Yes, and I will close with what the federal government can do, which I think is in the way of technology, important technology.
First of all, I'll talk about the key arguments around our health care system these days. I think the way technology veers into it is that it will save our system in terms of costs. Alternatively, there are concerns that new technology in health care tends to raise costs.
Currently I think people believe that health care costs are considerably out of control, and that there is a threat, with the aging of the population, that things will be even much worse.
As well, quite frequently in the public debate, which I'm privileged at times to be part of, the main alternatives being put out there are that there are no alternatives other than to cut some real services or to use more private-care finance.
This is where I think some of the new ways of delivering care and new ways of thinking about that and what we need to support these new methods of delivery come in. There is quite an argument about whether our system can be made more efficient.
Finally, there tends to be the argument that we need a so-called adult conversation, which is primarily used, I think, as a euphemism to reduce our expectations and make us see the need for alternative arrangements, particularly financial ones.
I've taken about a minute and a half to describe that argument, but usually it only takes 15 seconds in a sound bite, and that's the main theme that's driving our health care debate. On the other hand, as I've suggested to you, I think there is considerable evidence to the contrary on most of those points.
First of all, health care costs are not wildly out of control. They did jump to a new peak in 2009-10, to almost 12% of GDP overall, but that was largely due to a major recession and fall in the economy. Health care costs in those years in fact went up considerably less than the average for the previous ten years.
In fact, now it's predicted that over the past two years.... We just have estimates at this point, but it will likely be in the foreseeable future, even with economic growth, only about 3.5% in nominal terms. We're going to get a fall in health care costs against our gross domestic product growth, and therefore health as a share of our economy will go down and our health care system will be, by that definition, more sustainable.
This is particularly true of public sector costs, which in fact now are about 8% or 9% above the previous peak in 1992. They've been coming down for the last few years. It's private costs and in particular those related to pharmaceuticals, which I know we'll touch on later, that have gone up. Private sector costs have gone up 50% in relative terms over their previous peak in 1992.
Overall, if you look internationally, if you compare apples to apples and oranges to oranges, and if you compare the right years—because you can't compare, for example, as the OECD did, Canada in the recession year 2009 to other countries in the pre-recession year of 2007 or 2008. That report, which got a lot of play, was fatally flawed because they didn't take that into account.
When you look at overall health care spending as a share of provincial government spending, it has fallen in the last three to four years from about 40% overall in Canada to less than 38%. To the extent that Canadian health care spending is rising as a share of government spending, it's also due to the fact that government program spending in Canada has declined fairly sharply over the last 20 years.
Internationally, as I said, we are roughly comparable to others. We're a little bit less than what France and Germany spend, and a little bit more than what is spent in countries like Belgium, Austria, Finland, which have comparable health systems.
What's really different is that Canada, like these other countries, is at around 10% to 12% of GDP. Health care for Canada is estimated to be at about 11.5% this year. The United States is at nearly 18%.
Another issue is around aging of the population, which I think is seen as another area where technology may have some solutions and also some threats.
I want to make the point that it's been well known for over 25 years. Some research that I did a couple of years ago with Hugh Mackenzie , a Toronto-based economist, confirms what other people have shown for many years. Namely, the annual impact of aging on health care costs for the next 25 years will be about 1% per year. This is in the context of health budgets growing at 2% to 3% now, and 5% to 7% on average from the late nineties to about 2008.
I always like to quote Bill Dalziel, an Ottawa geriatrician, on the aging population:
It is not the aging of our population that threatens to precipitate a...crisis in health care, but a failure to examine and make appropriate changes to our health care system, especially patterns of utilization.
Canada really does have remarkably archaic processes of care, like the fact we don't provide care out of hospitals. According to the Commonwealth Fund, an excellent, not-for-profit, non-partisan organization in New York City, Canadians, among 11 countries surveyed, are the most likely to say that they can't get care in their family doctor's office the same day but have to go to the emergency room. We also have the highest use of emergency rooms of these 11 countries. And we're the second longest in wait times to see a specialist.
This is often seen as a lack of money, or as a consequence of our not having a private system. In fact, it's due to archaic processes. This was nicely shown in a study in Ontario a couple of years ago, which followed patients who had seen spinal surgeons in Ontario. They might have waited a year to see them. It turned out that only 10% of patients referred to a spinal surgeon actually went on to have surgery in the following 18 months. These patients were waiting maybe a year to see a spinal surgeon. But if they're not going on to surgery, they should actually see a rehabilitation medicine specialist, a physiotherapist, or perhaps a multi-disciplinary team, including people like social workers. That's just one example of our many inefficient models of care.
More efficient models of care use electronic health records. When we take a look at the way we deliver services, we find that less than 5% of family practices are offering same-day services. At a large medical group in Cambridge, Ontario, the Grandview Medical Centre, Dr. Janet Samolczyk is now offering her patients the opportunity to book whenever they want to see her. In the U.K., the goal is that people will be able to electronically book their own appointments completely by 2015. Even without more doctors, but with doctors better integrated with nurses and other health professionals and using electronic systems, we could be more efficient.