CIHI report indicates Ontario spends less than necessary to benefit its people

Nov. 20, 2018

When it comes to spending on health and health care, Ontario falls short of what's needed to meet people's care needs.

That's the view of the Registered Nurses' Association of Ontario (RNAO), which examined data detailing health-care spending trends across the country by the Canadian Institute for Health Information (CIHI).

According to National Health Expenditure Trends, 1975 to 2018, released today, Ontario ranks last in provincial per capita health spending at $4,064 per person. That's significantly lower than the rest of Canada where the figure is $4,594.

"When you crunch the numbers, Ontario is spending significantly less money per capita than any other province," says RNAO Chief Executive Officer Doris Grinspun. "Health care is important to safeguard people's health." Grinspun says "the imbalance between Ontario and all other provinces is especially concerning given that many people in our province still lack timely access to primary care." Added to this is the fact that not only is Ontario the lowest jurisdiction in per capita health-care spending, it also has the lowest RN-to-population ratio than any other province, a reality RNAO first brought to the government's attention in 2016. Sadly, no action has been taken, which poses a risk for patients. Ontario has only 669 RNs per 100,000 people compared with 828 RNs per 100,000 in the rest of Canada.

CIHI figures show that over time, Ontario's health-care cuts are hitting the hospital sector hard. Between 1975 and 2018, hospital spending dropped from 43.9 per cent of total health spending to 26.8 per cent. The result is that Ontario is the second-lowest per capita spender on hospitals, after Quebec; at $1,766, and well below the national average of $1,933. Grinspun says that has led to devastating results for patients because the funding crunch led hospitals to avoid filling 10,000 vacant RN positions, and resulted in massive replacement of RNs with less qualified health providers. "This ignores conclusive evidence that shows patients cared for by RNs are less likely to die; experience fewer complications, fewer readmissions, and are discharged sooner. Put simply, RN care means less suffering for patients and their loved ones, and health system cost-effectiveness," says Grinspun. In a report it released in 2016 called Mind the Safety Gap, RNAO recommended that every new hire in acute care hospitals and cancer care centres be an RN, and that RNs conduct all first home care visits. RNAO is also urging that funding models in the long-term care sector be changed and that the staffing mix in nursing homes be recalibrated to match the complex needs of residents today. This means a staff complement of at least 20 per cent RNs, 25 per cent RPNs and no more than 55 per cent PSWs, as well as having one NP for every 120 residents.

The amount of money the province spends on drug costs is another area where RNAO calls for a shift in policy that will yield better fiscal results and better coverage for Ontarians. CIHI's data show total Ontario drug expenditures jumped from 8.4 per cent to 17 per cent of provincial health spending between 1975 and 2018. Due to high drug prices, Canada has become the third biggest per capita spender on pharmaceuticals out of 30 countries from the Organisation for Economic Co-operation and Development (OECD). RNAO says Canadians would be better off under a universal pharmacare plan. "Supporting a national pharmacare program would provide people with better drug coverage and deliver billions in cost savings overall," says RNAO President Angela Cooper Brathwaite. RNAO says surveys routinely point out many people on modest incomes forego medicines because they can't afford them. Brathwaite adds that this leads to a double whammy in terms of increased sickness and higher health costs overall.

RNAO says nurses know that deficits have to be taken seriously, but it can't be at the expense of patient safety and their health outcomes. "Ontario does not have a spending problem; it has a revenue problem," insists Brathwaite. The latest CIHI data also show that in spite of the province's deficit, the province has the lowest overall program spending as a share of GDP (17.3 per cent versus 21.8 per cent for the rest of the country). "That's why progressive and fairer tax measures such as the planned surtax on the province's wealthiest are needed to ensure we have a health system that is equipped to serve all Ontarians," she emphasizes.

The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit our website at or follow us on Facebook and Twitter.


Contact info

Marion Zych
Director of Communications
Registered Nurses' Association of Ontario (RNAO)