
Spen
din
g ($
no
min
al)
19
98
Ave
rage
Per
Cap
ital
Sp
end
ing
($n
om
inal
)
Age Group
1998 (left axis) 2010 (right axis)Source: CIHI and Author’s calculations
6
xx
6
Expenditures on Prescription Drugs by Source of Financing
and Province, 2001 and 2011, ($2011) per capita
2001 2011 Average growth rate,
2001-2011
BC Provincial Government $198 $210 0.6
BC Other Sources $215 $366 5.5
BC Total $413 $575 3.4
ON Provincial Government $228 $335 3.9
ON Other Sources $323 $450 3.4
ON Total $551 $785 3.6
QC Provincial Government $217 $301 3.3
QC Other Sources $360 $612 5.5
QC Total $577 $912 4.7
Source: Morgan et al. upcoming
7
xx
7
Percentage of Adults Reporting Cost-Related Non-
Adherence for Drug Prescriptions, by Jurisdiction.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
22%
BC ON QB CAN US AU GER NZ UK NLSource: Morgan et al. upcoming
8
xx
8
Percentage of Households Reporting Out-of-Pocket Expenses
for Prescription Medicines exceeding $1,000 USD, by
Jurisdiction.
0%
2%
4%
6%
8%
10%
12%
14%
BC ON QB CAN US AU GER NZ UK NL
Source: Morgan et al. upcoming
9
xx
9
Private Charges for Government Subsidized Facility-
Based Care, Single Individual
11,200
16,200
28,200
36,200
12,600
17,600
19,400 19,400
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
OAS/GIS Max (~15,000) 20,000 35,000 70,000
Pri
vate
Ch
arge
s (a
nn
ual
)
Annual Income ($)
BC (net income) AB (gross income) ON (gross income)
Source: Various government documents; author’s calculations
10
xx
10
Current Funding System for Long-term Care in Canada
11
xx
11
Ownership of Nursing Home Facilities: The Public/Private
Mix, 2008
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NL PE NS NB QC ON MB SK AB BC Canada
% o
f A
ll Fa
cilit
ies
(Ho
mes
fo
r th
e A
ged
)
Public Private
Source: Various government documents; author’s calculations
12
xx
12
Publicly Funded For-Profit Nursing Home Beds, 2008
0
41
30
5
23
53
26
8
3031
35
0
10
20
30
40
50
60
NL PE NS NB QC ON MB SK AB BC Canada
For-
Pro
fit
Faci
litie
s as
a p
erc
en
tage
of
tota
l
Source: CUPE (2009)
13
xx
13
Funding System For Long-Term Care in France and
Nordic Countries – Money Follows the Patient
Managing the Cost of Healthcare for an
Aging Population: How Do the Provinces
Compare?
Colin Busby
Senior Policy Analyst
C.D. Howe Institute
