Question: Health care spending – is Canada inefficient?

Canada seems to have a poor reputation, among Canadians, when it comes to health care spending and efficiency.  This raises a few questions - how much does Canada spend on health care compared to other countries?  And how does universal pharmacare fit in?

Universal health coverage is about ensuring people have access to the health care they need without suffering financial hardship.

The following graphs compare spending in “high-income” countries that have universal (or near universal) coverage for core medical services.  The United States does not have a universal healthcare program (unlike most other developed countries) and is included below for reference only.

Total Health-care Spending (Private + Public) as a Percentage of GDP (2019)

SOURCE: OECD (Organization for Economic Co-operation and Development)

The next graph looks at the same data in a slightly different way:

Total Health-care Spending (Private + Public) per Capita – CAD$ (2019)

SOURCE: OECD

The above indicates Canada is near the top of OECD / developed countries for healthcare spending.  However, Canada is the only country in the world with public health care and no universal public system for providing prescription drugs (pharmacare).  Ultimately this means Canada’s government spending (public) is lower than most other countries in the same category.

Of the above, 70% comes from public funding (government), and 30% from private (health insurance, out of pocket, etc.)  The graph below compares the public / private split between select OECD countries.
 
Public and Private Split for Total Healthcare Spending

SOURCE: OECD

This is of particular interest when jobs are shifted from employee positions to contract roles.  When an individual no longer has employer health benefits the private portion of the total health care spend shifts to out of pocket, often making it unaffordable for individuals to access the care required.  

In addition to not including prescription drugs in Canada’s universal health care, we also have less public coverage of home care, dental care, and non-physician care outside hospitals (this includes mental health care).

The lack of universal pharmacare may explain the lower percentage of government funded health care, but the questions it raises for me are around efficiency of the government funded portion.  I think there is a case for universal pharmacare, but I’m also interested in understanding what Canadians are getting for the publicly funded care we do have – my next topic!