Good afternoon. I will be speaking in French.
I would like to thank the committee for having invited me to appear before it to discuss a topic that has interested me for many years.
In essence, I will try to cover 3 points in 10 minutes, and in each case, I will provide examples that may be the subject of questions afterward. I will first speak very quickly about costs, among others the costs of aging for health care services; second—and on this I agree with Mr. Reichman—I will talk about the need to integrate health care services for seniors, and finally I will present a few guidelines for possible policy, in particular policy that could be developed by the federal government.
You have my notes in your hands. There are tables and figures. The first table is on health care expenditures in Canada. It is important to make a distinction that is not usually made when talking about health care costs: we must absolutely separate what is included in the services covered by the Canada Health Act, that is essentially medical and hospital services, and all other services, at least in terms of funding. Only once this distinction is made do we start to understand what is happening.
There is another very important aspect, and on this matter, I have taken the advice of François Vaillancourt, a colleague who is an economist at the Department of Economics of the University of Montreal. He believes that, for citizens, what is important is not what each level spends, but rather what government spends. What concerns and interests me, therefore, as a citizen, is what government spends on health care services. In Canada, even though health is under provincial jurisdiction, there is federal spending. It is important to take into consideration all government spending, whether it be federal or provincial.
In the first chart, we can see the changes in health care expenditures. Look at the middle line, between 1989 and 2008. It is the proportion of spending on doctors and hospitals by all governments in Canada. It therefore includes the federal budget and provincial budgets. We see that in 1989, spending on doctors and hospitals covered by the system constituted 12% of spending by all governments. In 2007, that proportion was still 12%. There has been absolutely no change in these aspects.
When we look at what is not covered by the Canada Health Act, we see a constant increase over time. In fact, it is precisely in this sector that there are user fees, charges and coverage that are neither public nor universal and that are applied where provincial governments, especially, are investing to make up for what is not covered by the private system. It is precisely this sector that explains the increase in the burden on the provinces, and insofar as the federal government funds health care services, on the federal government. There is therefore an increase in the burden and not in the amounts allocated.
Finally, much is said about health care spending on seniors. Let's look at the second chart. There are at least two elements in all health care spending when we are talking about a population. There is the increase in the population or in different age groups. You see health care spending going up because the Canadian population is increasing, and concurrently, because there are more seniors. That is shown by the bars on the right that you see here. What you see is the increase in health care spending in Canada due to aging and the increase in the population. There is a significant increase between 1989 and 2007 in Quebec.
The curve illustrates the increase in intensity. In Quebec, from 1989 to 2007, the intensity of services provided to the elderly decreased. In this case, you must consider both demographics and the intensity of services which are provided to the elderly. In Quebec and basically everywhere else in Canada, there was an increase in the proportion of seniors in the population. However, the intensity of services which were provided did not increase at the same pace. Further, this intensity increased more for those aged 55 and over, or rather, for people between the ages of 45 and 64, rather than for people aged between 64 to 75.
Let's now look at the overall increase in health care costs. There is the average spending growth for all age groups in Quebec, and there is the spending increase for the various age groups. Surprise! People over the age of 75 saw their health care spending increase over the last 10 years, and at exactly the same pace as for the rest of the population. However, it is rather the baby boom population, those between the ages of 45 and 64, that saw an increase. So when people say that the elderly are responsible for the stunning increase in health care services, they are wrong, because they have not correctly analysed the data. People often make a very opportunistic analysis of the data as a whole.
As Dr. Reichman and Mr. Nolan said, on the one hand, elderly people who need intensive services are relatively few in number, and on the other hand, they really do need these intensive services. We have known for a long time that this was coming. I will quote some words, which I translated into French, from an American observer who said this back in 1975: “[...] about 1 of every 5 people aged 65 and over will eventually need a combination of intensive and extensive social and health care services [...]”. Since 1975 at least, we knew what was coming our way. In fact, we have known this for about 36 years.