Public-Sector Expenditures and Utilization of Home Care Services in Canada: Exploring the Data

Abstract

A number of factors can influence the resources devoted to home care and the use of home care services. The needs of an aging population for continuing care after discharge from hospital; an evolving model of health care delivery and the search for more cost effective modes of treatment can result in increased expenditures and use of home care services. This study attempts to compare changes in expenditures and utilization of home care services by asking the following key questions:

- What is the level of expenditures for publicly funded home care in Canada and how has it changed over time?

- How do changes in public home care expenditures compare to changes in the number of government-subsidized home care users?

Information from Public Accounts, special tabulations from Health Ministries and annual reports of provincial/territorial Workers' Compensation Boards are used to estimate the level of public home care expenditures from 1994-1995 to 2003-2004. As well, the first three cycles of the National Population Health Survey (1994-1995, 1996-1997 and 1998-1999) and the first two cycles of the Canadian Community Health Survey (2000-2001 [Cycle 1.1] and 2003 [Cycle 2.1]) are used to estimate the number of government-sponsored home care users. Whenever possible, home care is broken down into home health care (nursing care and health services) and home support (personal care, housework, meals, shopping and respite care).

In 2003-2004, total public home care spending in Canada is estimated to have been $3.4 billion in current dollars. Real per capita (in dollars of 1997) total public spending on home care in Canada is estimated to have been $93.60 in 2003-2004, an average annual growth of 6.1% from the 1994-1995 level. On the other hand, the number of users of government-subsidized home care services per 1,000 population was estimated at 26.1 in 2003, an average annual increase of only 1.0% from the 1994-1995 level. The fact that per capita spending on home care increased annually, on average, by 5.1 percentage points more than the number of users suggests that, in general, each home care user consumed more resources in 2003 than he or she did a decade previously.

Moreover, for selected jurisdictions where home care data can be split between home health care and home support, the share of home health within home care expenditures increased, on average, from 43.3% in 1995-1996 to 48.6% in 2003-2004. Notwithstanding data limitations, the fact that home health care accounts for an increasing share of home care services suggests a gradual shift in the model of home care delivery. This should permit incapacitated clients to stay relatively safe at home, with the effect of preventing, delaying or substituting for long-term care or acute care alternatives; which could potentially turn into cost savings for the Canadian health care system.

Keywords: Home Care, Expenditures, Utilization

JEL Classification: I12, I18