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

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)
Rae (NDP)
William Davis(conservative)
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
(No Transcript)
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
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
Annual gains losses in staff
18
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 Distribution of 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
gt 65 years old.
19
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