single-payer model

Seniors migration cost British Columbia $7.2 billion in health-care expenses

Average per person spending on health care for Canadians over 70 is $13,797.

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The Impact of Interprovincial Migration of Seniors on Provincial Health Care Spending

Summary

  • The dominant role played by government financing in Canada’s single-payer health care system has led to an oversight related to demographics: senior migration.
  • Health care spending is skewed towards the first year of life and after retirement. The average amount spent on health care by governments in a person’s first year of life is $10,800. For those between the ages of 65 to 69, that amount is $6,424, but it rises to $13,797 for those over 70.
  • Taxes, on the other hand, start out quite low and then climb steadily to one’s prime earning years (56-63), before beginning to decline as one nears and then enters retirement.
  • When a senior migrates from one province to another, they are likely to have paid the bulk of their lifetime taxes in one province but will consume the majority of their health care in another.
  • Six provinces experienced a net inflow of seniors between 1980 and 2016: BC, AB, ON, NB, NS, and PEI. The remaining four provinces (SK, MB, QC, and NL) experienced a net outflow of seniors. British Columbia recorded the greatest inflow (40,512), while Quebec experienced the greatest outflow (37,305).
  • Based on average annual health care costs by age, British Columbia had the largest cost at $7.2 billion (in 2017 dollars) while Quebec had the largest savings at $6.0 billion.
  • A partial analysis of potential tax revenues provided by migrating seniors suggests that BC’s costs could have been mitigated by as much as 36.3 percent while Quebec’s savings could have been reduced by as much as 19.2 percent.

Lessons for ’Medicare for All’ from Canada

In 2016, the median wait to see a specialist for treatment after receiving a referral from a GP was 20 weeks.

The primary obstacles of single-payer health care in American states

Canadian Medicare did not start out as a national institution. It started in one province, Saskatchewan, and spread to others over the years.
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Modern medicines are essential for improving health outcomes, alleviating pain and suffering, increasing longevity, and reducing expenditures on other medical services. While there is merit to pursuing a policy that expands access to those in need, it should be recognized that several avenues exist between the current, decentralized approach in Canada, and the sort of government-run, universal program that proponents of the single-payer system propose.  Expansions in government insurance coverage are also not costless, and must be judged against coverage already provided by governments to lower income Canadians.

The two essays in this study seek to help inform the debate over drug insurance policy in Canada.

The first essay by Nadeem Esmail explains the drug insurance coverage already available to lower income Canadians. Specifically, in every province, those on social assistance receive coverage for drugs at very low or no cost to the patient or insured individual. And while qualifying income levels vary across Canada, lower-income Canadians have access to at least catastrophic insurance for prescription drugs.

In the second essay, Bacchus Barua examines how Switzerland and the Netherlands, two nations with high performing universal access health care systems, provide drug insurance coverage to their populations. Both nations provide more timely access to higher quality health care services at a similar or lower cost than Canada. Neither has opted to pursue a government-run insurance scheme; both provide universal pharmaceutical coverage as a fundamental component of universal health insurance coverage, which is provided through regulated, competing, private insurance companies.

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