More Trips to Doctor Drive Up Health Care Spending

By Kenyon Wallace, The Toronto Star

February 23, 2009

Canada

Nearly half of the whopping $76 billion increase in national health care spending over the past decade is due to accelerated use of the system by all Canadians, says a new report. 

Contrary to popular belief, population growth and aging are not the major causes of increased health care spending, according to "Value for Money: Making Canadian Health Care Stronger," a discussion paper released today by the Health Council of Canada, a non-profit agency established in 2003 to report on the progress of the Canadian health care system.

"The fear that the aging population is what's going to cripple the health care system doesn't actually seem to be all that well-founded," said Dr. Danielle Martin, chair of the council's "Value for Money" committee who authored the report. 

"The frail and the elderly don't use health care as much as we think. In fact, what's going on is Canadians across all age groups are using health care more."

Using data compiled by the Canadian Institute for Health Information, the council found increases in the use of such services as surgeries, treatments and prescriptions account for 48 per cent of the growth in spending. Population growth is responsible for a 14 per cent increase, the number of people living longer, about 11 per cent, while inflation is responsible for 27 per cent of spending growth. Overall, spending rose to $160 billion in 2007, up from $84 billion in 1998.

Although the report doesn't fully examine the reasons for the rise in spending, it questions whether all patients really need the health care services they use. For example, the report alludes to a 2002 study done in British Columbia that suggests some patients are getting unnecessary cataract surgery.

Advances in medical technology are also a possible cause, says Dr. Heather Manson, senior medical advisor to the president of the Ontario Agency for Health Protection and Promotion.

"When technology makes it easier, faster and less invasive, more patients will use that technology and spending will increase," she said, giving the example of knee replacements, which are now done using less invasive techniques than in the past. 

About 70 per cent of health care spending comes from taxes, while individual out-of-pocket spending and private insurance cover the remainder. 

The council reports that Canadians spent an average of $400 more of their own money or insurance money on health care in 2007 than they did a decade earlier. In addition, Canada spends more on health care than many other countries, but continues to rank low in access, adoption of information technology and timeliness, according to the report. 

The council provides several examples of how Canada's health care system can get more value for money, such as the use of health care teams for more efficient management of chronic disease and the creation of electronic health care records, initiatives some provinces have already undertaken. The report also questions whether nurses could provide services currently offered only by doctors, and if family doctors could treat conditions reserved only for specialists. But the paper stops short of making any concrete recommendations.

John Abbott, chief executive officer of the council, said today's report is meant to be the first in a series of initiatives aimed at starting a national dialogue about whether Canadians are getting value for money.

"Can we improve the quality and value of our system? Are we getting the value we think we should be getting? Certainly before we invest any significant dollars in the future, we need to ask these questions," said Abbott. "We haven't really addressed that as a society and we really need to do so, especially in the current economic climate when tax revenues are falling."

Coinciding with the release of today's report is the launch of a website, www.CanadaValuesHealth.ca, offering a message board, podcasts, blogs, online polls and research papers in order to engage Canadians in a discussion. The council will report its findings to legislators and the public in a few months.

The last major national consultation on health care occurred in 2001 with the Commission on the Future of Health Care in Canada (the Romanow Commission), which conducted 12 citizens' dialogues on collective objectives.

"I think some of what's going to happen as a result of this consultation is that citizens and health care workers are going to bring to our attention some of the ways that we get really poor value for money. We shouldn't be afraid of that discussion," said Martin, who practises family medicine in Toronto and northern Ontario. "It doesn't mean we're giving up on our health care system to say there are some areas where we're not spending intelligently."

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