The economic burden of illness
CMAJ 1997;157:620
© 1997 Canadian Medical Association
A new Health Canada report says information on health spending represents only 1 part of a larger picture. The report, Economic Burden of Illness in Canada, 1993, attempted to quantify both direct costs (traditional expenditures) and indirect costs related to illness and injury. The researchers estimated indirect costs by measuring the present value of lost productivity due to long- and short-term disability and premature death.
They determined that illness cost Canadians $5450 per person in 1993, for a total of $156.9 billion, or about 22% of the gross domestic product. The direct-cost component of this was $71.7 billion, with indirect costs accounting for the remaining $85.1 billion.
At $19.7 billion, cardiovascular disease ranked highest in terms of total costs (both direct and indirect). It was followed by musculoskeletal disease ($17.8 billion), injuries ($14.3 billion) and cancer ($13.1 billion). These 4 categories represented more than 50% of the total costs that could be classified by diagnostic category.
However, rankings differ when direct costs are considered by type of expenditure. Of the $7.2 billion spent on drugs that could be allocated to a diagnostic category, 43.7% of spending was attributable to cardiovascular, respiratory and mental diseases. However, based on the cost of physician services, the top 3 expenditure categories (29.7%) were well-patient care, respiratory diseases and nervous-system/sense-organ diseases. The largest hospital expenditures (42%) related to cardiovascular disease, mental disorders and cancer.
Indirect costs of mortality and long- and short-term disability were highest for musculoskeletal diseases (18%) followed by cardiovascular diseases (14.5%) and injuries (13.2%).
| Costs by highest-ranking diagnostic categories (1993) |
| Diagnostic category |
Direct costs
($ billions) |
Indirect costs
($ billions) |
Total costs
($ billions) |
| Cardiovascular diseases |
7.35 |
12.37 |
19.72 |
| Musculoskeletal diseases |
2.46 |
15.33 |
17.79 |
| Injuries |
3.12 |
11.22 |
14.34 |
| Cancer |
3.22 |
9.85 |
13.07 |
| Respiratory diseases |
3.79 |
8.39 |
12.18 |
Nervous-system/
sense-organ diseases |
2.25 |
7.32 |
9.57 |
| Mental disorders |
5.05 |
2.79 |
7.84 |
| Digestive diseases |
3.33 |
2.92 |
6.25 |
| Ill-defined diseases |
1.85 |
2.52 |
4.37 |
| Endocrine-related diseases |
1.33 |
2.09 |
3.42 |
This column was written by Lynda Buske, chief, physician resources information planning, CMA. Readers may send potential research topics to Patrick Sullivan (sullip@cma.ca; 800 663-7336, x2126; fax 613 523-0937).
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