Canada’s well being care disaster? That’s so final week. It was only a few days in the past that the provinces have been sounding dire warnings concerning the imminent collapse of medicare except Ottawa handed them tens of billions of {dollars} to inject into the system. The federal Liberals, as an alternative, gave them solely billions of {dollars}.
After a couple of days of undoubtedly tense deliberation, the premiers grudgingly agreed to simply accept that free cash. However they aren’t but speeding to spend their very own, if fiscal updates that landed this week are something to go by. Or, in case you desire one other measure, the provinces’ latest spending historical past.
Inflation-adjusted well being care spending by the provinces and territories is projected to be primarily flat within the present 2022-23 fiscal yr, in response to knowledge from the Canadian Institute for Well being Info. The nationwide common will nudge up simply 0.1 per cent, though there may be appreciable variation between jurisdictions, starting from a 7.8-per-cent improve in Nova Scotia to a drop of 18.2 per cent in Nunavut.
Well being care spending is definitely declining this yr on common, as soon as inhabitants progress is factored in, with inflation-adjusted per capita expenditures projected to dip 0.7 per cent. Once more, there are massive variations between jurisdictions. However among the many large provinces, actual per capita spending in fiscal 2023 is projected to say no in Quebec and Alberta, and to rise solely modestly in Ontario and British Columbia.
These spending projections embrace the quantities that Ottawa offers the provinces underneath the Canada Well being Switch; provincial will increase are even much less spectacular than they first appear.
Solely the three Maritime provinces are planning to spice up well being care spending sooner than the rise within the federal switch. For the opposite provinces and territories, Ottawa’s well being care spending is rising sooner than their very own.
At this level, the cry will go up from provincial finance departments – however the pandemic! It’s true that well being care expenditures are up throughout the board for all provinces and territories from the pre-pandemic yr of fiscal 2019.
However the level is that the tempo of well being care spending is ready to gradual considerably this yr, even because the premiers ramped up the stress on Ottawa to splash federal money their method.
One other caveat is that the figures from CIHI, launched in November, are somewhat lengthy within the tooth. However this week’s fiscal replace from Ontario signifies that not a lot has modified.
The province’s third-quarter fiscal replace initiatives spending on well being care and long-term care of $75.2-billion – unchanged for the reason that spring finances. The Ford authorities did hike COVID-specific well being care funding by $168.7-million, amounting to a 0.2 per cent improve.
Additional east, New Brunswick did increase its well being care expenditures from the unique budgeted quantity by $82-million, simply over 2 per cent, in response to its third-quarter replace this week. However greater than three-fifths of that additional spending may be accounted for by the province’s higher-than-forecast federal well being transfers.
It’s unlikely that Ontario and New Brunswick are outliers. To date, the provinces have been far more targeted on prying money from Ottawa than spending their very own cash.
Price range season is gearing up, so Canadians will quickly get a greater image of the place provincial and territorial well being care spending is headed as new federal transfers materialize.
Within the quick time period, federal Well being Minister Jean-Yves Duclos is heading in the right direction when he warns that the provinces can not scale back their well being care spending as Ottawa will increase its transfers. That could be a remarkably low bar to clear, although. In response to CIHI, nominal well being care spending has declined in just one yr since fiscal 1975.
Extra essentially, the distinction between the pressing rhetoric of the premiers and the tepid progress of spending underscores, once more, the necessity to firmly place the accountability for well being care funding on the provinces.
As we now have argued earlier than, the very best path ahead for Ottawa could be to cut back its tax charges in order that the provinces may increase theirs a corresponding quantity. The federal authorities would nonetheless have the prevailing Canada Well being Switch to wield as a persist with implement portability of protection. That shift could possibly be accompanied by reform of the equalization system to help provinces with smaller tax bases.
However the provinces could be answerable for the sustainable funding of well being care, placing what they noticed as the proper stability between entitlements and tax burdens.
