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"With the recent changes in the health system, particularly earlier discharges from hospital and the move towards providing more care in the home, the costs of informal family care [for the elderly] have been characterized as the ‘hidden costs’ of the health care system."

Conference Board of Canada, "Caring About Caregiving: The Eldercare Responsibilities of Canadian Workers and the Impact on Employers".

Health care cuts mean pay-per-care

As government spending on health care declines, individuals are faced with more out of pocket costs. The growing crisis in health care is accompanied by a push to privatize services. Governments stop covering drugs and procedures, hospitals shorten stays and the pressure for private health providers grows.

In five short years from 1992 to 1997, household spending on health care increased by 30.5 per cent. Almost half that increase, 13.9 per cent, occurred in 1996-97. In 1997, households spent an average of $1,179 on health-related costs, including drugs, de-listed services, dental care and health insurance premiums.

Included in the increased household spending is a 144 per cent increase in health supplies including bandages, hearing aids, wheelchairs and canes. This is a troubling trend, given Canada’s aging population and the lack of a coherent national home care and pharmacare program. More reliance on at-home care carries extra costs that would have been covered in hospitals or long term care facilities. This downloading of costs to individuals will continue, as financially-strapped hospitals shorten stays for many procedures and move increasingly to day surgery. The option of recovering in hospital does not exist for many Canadians, who have no choice but to rely on patchwork home care services. This often means family members fill in the gaps or patients pay out of pocket for additional services.

The cost of prescription drugs and other pharmaceutical products is also being borne increasingly by individuals and families. Between 1992 and 1997, household expenditures rose by over 51 per cent, the result of governments de-listing drugs and ending coverage of drug dispensing fees. Canadian families are also spending more on hospital care and related services. In 1992, households that reported spending in this area spent an average of $275. By 1997 spending had increased by nearly 29 per cent to $353, with over half the increase between 1996 and 1997.

As user fees have risen, so government spending has fallen. Provincial and local government spending on health care in general increased by a mere 7.4 per cent between 1992 and 1997 — not enough to keep pace with years of federal funding cuts and population growth. Provincial and local health spending dropped by 0.3 per cent in 1996-97. Spending on hospital care dropped by 0.7 per cent in the same period.

The once proud claim of universal Medicare is slowly being eroded. With every new user fee, de-listed service and unmet need, Canada’s health care system becomes less and less accessible.