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Canadian Institute for Health Information

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Chartbook: Trends in National Health Expenditure, 1975 to 2013

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The following slides are provided to facilitate reuse in your own presentations

Please cite as follows: Canadian Institute for Health Information. Chartbook: Trends in National Health Expenditures, 1975 to 2013. Ottawa, ON: CIHI; 2013.

To download the data tables in Excel format, please visit www.cihi.ca/nhex.

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This presentation

• Key findings

– How much is being spent on health care?

– What is the money being spent on?

– Why is health spending increasing?

– How does Canada compare internationally?

• Looking forward

– Issues to monitor in the future

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How much will we spend on health in 2013?

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What is the money being spent on?

7

Where does the money come from?

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What is the money being spent on?

9

How do the provinces and territories compare?

10

How does Canada compare internationally?

2010 is the latest year available.

*

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How much is being spent on health care?

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There have been three distinct periods of growth in health spending since 1975

19761978

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20082010

2012-2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20% 17.8

Annual Growth Rates, Total Versus Real per Capita

Total Real per Capita (Inflation and Population Adjusted) Forecast

2013

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A fourth period is emerging

19751977

19791981

19831985

19871989

19911993

19951997

19992001

20032005

20072009

20112013

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

$2,200

$2,400

$2,600

$2,800

Actual Forecast Trend (1975–1992)Trend (1993–1996) Trend (1997–2010)

P/T Government Spending on Health, per Capita in Constant $

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The percentage of total health spending as a proportion of Canada’s gross domestic product (GDP) has fallen gradually in the past few years

19751978

19811984

19871990

19931996

19992002

20052008

20116%

7%

8%

9%

10%

11%

12%

8.1%

9.7%9.7%

11.6%

Actual Forecast

SourcesNational Health Expenditure Database, CIHI; The Conference Board of Canada.

2013

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Public/private split unchanged

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%77.0% 76.1%

74.1%70.1%

23.0% 23.9% 25.9%29.9%

Public- and Private-Sector Shares of Total Health Expenditures, 1975 to 2013

Public-Sector Share Private-Sector Share Forecast

2013

SourceNational Health Expenditure Database, CIHI.

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Where does the money come from?

Other Private3.1%

Out of Pocket14.7%

Private Health Insurance11.8%

Provincial-Government Sec-tor

65.3%

Other Public5.1%

Note2011 actual data.SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

Public Sector

Private Sector

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There is a difference of $1,600 between the highest and lowest spenders

Que. B.C. Ont. P.E.I. N.B. N.S. Sask. Man. Alta. N.L.$0

$4,000

$8,000

$5,531 $5,775 $5,835$6,354 $6,474 $6,514 $6,626 $6,633 $6,787

$7,132

Total Health Spending per Capita, by Province, 2013f

Public PrivateCanada $5,988

Notef: forecast.SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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On average, provincial/territorial governments spend almost 40% of their budgets on health care

Que. Sask. P.E.I. N.L. Alta. Ont. N.B. B.C. Man. N.S.0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

33%

37%

33% 34%37%

45%

39%41% 43% 42%

31%

36%38%

39% 40%41% 41%

42%44%

47%

2008 2012f

2008 2012f

Canada Average 39% 38%Notef: forecast.SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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Public-sector health spending is growing faster than revenues; spending on other government programs also continues to increase

Series1

-6%

-4%

-2%

0%

2%

4%

6%

1.1%

-5.4%

3.7%

2.5%1.7%

0.7%

Average Annual Real per Capita Expenditure Growth,Canada, 1998 to 2009

Revenue Debt Charges Health Transportation/Communication Education Social services

SourceStatistics Canada.

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What is the money being spent on?

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About 60% of total health spending is directed to hospitals, drugs and physicians

Hospitals29.5%

Drugs16.5%

Physicians14.6%

Other Professionals9.8%

Other Health Spending6.0%

Public Health5.2%

Administration3.1%

Capital4.9%

Other Institutions10.4%

Note2011 actual data.SourceNational Health Expenditure Database, CIHI.

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29%

15%

16%

11%

10%

18%

35%

15%13%

11%

11%

15%

Hospitals Physicians Drugs Other Professionals Other Institutions Other Expenditures

Spending on hospitals declined in the last decade as spending on drugs and other expenditures increased

Notef: forecast.SourceNational Health Expenditure Database, CIHI.

2013 f1993

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On average, we spend three times more on older seniors than on younger seniors

<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+$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$9,6

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$1,5

63

$1,2

85$1

,318

$1,5

84$1

,712

$2,0

76$2

,300

$2,1

94

$2,2

20$2

,475

$2,9

64

$3,6

00$4

,591

$6,4

31 $8,6

31 $11,

740 $1

6,10

4$2

4,00

3

$26,

336

Total P/T Health Spending Per Capita, 2011

Expenditure per Capita Average: $3,790

SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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Share of health spending on seniors has risen only slightly since 2001

2001 20110%

10%

20%

30%

40%

50%

60%

2.8% 2.9%

52.7% 52.1%

44.5% 45.0%

<1 1–64 65+SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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Compared with 2001, share of spending on older adults (55 to 64) and older seniors (75+) is higher

2001 20110%

5%

10%

15%

20%

25%

30%

35%

40%

45%

2.9% 2.9%

42.2%

38.5%

10.5%

13.6%15.6% 15.1%

28.8%29.9%

<1 1–54 55–64 65-74 75+

SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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How does Canada compare internationally?

