Federal Health Care Funding in Canada: Is It Allocated According to Need?
- Presenter:
Chair: Jon Christianson; Discussant: Jon Christianson Mon June 5, 2006 13:45-15:15 Room 309
Background: Equity is one of the defining values of the Canadian health care system. While equity in the access to or utilization of health care has often been the focus of passionate public and policy debate, equity in federal health care funding has been largely neglected. The Canadian government currently distributes targeted health funding to provinces largely on an equal per capita basis. Thus, differences in average per capita need resulting from differences in health status or demographics are not taken into account. The objectives of this study were to assess potential magnitude of unequal need for health services between provinces and to compare different indicators and approaches to measuring need for health services.
Methods: We estimated relative per capita need for general practitioner, specialist, and hospital services by province using the following three approaches: (1) estimating relative per capita need for health services based on demographics (age and sex), (2) estimating relative per capita need for health services based on demographics, socioeconomic status, and health status, and (3) estimating relative per capita need for health services based on demographics and premature mortality. For all three approaches, we first fitted regression models to estimate standardized utilization of each of three types of health services by indicators of need. The standard was assumed to be average levels of utilization by needs indicators in the national sample. Two-part regression models were employed: logistic regression for use and nonuse, and negative binomial regression for frequency of use. Subsequently, the standard was used to estimate “expected” per capita utilization of each type of health services in each province. In addition, for (3) we combined expected per capita utilization of health services based on (1) and the standardized mortality ratio for people younger than 75 years of age. Data on health care utilization, demographics, socioeconomic status, and health status came from the 2000/2001 Canadian Community Health Survey. Data necessary to calculate the standardized premature mortality ratio for each province in 2001 came from E-STAT and CANSIM. The sample size for all analyses in this study was 111,249.
Results: All three approaches suggested that expected relative per capita utilization for general practitioner, specialist, and hospital services was not uniform across provinces, ranging from -1.07% to 24.31% of the Canadian average utilization. Higher need provinces indicated by all three approaches were Nova Scotia, New Brunswick, and Saskatchewan for general practitioner services, Nova Scotia and New Brunswick for specialist services, and Prince Edward Island, Nova Scotia, New Brunswick, Manitoba, and Saskatchewan for hospital services. Different approaches, however, yielded inconsistent results for Newfoundland and Quebec. For all three types of services, these two provinces had higher than average need based on (3) and lower than average need based on (2).
Conclusions: This study suggests that there may be substantial differences in need for health services across provinces. Different approaches provided different results, and the assessment of needs for health services requires further methodological refinement.
