Summary
Geographic imbalances in health human resources exist in a health care system when the composition, level, or use of health care providers does not lead to the same optimal health‐system goals in all regions. This can lead to inequitable distribution of health care services, particularly for rural and remote populations. This study aims to determine to what extent the distribution of regulated health professionals and seniors in urban and rural areas of the Canadian jurisdictions is different from one another and from the national average. Data used in this study are for the 2016 calendar year. Information about physicians was obtained from the Canadian Institute for Health Information (CIHI) Scott's Medical Database. The data for nurses (nurse practitioners, registered nurses, and licensed practical nurses) were also sourced from CIHI, Health Workforce Database. Geographic information is based on the postal code of physicians' preferred mailing address, and the residence in the case of nurses and the population. Using the Statistical Area Classification from Statistics Canada, each physician and nurse was assigned to either an urban metropolitan, urban non‐metropolitan, or rural/remote area. Findings indicate that there were twice as many nurses per 1000 seniors in urban Canada than in rural Canada. However, this gap was threefold in the case of physicians. Provinces with the largest and lowest gap and international comparisons are also provided. Three broad strategies are offered for policymakers in order to mitigate this health workforce imbalance and reduce the regional shortage of nurses and physicians.
The long-term increase in international health spending sparked concerns about sustainability of health care systems but also the impact of such spending and the value for money from health spending. The period since 1975 has witnessed an increase in per capita health spending in Canada along with improvements in health outcomes. This paper is an economic evaluation of health spending in Canada-an analysis of the cost-effectiveness of aggregate health spending. Estimates of the cost per quality-adjusted life-year (QALY) are made for the whole 1980-2012 period and for four sub-periods of time-1980-1989; 1989-1998; 1998-2007 and 2007-2012. This is done for both the general population as well as Canadian seniors. Under a medium contribution of health spending to life expectancy scenario for the 1980-2012 period, the costs per QALY gained averaged $16,977 and $14,968, respectively for the general population and the seniors. This suggests that the Canadian health system produces relatively good value for money, especially for the seniors. After applying separate adjustments to match total health spending in the US and NHS health spending in the UK, we found that costs per QALY gained in Canada were generally lower than those found for the US, but not for the UK.
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