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Physician Supply, Demand and Costs in Canada, with a focus on Ontario

Physician Supply, Demand and Costs in Canada, with a focus on Ontario. Health Expenditures in Ontario. Total government expenditure in 2002 was $83.9B; of which $32.8B was for health (39.1%) Largest cost component was hospitals, at $14.8B (45% of health budget)

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Physician Supply, Demand and Costs in Canada, with a focus on Ontario

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  1. Physician Supply, Demand and Costs in Canada, with a focus on Ontario

  2. Health Expenditures in Ontario • Total government expenditure in 2002 was $83.9B; of which $32.8B was for health (39.1%) • Largest cost component was hospitals, at $14.8B (45% of health budget) • Physician services cost about $7B (21.3%) • Fastest growth in cost in recent years is for drugs: double digit growth rates

  3. 1. Cost of Services. Health Care forms the largest single component of Provincial Budgets. Health Expenditures as % of Provincial GDP, Provinces & Canada, 2005 % of GDP Source: CIHI, 2005, ‘National Health and Expenditures Trends, 1975-2005’

  4. Physician costs have risen and fallen over the years. Rising costs contributed to the decision to reduce enrolment in medical schools (see below). Expenditures on Physician Services as % of Provincial Health Budget, Ontario, 1975-2005 % of health budget ProvincialPremiers Harris(conservative) William Davis(conservative) Rae (NDP) Peterson(liberal) Source: CIHI, 2005, ‘National Health and Expenditures Trends, 1975-2005’

  5. Drug Costs are Rising: Expenditures on Drugs as % of Provincial Health Budget, Ontario, 1975-2005 % of health budget Source: CIHI, 2005, ‘National Health and Expenditures Trends, 1975-2005’

  6. Total drug expenditure in Canada, 1985 to 2007, showing current and constant dollars. Note: this includes prescription and non-prescription drugs, dispensing charges & taxes. Almost all of the growth has been in prescription drugs. Source: “Drug Expenditure in Canada, 1985 to 2007” Canadian Institute for Health Information, 2008.

  7. Costs of Care are Driven by Age of Patients.Government Health Expenditures per Person, by Age of Patient, Ontario, 2002 Age of Patient Source: CIHI, 2005, ‘National Health and Expenditures Trends, 1975-2005’

  8. 2. Demand for Services. Demand, of course, is driven by the size and age of the population. Projected Population Growth, Ontario, 2000-2025 Population 65+ Overall Population

  9. Demand for Services: Medical Services per Patient, by Age of Patient, Ontario, 2002 # services Age of Patient Source: Ontario Medical Association

  10. 3. Physician Supply: Number of MDs per 100,000 Population by Province, Canada, 2005 Source: CIHI “Supply, Distribution and Migration of Canadian Physicians, 2005”

  11. Population per GP, Canada and the Provinces, 2005 Source: CIHI: “Supply, distribution and migration of Canadian physicians”, 2005

  12. Physicians per 100,000 population, Ontario, 1995-2005 MDs / 100,000 Source: Ontario Medical Association On the left of the diagram, MD supply was not keeping pace with the growing population Increased medical schoolcapacity began to pay off

  13. Physician Supply: How Do We Compare? Physicians per 1,000 Population for Selected OECD Countries Belgium France Germany Australia Canada USA UK Source: OECD 2006 Health Data So, Canada has been flat-lining. What about Ontario? See next slide...

  14. How are we tackling the physician shortage?First Year Enrolment in Ontario Medical Schools, 1990-2005 Deficit = about 7 years x 80 physicians ≈ 560 total The Bob Rae cut-back Source: ACMC “Canadian medical School Statistics

  15. Number of new certificates of registration issued by College of Physicians and Surgeons of Ontario Growing MD numbers in Ontario Why the increase? Increased medical school enrolment Inflow from other provinces (incentive strategies) Repatriated Ontario physicians More international medical graduate residency positions

  16. Trends in overall numbers of MDs, Ontario, 1995-2005 # of MDs Source: OPHRDC, “Physicians in Ontario”

  17. 1. Migration of Physicians between Canada & U.S., 1996 - 2006 Net 2. Nurses in Ontario, 1998 - 2007 Annual gains & losses in staff

  18. % of MDs 1994 mean age39.5 yrs 2005 mean age 49.1 yrs Light grey bars = 1994; dark = 2005 So, will this fix it?? A side-effect of the enrolment reduction was to increase the average age of Ontario doctors.And older doctors see fewer patients... Age Distributionof Ontario Physicians, 1994 and 2005 Source: Ontario Medical Association A survey by the College of Physicians & Surgeons of Ontario gave different figures: Average age has risen from 50.7 years in 2005 to 51.2 in 2007; 14% of practicing Ontario physicians are > 65 years old.

  19. ♂ ♀ Average consultations per family doctor by age and sex of the physician Male doctors Physician age Female doctors Physician age group Source: OMA Growing numbers of young physicians are female... And, on average, they tend to see fewer patients

  20. Percentage of all Family Physicians accepting new patients, Ontario 2007 % Source: College of Physicians and Surgeons of Ontario. MD Dialogue, April, 2008

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