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Canada’s per person spending is just more than half of what is spent on health care in the U.S. but higher than the OECD average

Turkey‡

Estonia

Hungary

Czech Republic

Israel

Portugal

New Zealand

Iceland

United Kingdom

Sweden

France

Denmark

CANADA

Netherlands

Norway

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000

$906$977

$1,303$1,452

$1,689$1,915$1,966

$2,198$2,239

$2,421$2,619

$3,072$3,182$3,213$3,305$3,374$3,405

$3,800$3,925

$4,061$4,118

$4,246$4,448$4,495$4,522$4,546

$5,099$5,643$5,669

$8,508

Total Health Spending Per Capita, US$, 30 Selected Countries, 2011

Average: $3,410

Notes* Data for 2010. ‡ Data for 2008. SourceOECD Health Data 2013, June edition.

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Canada spends more on health as a percentage of its economy than most OECD countries

Estonia

Mexico*

Poland

Czech Republic

Hungary

Slovenia

Finland

Norway

United Kingdom

Japan*

New Zealand

Austria

Switzerland

Germany

Netherlands

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

5.9%6.1%6.2%

6.6%6.9%

7.4%7.5%

7.7%7.9%7.9%

8.9%8.9%9.0%9.0%

9.3%9.3%9.4%9.5%9.6%

10.2%10.3%

10.5%10.8%10.9%11.0%11.2%11.3%

11.6%11.9%

17.7%

Average: 9.3%

Notes* Data for 2010. ‡ Data for 2008. SourceOECD Health Data 2013, June edition.

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The ratio of health spending to GDP increased in all G7 countries in the last decade

United Kingdom

Japan Italy Canada France Germany United States0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

7.37.8 8.1

9.310.2 10.5

14.3

9.4 9.6 9.2

11.211.6 11.3

17.7

2001 2011

2010 is the latest year available.

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The share of health spending funded by the public sector in Canada is less than the OECD average

Mexico*

Korea

Switzerland

Hungary

Poland

Slovak Republic

Spain

Finland

Austria

France

Iceland

Japan*

United Kingdom

Czech Republic

Denmark

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

47.3%47.8%

55.3%60.8%

64.9%65.0%65.0%

67.8%70.3%70.4%70.9%

73.0%73.0%73.7%

75.4%75.9%76.2%76.5%76.8%

79.3%80.4%

81.6%82.1%82.7%82.8%

84.1%84.2%84.9%85.3%85.6%

Average: 73.3%

Notes* Data for 2010. ‡ Data for 2008. SourceOECD Health Data 2013, June edition.

As GDP grows, so does per person health spending

-1% 0% 1% 2% 3% 4%0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

AUS

AUT

BELCAN

DNK

FIN

FRA

DEU

ISL

IRL

ISR

ITA

JPN

KOR

NLD

NZL

NOR

SWE

CHE

UK

USA

OECD

Average Growth, Constant Dollars, 2001 to 2011(Countries with health spending above $2,000 per capita)

Annual Average Real Growth in GDP per Capita

45 degree

An

nu

al A

vera

ge

Rea

l Gro

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in T

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l Hea

lth

Ex-

pen

dit

ure

s p

er C

apit

a

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Health spending growth in 2013 mainly driven by inflation and population growth, unlike period 2001 to 2011

2001–2011Average Annual Growth

2013f-2%

-1%

0%

1%

2%

3%

4%

5%

6%

7%

2.7

1.4

1.1

1.1

0.9

0.9

1.8

-0.9

Total: 6.5%

Other

Aging

Population Growth

General Inflation

Total: 2.5%

Average Annual Growth Rate, 2001 to 2011

Notef: forecast.SourcesNational Health Expenditure Database, CIHI; Statistics Canada.

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The contribution of population increases and aging to growth in health spending varied from province to province (2001 to 2011)

N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Canada

-1%

0%

1%

2%

3%

-0.2%

0.6% 0.2% 0.1% 0.8% 1.2% 0.8% 0.6% 2.1% 1.2% 1.1%

1.3% 0.6%1.0% 1.2%

1.2%0.9%

0.4%

0.4%

0.7%

0.8%0.9%

Population Growth Aging

Av

era

ge

An

nu

al G

row

th

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Looking forward: Issues to monitor in the future

• New Canada Health Transfer formula

– Growth in health care funding in line with GDP growth

• Moderating effects of economic growth and government deficits

• Growth in number of physicians and physician compensation

• Population aging and potential impact on spending

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Why is health spending increasing?

• Canadians are using more health services

• Increased number of health care providers, with higher wages

• Newer and more costly drugs, diagnostic tests and surgical procedures

More Information

The annual report National Health Expenditure Trends, 1975 to 2013 provides an overview of

• How much is spent on health care every year

• What the money is used for

• Where that money comes from

To download the annual report, information sheets, presentations, methodological notes or up-to-date data tables, all free of charge, visit our website at www.cihi.ca/nhex

Feedback and questions are welcome at nhex@cihi.ca

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Thank you

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