Economic Burden of Illness in Canada,
1993
APPENDIX 2
Definitions
National Health Expenditures in Canada,
1975-1994
All expenditures in National Health Expenditures in Canada,
1975-1994 (NHEC) are based on public and private sectors of
finance. The four main areas of public sector finance are these.
- federal direct health expenditures
- provincial and territorial government health expenditures
(supported by health-related federal transfers to the provinces and
provincial and territorial government funds)
- municipal government health expenditures
- workers' compensation board health expenditures
Private sector health expenditures are subdivided
into three major categories.
- expenditures from health insurance plans (commercial and
non-profit)
- out-of-pocket expenditures of individuals
- revenue of health care institutions from patient and
non-patient services
Unless otherwise stated, total direct health expenditures are based
on NHEC figures. In the NHEC report, total health expenditures
always refer to the sum of public and private sectors of finance.
For more details, refer to Health Canada's National
Health Expenditures in Canada, 1975-1994 (or the 1975-1987
version for some of the definitions of terms).
Drug Expenditures
The IMS audits include:
- prescription drugs used in hospitals or purchased in
computerized chain and independent retail drug stores, whether paid
through provincial or other third party plans or directly by the
patient
- some non-prescription drugs prescribed by a physician and
dispensed by a pharmacist in a retail drugstore
and exclude:
- non-prescription products sold in retail outlets other than
drugstores
- prescription drugs supplied by dispensing physicians
- drugs prescribed by specialized health centres/clinics (e.g.
cancer, family planning) outside of hospital
- drugs prescribed in other institutions (These are included in
Expenditures for Care in Other Institutions.)
The
NHEC national drug expenditure includes:
- prescription drugs, non-prescription drugs and personal health
supplies purchased in retail stores
and excludes:
- drugs prescribed in hospitals and in other institutions (These
are included in Hospital Care Expenditures and Expenditures for
Care in Other Institutions.)
The NHEC cost estimates for prescribed drugs are derived from
figures obtained from federal, provincial and territorial
governments, workers' compensation boards, private insurers and
Statistics Canada's
Survey of Family Expenditures.
Cost estimates for non-prescription drugs and personal health
supplies were developed from a special tabulation obtained from
A.C. Nielsen (Canada).
Physician Care Expenditures
The NHEC national physician expenditure includes:
- professional fees paid by provincial medical care insurance
plans
- physicians' salaries and contractual professional
incomes
- fee payments by workers' compensation boards
- direct expenditures by federal agencies and private sector
payments for physicians' services not covered by provincial
plans
and excludes:
- physicians on hospital, public health agency payrolls, etc.
(These are included in Hospital Care Expenditures).
The
Manitoba physician expenditure includes:
- payments made on a fee-for-service basis and excludes:
- psychiatrists paid through the provincial mental health
services branch
- radiologists and pathologists paid through hospitals
- out-of-province medical care costs
- optometric, oral, dental, periodontal and chiropractic services
and costs
Hospital Care Expenditures
Acute care hospitals include:
- non-teaching general hospitals with no long-term care
units
- non-teaching general hospitals with long-term care units
- pediatric hospitals
- teaching general hospitals (excluding pediatric)
- nursing stations, outposts
- other (cancer hospitals, cardiology hospitals or institutes,
maternity hospitals, neurological institutes, orthopedic hospitals,
etc.)
Long-term care hospitals include:
- extended care hospitals (including chronic)
- rehabilitation hospitals (including convalescent)
Psychiatric hospitals include:
- short-term care, including alcohol/drug recovery
- long-term care
Statistics Canada hospital expenditures include
the costs, on an accrual basis, of operating and maintaining the
reporting public hospital during the year. This includes gross
salaries and wages covering all medical staff remuneration,
employee benefits, supplies and other expenses.
Refer to Statistics Canada's Hospital Statistics:
Preliminary Annual Report, 1993- 94 for more detail.
Expenditures for Care in Other
Institutions
The Health Canada definition of Other
Institutions includes residential care facilities for the
following groups:
- aged (including nursing homes)
- physically handicapped
- mentally handicapped
- developmentally delayed
- psychiatrically disabled
- clients with alcohol and drug problems
- emotionally disturbed children
These estimates do not include:
- non-health expenditures in these facilities
- facilities solely of a custodial or domiciliary nature (i.e.
Type I care or less)
- facilities for transients and delinquents
Types of Care
Self-sufficient:
- only minor supervision required
Type I care:
- less than 90 minutes, in a 24-hour day, of supervision and/or
assistance with activities of daily living and provision of support
in meeting psycho-social needs
Type II care or higher:
- a minimum of 1.5-2.5 hours, in a 24-hour day, of medical and
professional nursing supervision and provision of support in
meeting psycho-social needs
Health Science Research Expenditures
Additional categories include the following:
Basic Research
- metabolism
- immunology
- cell and molecular biology
- embryology
- other basic research not classified
Education/Medical History
- certain conferences
- workshops
- symposia
- visiting professors and scientists
- scholarships
- studentships
- fellowships
- travel grants
- history of health care
Equipment/Capital
Health
- general health promotion and disease prevention programs
- approaches to patient care
- communication with health professionals
Granting sources not included in the Medical Research Council's
Reference List:
- agencies situated outside Canada (e.g. National Institutes of
Health)
- Canadian and foreign business enterprises (e.g. pharmaceutical
industry)
- smaller, local and regional agencies and foundations
- endowments and funds at the discretion of universities,
hospitals and affiliated institutions
Additional Direct Health Expenditures
Other professionals include chiropractors,
optometrists, podiatrists, osteopaths, naturopaths, private duty
nurses and physiotherapists.
Home care represents "care rendered to
patients in the patients' homes by nursing or other
staff." When home care is provided by a hospital, it is
included in Hospital Care Expenditures.
Other private health care costs comprise
extended health benefits (hearing aids, appliances, etc.) that many
insurance companies were unable to categorize.
Public health consists of "governmental
expenditures for the prevention of disease and the protection of
health and for the general administration of health departments . .
. The internal administration of health institutions (hospitals,
nursing homes, etc.) is treated as part of the expenditures for
institutional care."
Capital expenditures include "expenditures
on construction, machinery and equipment of hospitals, clinics,
first-aid stations, and homes for special care."
Prepayment administration "is intended to
measure the cost of having insurance coverage; that is to say, the
amount of expense over and above the cost of the health care
rendered that is involved in providing that care on a prepaid
basis."
Miscellaneous health costs comprise the
following three subcategories.
- Training of health workers: "reported expenditures, by
federal and provincial departments responsible for health, that are
specifically designated as being for the training of health
workers. Only incidental expenditures of the departments are
included here, not the cost of programs for complete training of
persons to become health workers. Where the expenditures for
training are made by hospitals, the amounts are included under
[Hospital Care Expenditures]."
- Voluntary health organizations: "selected expenditures of
certain national non-profit health organizations. The figures . . .
exclude data for personal health care and for research, which have
been included under other headings."
- Occupational health expenditures: "expenditures to promote
and enhance health and safety at the workplace and to provide
emergency care in the event of injury at work."
Mortality Costs
Employment income refers to total income
received by persons 15 years of age and over during 1993 as wages
and salaries, net income from unincorporated non-farm business
and/or professional practice, and net farm self-employment
income.
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