By Mata Press Service

British Columbians are spending more privately on dentists, physiotherapists, psychologists and other non-physician health professionals than anyone else in Canada, as a new analysis warns that private health-care spending is growing almost twice as fast as public funding.

B.C. residents spent $1,024 per person on privately funded non-physician health services, the highest amount among the provinces, according to a Canadian Centre for Policy Alternatives (CCPA) analysis of national health expenditure data.

Alberta ranked second at $975 per person and Ontario third at $869.

The finding highlights a less visible side of Canada's health-care system: while visits to doctors and medically necessary hospital treatment are generally covered by provincial health plans, Canadians routinely pay directly or through workplace and individual insurance for other health services.

Nationally, 29 per cent of health spending was privately financed in 2022, while 71 per cent came from public sources. Canada ranked 28th among 35 OECD countries measured by the CCPA for the proportion of health spending financed publicly. In Germany, Sweden, Norway and the United Kingdom, more than 80 per cent is publicly financed.

The distinction between public and private health-care spending can be confusing because it describes who pays the bill, rather than whether the doctor, clinic or facility is government-owned.

Publicly funded care is paid for by governments and public agencies, largely from tax revenues.

For example, when a B.C. resident goes to an emergency room, has medically necessary surgery in hospital or visits a family physician who bills the Medical Services Plan, that counts as public health spending. The doctor's office itself may be privately owned and the physician may operate as an independent contractor, but the treatment is publicly funded because the patient isn't paying the medical bill.

Health Canada notes that family physicians commonly operate as private contractors billing provincial health plans, while private facilities can also provide publicly insured services.

Private health spending is money paid directly by households or through private insurance.

A person paying a dentist $200 for treatment, using an employer health plan to cover physiotherapy, paying part of the cost of prescription medication, purchasing eyeglasses or paying accommodation charges in long-term care is generating private health spending.

That distinction means private delivery and private funding aren't the same thing.

A privately owned surgical clinic performing a procedure paid entirely by the provincial government is publicly funded health care. A physiotherapy clinic charging a patient or their insurance company is privately funded health care.

The CCPA report, written by senior researcher Andrew Longhurst, found private spending per Canadian grew 8.1 per cent between 2021 and 2023, compared with 4.3 per cent growth in public spending.

Provincial health spending remained substantially higher at $5,868 per person in 2023, compared with $2,602 in private spending, but the private side was expanding considerably faster.

More recent Canadian Institute for Health Information figures show the overall split remains largely unchanged.

CIHI estimates governments and other public sources will finance 71.2 per cent of Canada's health spending in 2025, with the private sector accounting for 28.8 per cent. Total Canadian health spending is projected to reach $399 billion, or $9,626 per person, in 2025.

Private expenditure is concentrated in several areas that aren't universally covered by Medicare.

The CCPA found 77 per cent of private spending in 2023 went to three categories: non-physician health professionals, at 32 per cent; prescription drugs, at 30 per cent; and long-term care, at 15 per cent.

That reflects the boundaries of the Canada Health Act.

Provincial health insurance plans are required to cover medically necessary hospital care, physician services and certain dental surgery that must be performed in hospital.

Prescription drugs outside hospital, routine dental treatment, optometry, physiotherapy, psychology, ambulance services and other services aren't universally insured under the Act. Provinces can choose to cover some of them, often for children, seniors, people receiving social assistance or other designated groups.

For a B.C. family, the difference can be straightforward.

A child's broken arm treated in a hospital emergency department is publicly funded. The X-ray, physician and hospital treatment are generally covered.

If that same child later requires physiotherapy outside hospital, some or all of the cost may fall to the family or a private benefits plan.

A visit to a family doctor for an insured medical problem is publicly funded. A routine dental filling is generally paid privately unless the patient qualifies for a government dental program.

Prescription drugs administered while someone is admitted to hospital are generally publicly insured, while medication picked up at a pharmacy after discharge may involve government coverage, private insurance, a deductible or direct payment, depending on the patient and provincial program.

The report found substantial differences among provinces.

Nova Scotia recorded the highest overall private health spending at $3,015 per person, followed by Alberta and Ontario at $2,852 each. The Canadian average was $2,602.

At the same time, Ontario recorded the lowest provincial government health expenditure at $5,425 per person, followed by New Brunswick at $5,685. Alberta was at $5,870.

B.C.'s distinction was particularly pronounced for health professionals outside the physician system.

At $1,024 per person, private spending on services including dental care, physiotherapy and psychology was more than 17 per cent higher than Ontario's $869.

The report argues those figures expose gaps in medicare because many services increasingly regarded as important to maintaining health or managing chronic conditions fall outside universal coverage.

Long-term care represents another significant area of private expenditure.

Saskatchewan residents spent $631 per person privately on long-term care, followed by Nova Scotia at $620, New Brunswick at $558 and Prince Edward Island at $513. The national average was $386.

Those costs can include completely private long-term care as well as accommodation and other charges paid by residents of publicly funded facilities.

CIHI's latest national figures show Canadians paid an average $1,327 per person directly out of pocket for health care in 2023, while private insurance financed another $1,057 per person.

The CCPA argues Canada's relatively large private share of health spending should receive greater attention as governments debate health-care privatization.