Abstract :
The public share of Canadian total health expenditure declined
between 1975 and 2005 but categories such as physicians stayed constant while
drugs, other institutions, and capital spending saw increases. Regressions find
the key determinants of the public share to be: the relative price of health care,
per capita income, federal transfers, proportion of population over age 65,
provincial dummy variables, political parties, the onset of the Canada Health
Act and the Canada Health and Social Transfer (CHST), and a time trend
invoking technological change. Increasing income inequality is not a factor
eroding the public share. Moreover, provinces governed by center-left parties are
associated with lower public shares in the physician and other health
professional categories. The significance of variables like the Canada Health and
Social Transfer, the Canada Health Act and provincial differences suggest the
increase in the private share of health spending since 1975 is partly the result of
policy choices. As the public share has only declined from approximately 76% to
70% over 30 years, it appears the shift towards private care is one of marginal
increments. Canadians remain in conflict over their health care system as they
appear willing to tolerate only marginal accretions in the overall private share of
health spending but accept larger changes across health expenditure categories
and provincial systems.
