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Health Expenditures in Canada

The following table is extracted from published data using the National Health Expenditure database maintained by CIHI. The columns give total spending for 2007 (in Billion $ Canadian), and divide these into public and private share (totaling 100%). Public share includes the following ‘sources of finance’: federal, provincial, territorial and municipal governments, workers’ compensation boards and other social security funds. Private share includes private out of pocket and private insurance. CIHI also breaks down expenditures into several ‘uses of funds.’ This gives some insight into who currently pays for these various types of care, and where private spending is concentrated.

Health expenditures in Canada, 2007:
Key categories by public and private shares

Main Category	Sub Category	$ (Billion)	Public Share	Private Share	Total
Hospital		45.4	90.7%	9.3%	100%
Other Institutions1		16.4	73.2%	26.8%	100%
Physicians		21.5	99.1%	0.9%	100%
Other Professionals2	Dentists	11.1	4.5%	95.5%	100%
	Vision Care	3.7	5.4%	94.6%	100%
	Other	2.5	20.0%	80.0%	100%
	Total Other Professionals	17.3	6.9%	93.1%	100%
Drugs	Prescribed	22.0	46.4%	53.6%	100%
	Over The Counter (OTC)	2.5	0.0%	100%	100%
	Personal Health Supplies (PX)	2.0	0.0%	100%	100%
	Total Drugs	26.5	38.5%	61.5%	100%
Other	Capital	$7.3	78.1%	21.9%	100%
	Public Health3	$10.6	100.0%	0.0%	100%
	Administration4	$5.6	46.4%	53.6%	100%
	Other Health Spending5	$10.3	80.6%	19.4%	100%
	Total Other	$33.8	80.5%	19.5%	100%
Total		$160.9	70.3%	29.7%	100%

^{Table notes:}

¹ Other Institutions includes Nursing Homes and Residential Care Facilities

² Other professionals includes care primarily provided by Dentists and Denturists, Optometrists and Opticians, Chiropractors, Physiotherapists and Private Duty Nurses

³ Public health includes expenditures for Food and Drug Safety, Health Inspections, Health Promotion Activities, Community Mental Health Programs, Public Health Nursing, Measures to prevent the spread of communicable disease and Occupational health to promote and enhance health and safety at the workplace. Note that as defined, this is entirely public sector spending.

⁴ Other administration includes Infrastructure costs to operate health departments and prepayment administration (the administrative expenses of providing health insurance by governments and private health insurance companies) but not the administrative expense of non-insured services.

⁵ Other Health Spending includes Health Research (but not research funded by pharmaceutical companies, which is included in the drugs category), Medical Transportation, Hearing Aids and Appliances, Voluntary Health Associations, and Explicitly Identified Home Care. Note that certain services that are identified by data sources as home care are included under the broad category of Other Health Spending. Private nursing care in the home would be included in the Other Professionals category. Home care programs provided by hospitals are included in the Hospitals category. Support services such as domestic maintenance and delivery of meals are considered to be social services within the current definition of home care and are removed when identified.

This table can be used to compute rough estimates of where private spending is concentrated. Note that if one uses all health expenditures as the denominator, 34% of private spending is for drugs (24.7% for prescribed drugs, 5.2% for over-the-counter medications, and 4.18% for personal health supplies). 22.2% for dental care, and 7.3% for vision care. However, 14.8% of the private spending goes to the ‘other’ category of expenditures, and should probably not be included since it primarily represents system-related costs (e.g., private funding for research or capital) rather than the sort of personal health expenditures that might be addressed by MSAs. CIHI also notes that the proportion of private expenditures for prescription drugs being paid out-of-pocket has dropped from 44.5% in 1988 to a still substantial 33.3% in 2007. For dental care, private health insurance accounted for 54.3% of spending in 2007, and out-of-pocket spending for 45.7%. In 1975, administration accounted for 2.9% of total public sector expenditure and 2.5% of private-sector expenditure; by 2007, it accounted for 2.3% of public-sector expenditures, and 6.2% of private sector expenditures.

Source:  Raisa B. Deber, Kenneth Lam,  MSAs in financing health care , 2010,  Prepared for the Canadian Health Services Research Foundation.

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