Good morning. I would also like to thank you for the invitation to appear today.
Decisions regarding the federal government's policies and guidelines on the medical inadmissibility of immigrants are based on many factors: moral, legal, economic, etc. I'd like to focus my remarks on economic issues.
While the government's current goal is to mitigate excessive demand on health and social services, as far as I'm aware, we—and I use “we” to refer to all of us who make up the Canadian community—have no good measures of actual demand or costs for such services by the subset of potential immigrants who are at risk of being adjudicated as excessive cost or risk. Although there would be some challenges, it would not be extremely difficult to produce such estimates using mostly provincial health and social service administrative data, although it would need to be done province by province. If a complete picture for all provinces were required, the task would take a little bit of time. Overall, while some bits and pieces of evidence do exist, as far as I'm aware, we do not know how well we, at the time of screening new immigrants, are able to predict who will be high cost.
I encourage you, as part of your deliberations, to go beyond simply listening to those who appear before you and what they happen to say and, rather, to produce any evidence you need for good decision-making yourselves. Moreover, I encourage you to take full responsibility for any costs of decisions you recommend. One of the oddities of our Constitution is that the decisions and costs of decisions are not always borne by the same level of government. This can sometimes lead to poor decisions. I encourage you, therefore, to not only figure out what the costs of your decisions are, but if there are increases in costs by provincial governments, that those increases are funded by the decision-maker. Having pointed out our lack of knowledge on the topic, I can point to a few things that we do know.
First, health care costs are extremely unevenly distributed among the population. For example, a group inside the Ontario Ministry of Health and Long-Term Care recently calculated that about 1.5% of Ontario's population represents about 5% of those with the highest costs, and they incur about 61% of total hospital and home care costs. Put another way, of Ontario's population, about 3.9 million people incurred hospital and home care costs in 2009-10 and the total cost was just over $14.2 billion. Of this group, the top 1% in terms of costs, which is just under 200,000 residents, incurred costs that made up $8.6 billion out of that $14.2 billion. A small number of users can make a great deal of difference to total costs. As an aside, these dollar values are limited and do not include, for example, physician billings, which are not normally part of hospital and home care budgets.
An important follow-on to this question has to do with the persistence of costs. It turns out that high-cost use is quite persistent, though clearly there is some turnover. Looking at physician billings, which are less persistent than, say, residential care, one of my students calculated that over 40% of those in the top 5% of costs in 2004-05 were still in the top 10% of costs in 2008-09. A group in the Ontario Ministry of Health also found high levels of year-over-year persistence looking at a broader cost base.
Another important issue for this committee is whether the immigration system as it works at the moment introduces immigrants to Canada who are more or less likely to be high-cost users of health care than people who are Canadian born. As far as I can tell, based mostly on work by researchers at the University of Toronto and Ontario's Institute for Clinical Evaluative Sciences, there is absolutely no difference. In Ontario, immigrants and Canadians by birth are exactly equally likely to be high-cost users of health care. Overall, the cost implications for health and social services resulting from a small and somewhat persistent set of so-called high-cost users, in Ontario at least and probably more broadly in the Canadian health payment system, are substantial. However, none of this evidence speaks to the anticipated costs of those affected by the current operation of our immigration system's effort to mitigate excessive demand on health and social services. Figuring out costs for that group would take more work and, of course, deciding if our society wishes to bear those costs is another issue altogether.
Thank you.