| Chapter 1: | Examining Provincial Variability |
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to pay the new taxes needed to cover the growing costs of the system or are willing to support political decisions that direct a larger proportion of public budgets to health care, though an efficiency problem might remain, sustainability would not be an issue. Romanow went on to characterize the “mixed” nature of the Canadian heath care system:
People tend to think of the private sector involvement in health care as the direct delivery of services—such as eye and hernia clinics. But, there are also “private-for-profit” businesses whose revenues derive largely from the public system by providing important and expensive “second-line” items like medical supplies, lab and food supplies, laundry, IT, data processing, maintenance, security and so on.… The reality is that our health care system is a mixed bag of non-profit and “for-profit”; self-employed practitioners and salaried professionals; unionized and non-unionized workers; and government and private financing mechanism.
(Romanow 2002).
No doubt many experts would conclude that the current health care financing problem is essentially political in nature (Boychuk 2004; Evans 2004; Flood, Stabile, and Tuohy 2008). The main argument is based on the fact that provinces have willfully reduced their tax bases in the last two decades, aiming to stay competitive in the search for investments and skilled labor. Therefore it should be no surprise that health expenses claim a growing share of public budgets, even if they grow in a constant and predictable fashion and the proportion of publicly funded expenses stays relatively constant. Moreover, pressures resulting from deficit-reduction strategies at federal level have not helped matters. To put things simply, the funding crisis is not entirely inherent in the health system. To some extent it is imposed from outside, in so far as fiscal conservatism gains influence in the electorate. But overall, pressures both within and external to the health care system influence the development of more commercial activities in the system.
In this regard, it is noteworthy that in 2010, some 39.8 percent of Ontario’s provincial budget was devoted to health care expenditures; for