Ammi Mehdi, Arpin Emmanuelle, Allin Sara
School of Public Policy and Administration, Carleton University, Richcraft Hall, 1125 Colonel By Dr, Ottawa, ON K1S 5B6, Canada; Centre for the Business and Economics of Health, University of Queensland, Sir Llew Edwards Building, St Lucia QLD 4072, Australia.
Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
Health Policy. 2021 Dec;125(12):1557-1564. doi: 10.1016/j.healthpol.2021.10.004. Epub 2021 Oct 8.
The COVID-19 pandemic has raised concerns around public health (PH) investments. Among OECD countries, Canada devotes one of the largest shares of total health expenditures to PH. Examining retrospectively PH spending growth over a very long period may hold lessons on how to reach this high share. Further, different historical periods can be used to understand how macroeconomic conditions affect PH spending growth. Using forty-three years of data, we examine real PH spending growth per capita, comparatively between thirteen Canadian jurisdictions and with other key publicly funded healthcare sectors (physicians, hospitals, and pharmaceuticals), as well as by four periods defined by macroeconomic conditions. We find a five-fold increase on average in PH spending since 1975, a growth above physicians and hospitals, but below pharmaceuticals. However, there is substantial variation in PH growth between periods and across the country. Because concerns have been raised over PH spending data in other OECD countries, we explore differences between spending estimates reported by the national agency and ten provincial budgetary estimates, and find the former is larger. The magnitude of the difference varies between jurisdictions but not much over time. Although these differences do not challenge the presence of growth in PH spending, they show that the growth may be below that of hospitals. A better categorization of PH financing data is warranted.
新冠疫情引发了人们对公共卫生（PH）投资的关注。在经合组织国家中，加拿大在卫生总支出中用于公共卫生的份额是最高的之一。回顾性地审视很长一段时间内公共卫生支出的增长情况，可能会为如何实现如此高的份额提供经验教训。此外，不同的历史时期可用于了解宏观经济状况如何影响公共卫生支出的增长。利用43年的数据，我们考察了加拿大13个司法管辖区人均实际公共卫生支出的增长情况，并与其他主要的公共资助医疗部门（医生、医院和药品）进行了比较，同时还按宏观经济状况定义的四个时期进行了考察。我们发现，自1975年以来，公共卫生支出平均增长了五倍，高于医生和医院部门，但低于药品部门。然而，不同时期和全国各地的公共卫生支出增长存在很大差异。由于经合组织其他国家对公共卫生支出数据存在担忧，我们探讨了国家机构报告的支出估计数与十个省级预算估计数之间的差异，发现前者更大。差异的幅度因司法管辖区而异，但随时间变化不大。虽然这些差异并不影响公共卫生支出增长的存在，但它们表明其增长可能低于医院部门。有必要对公共卫生融资数据进行更好的分类。
