Quebec must Deal with $682 Billion Healthcare Bill or Risks Going over Fiscal Cliff

December 16, 2014 – Quebecers are carrying a $682 billion fiscal burden – the higher tax bill for increased healthcare costs over the next half-century – and should prepare now for the coming demographic squeeze, says a report released today from the C.D. Howe Institute. In “An Aging Population Fiscal Challenge: Planning for Healthcare Costs in Quebec,” authors William B.P. Robson, Colin Busby and Aaron Jacobs recommend that Quebec prefund selected healthcare services and benchmark against other provinces to get better health bang for their tax bucks.

“Quebec spends less per capita than any other province on total healthcare and, inparticular, on physicians and public-health programs such as food and drug safety, health inspections, health promotion activities and community mental health programs,” says Busby.  “By contrast, Quebec spends more – and has been increasing spending faster – on institutions such as nursing and residential care homes. Bringing its nursing and residential home costs in line with the national average, for example, would lower Quebec’s spending by some $750 million annually.”

The report rejects higher federal transfers as a solution, noting much of the money the federalgovernment already transfers to the provinces simply reflects differences in the degree to which the two levels of government tax these bases – which are a matter of history and politics, not logic or economics. “Quebecers, like Canadians in other provinces, will be better able to hold their provincial government to account for the performance of publicly funded healthcare in Quebec if the province is raising, and is seen to be raising, more of the necessary funds itself, argues report co-author William Robson.

As for getting more bang per healthcare buck, and more efficiency in spending on an older population particularly, Quebec should:

• Reduce the ambiguity of current public-private responsibilities for financing long-term care to bolster private savings, and better target public long-term care subsidies to those without the means to pay for it;
• Develop better integration of follow-up care for patients once they are discharged from hospital;
• Establish and expand use of electronic health records that patients and their agents can access from different locations;
• Renew efforts at primary-care reform, financing primary-care teams through a mixed capitation system that encourages patient mobility;
• Change scope-of-practice that would allow providers such as pharmacists and nurse practitioners to offer services now delivered by more expensive alternatives;
• Increase use of clinical evidence to reduce variation in diagnostics and therapeutics use.

The report concludes that in the face of Quebec’s healthcare challenges, selective prefunding and benchmarking against other provinces’ best practices can help Quebec deliver high-quality healthcare in a sustainable fiscal framework for years to come.

For the report go to: http://www.cdhowe.org/le-defi-budgetaire-quentraine-la-population-vieillissante-planifier-les-couts-des-soins-de-sante-au-quebec/28239

The C. D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. It is Canada’s trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review. It is considered by many to be Canada’s most influential think tank.

For more information contact: William B.P. Robson, President and CEO, C.D. Howe Institute; Colin Busby, Senior Policy Analyst, C.D. Howe Institute, at 416-865-1904; E-mail: amcbrien@cdhowe.org.

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