Provincial health ministers, including those from British Columbia and Alberta, will present their federal counterpart with demands for more money to cope with the medical needs of aging populations when the two levels of government meet in Toronto early next week.
But the changing demographics of Canada have, to this point, not been significant drivers of increased health expenses. In fact, the rise in health-care costs tapered off over the past five years even as the average age of Canadians climbed. And some experts say simply boosting the transfer of money from Ottawa to the provinces without tying it to specific initiatives aimed at seniors will not alleviate the financial pressures caused by the ballooning population of older people.
Alberta and British Columbia are joining other provinces and territories in calls for the Liberals in Ottawa to abandon the Conservatives' plan to cut the annual increase in the Canada Health Transfer from 6 per cent to a minimum of 3 per cent starting next year. They say the move will overburden already strained health-care systems as baby boomers transition through their 60s and become major users of medicare.
"We are still a growing province and that means we have increasing needs in a number of areas, as well as with the aging demographics," Sarah Hoffman, the Alberta Health Minister, said in a telephone interview arranged to discuss what she wants from next week's meeting. "It's my job to lay out some of the facts and the realities of our budget and what the implications will be if we don't seek the level of increase [to the Canada Health Transfer] comparable to those that we saw in the past."
B.C.'s Health Minister, Terry Lake, said the current system, in which the transfer is based on population numbers and takes no account of average age, is a problem.
"If you look at a person who is 75 years of age, their health-care needs are quite different to someone who is 35 years of age, so it really does impact British Columbia very negatively. I have made presentations to the former government, to this government, I have raised it at every opportunity. … So far, we haven't seen any positive response. But the dialogue will continue."
Although it is true that older Canadians consume more of the country's public health dollars than do younger generations, the Canadian Institute for Health Information said in its most recent report that the aging population is a "modest" driver of increased health-care costs, boosting the overall bill by less than 1 per cent a year.
The situations of Alberta and British Columbia bear this out. Alberta, which has the youngest median age of all provinces, has the second highest per capita health expenditure. British Columbia, which has a median age that is slightly higher that that of the country as a whole, has the lowest.
Dale Orr, a Toronto economist who studies public policy and health care, says many factors increase the costs of medical care. Population density is one of them, he said, as is the amount a province pays its doctors. Provinces can control some things and not others.
But even if they can wrestle more money from Ottawa through a larger Canada Health Transfer, it will not necessarily be used for health care, Dr. Orr said. "The money goes into the general revenue pot, and trying to earmark it for this or that is almost impossible."
In fact, federal Health Minister Jane Philpott, who has indicated no willingness to alter plans to cut the increase in the transfer, wants the extra amount her government is willing to give the provinces to be spent on home care.
Mr. Lake is not impressed. He said the additional $3-billion over four years Dr. Philpott proposes to invest in home-care services is "a relatively small amount" in the grand scheme of things. "And we're not sure if it would be impactful or not."
But some experts say a better system of home care is exactly what is needed for an aging population.
John Church, a public policy professor at the University of Alberta whose research has focused on accountability in health care, said one of the big issues around seniors' care is not enough basic life aids, including transportation and domestic help.
"They end up taking up beds in hospitals because they can't get the support out in the community," Dr. Church said. "We also have a shortage of long-term-care beds. So the hospital is increasingly the place where seniors end up …"
If the federal government is smart, he said, it will target its money to build up that system outside the hospital. And, even if seniors' care is not significantly adding to the overall health care bill at this moment, Dr. Church said, "it could ultimately be an issue financially if we don't change the way that we do things."