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Canadian Masterclass on Managing a Health System through an Economic Downturn (Terrence Sullivan)
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NUFFIELD TRUST/CHSRF MASTERCLASSCANADIAN HEALTH SPENDING: MANAGING IN A DOWNTURN (1990-1999)May 17, 2011 – London, England
Terrence SullivanProfessor, Dept of Health Policy Management and Evaluation
Dalla Lana School of Public Health, University of Toronto
CURRENT PICTURE SASKATCHEWAN ONTARIO U.K.
Combined Life expectancy at birth (‘97)
79.5 81 79.7
Population (2011) 1M 13.2M 60.5M
Current Debt (2011) • 20 million surplus
• Net Debt: 7% of provincial GDP
• $16.7B deficit• Net Debt: 37.6%
of Provincial GDP
• £ 163B deficit• Net Debt: 59% of
GDP
Per Capita GDP (2009) C$45,718 C$43,847 US$32,798
2
SourcesFigure 1: Canadian Institute for Health Information; United
Kingdom Office for National StatisticsFigure 2/3: OECD Health Data 2010. 3
• Recession hits North America hard (Black Friday/Gulf War/Oil Shocks)
• Significant growth in debt burden by federal/provincial governments
• Multiple Premier’s Commissions on Health Reform• Experimentation with regionalization emerges in English
Canada• Significant contraction caused decline in public confidence but
no evidence of any adverse health outcomes• Significant National Reform Commission Efforts followed in
early 2000
Important Context for Canada (1990-2000)
4
Source: Public Accounts and 2000 budgets.
Total health expenditure per capita, US$ PPP
5
Federal and provincial-territorial surplus/deficit(-)Public Accounts basis
Source: Public Accounts and 2000 budgets.
6
Source: Public Accounts and 2000 budgets.
Federal and provincial-territorial net debtPublic Accounts basis
7
8
9
Provincial/Territorial Government RevenuesConstant Dollar Indices (1993 = 100), Canada, 1993 to 2009
federal revenue as a proportion in the current document
Change in Federal Transfers
Source: NHEX Database, CIHI.
10
ONTARIO & SASKATCHEWANCASES
11
12
13
Per Capita Physician Spending 1981-2010
14
Hospital beds per 1,000 population
Source: OECD Health Data 2010.
15
Evolution of Assessments of the Quality of the Health Care System“Thinking broadly about Canada's health-care system and the quality of medical services it provides, how would you describe it overall? Would you say it is excellent, very good, good, only fair, poor or very poor?”
Source: Department of Finance.
16
QUESTIONS?
17
18
Source: Department of Finance.
Net Debt-to-GDP Ratio
19
Source: 2000 Federal Budget
20
21
The provinces and territories recorded an aggregate surplus in 1999-2000
Federal and provincial-territorial budgetary balancePublic Accounts basis
Source: Public Accounts and 2000 budgets.
22
Federal and provincial-territorial surplus/deficit(-)Public Accounts basisSource: Public Accounts and 2000 budgets.
23
Provincial-territorial revenues and program spendingNational Accounts basis
Source: National Income and Expenditure Accounts.
24
Interprovincial comparison of taxpayer-supported debt as a percentage of GDP
Source: Moody’s Investors Service Inc.
25