RED, WHITE and Maple too!

Sadiq Panjwani

Just north of United States, a land mass of 9.98 million square kilometers spread over 10 provinces and 3 territories – is home to 35 million Canadians. It’s a state with 2 official languages including English and French with prominent ranking in international measurements of government transparency, quality of life, economic freedom, and education.

While North America offers comparable social, cultural, and geographical environment; Canada and US significantly differs in the way health care system is structured and works. Canada is primarily a single payer system that is publically funded and administered on provincial or territorial basis. The system is governed by 5 principles of being publically funded, robust in its offering, universality in providing equal level of care, portable across any part of Canada and accessible.  While the system covers basic services including primary care physicians and hospitals, there are additional services such as dental services, optometrists, and prescription medications that are not covered under healthcare system and available through private health insurance.

Canada is facing unprecedented demographic changes, particularly in the area of aging population, shortage of labor, slower population growth and improved life expectancy. Coupled with current economic challenges due to oil prices and a weaker Canadian dollar, there is more scarcity of funding – questioning the very “sustainability” of health care spend in years to come.

The good news is that healthcare spending growth is decreased to around 2.1% in 2014[1] – the lowest in the decade and lower than the economic growth rate. This has been achieved by almost no growth in drug spending, reduced capital spend on medical equipment and construction project, consolidation of health care services and adapting good procurement practices. There are still 3 detractors that can make these efficiency gains a temporary success – hospital, doctors and drugs.

Currently 30% of healthcare spending goes to hospital out of which 60% is consumed by wages[2] leaving the rest for capital projects, operations, technology refreshes, etc. Technology advancement has enhanced early detection, treatment and patient outcomes, however its impact to cost drivers is difficult to quantify.

A report by Canadian Institute of Health Information3 indicates a growth in technology adoption of computerized tomography (CT) and magnetic resonance imaging (MRI) scanners across hospitals. While the budget growth rates have been double digit for these two technologies, the overall expenditure growth of all of diagnostic imaging across hospitals has not significantly outgrown CT and MRI cost trends. It appears that high growth rates for expenditure for CT and MRI represents a replacement effect within diagnostic imaging within hospitals.

Another report from Accenture4 indicates that 76% of Canadian doctors use electronic medical record (EMR) as compared to 91% globally. The technology adoption is improving in Canada; however we continue to see paper as a major enabler for clinical documentation, assessment, and record keeping. Anesthesia documentation in perioperative environment, clinical documentation, and fetal strips archiving in perinatal care are few examples.

We anticipate healthcare executives and policy makers influencing the agenda of technology, innovation and healthcare reforms as a major enabler of healthcare transformation. The system continues to transform but will require a much more accelerated pace to self-sustain.

In my next blog, I will expand on aging population and share my perspective on role of technology in enabling better care at home.



[1] Media Release on Oct 30, 2014 by Canadian Institute of Health Information entitled “Canada’s Health Spending Hits Slowest Growth Rate Since 1997”

[2] Report entitled “Hospital Cost Drivers Technical Report” by Canadian Institute of Health Information




One thought on “RED, WHITE and Maple too!

  1. Very interesting well laid article and lot of insight with facts & figures! Impressed with the fact that Canadians have reduced the cost yoy whilst maintaining (& enhancing) the services!

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