Canada's Premiers are meeting in Winnipeg July 10-12 and along with all the photo opps and media availability sessions, they are also expected to have some discussions on a number of pressing policy concerns including how to spend the forthcoming increases in federal transfers. Given that none of them have yet submitted plans on the targets and timelines they will use to convert the increased funding into health system improvement outcomes, one suspects it will be some time before the funding increases have any impact.
Of course, it remains that simply increasing funding alone will not necessarily solve the current chaos as emergency rooms close down during busy summer months, the rosters of people without family physicians grows as physicians retire and nursing shortages lead to delayed or postponed procedures. As the premiers know, Canada already is one of the biggest spenders in the OECD on health and well above the OECD average both as a share of its economy (See figure 1) and in dollars per capita (See figure 2) . Yet, as figures 3 and 4 illustrate, this larger amount of spending does not translate into more physicians per capita or more hospital beds per capita.
Now these simple types of comparisons can be critiqued on a number of levels. After all, while we have fewer physicians per capita, our nurses per capita match the OECD average. Moreover, Canada's physician to population ratio has been rising in recent years and it has been noted that simple physician to population ratios are not always helpful. Physicians in many other countries sometimes perform a broader range of functions than physicians in Canada which means having more of them per capita is not always an indicator of greater availability. Yet, if you look at physician consultations per capita, in 2019 - just before the pandemic - Canada stood at 6.6 while the OECD average was 7.0.
Canadian physician consultations per capita a decade ago were above the OECD average meaning that with fewer physicians per capita and higher consultations, Canadian physicians were seeing more patients than their international counterparts. That appears to no longer be the case. The case loads of the average Canadian physician have been declining and part of that is a change in practice culture and the arrival of the desire for better work-life balance. And there are other indicators where Canada does not perform as well - we are below the OECD average on diagnostics such as MRI and CT scans per million population.
So, throw in the chaos of the pandemic era, and we can see that the current problems are a function both of long term trends in Canadian health system resources, practices and staffing combined with the short-term shock of the pandemic's disruptions. We are already spending a lot more money than many other countries but we are definitely seeing less health service outcomes with that money. The per capita statistics also in the Canadian case reflect the fact that there are a lot more people in Canada given recent population growth which when combined with an aging population has certainly resulted in demand side increases too. The Premiers face quite the challenge. They will have more money to spend and do need to spend more to deal with the short term supply shortfalls. At the same time, they need to set up mechanisms to ensure that over the medium to long term, more money does not continue the recent trends of spending more and getting less.
