Policy library

Private share of health expenditures (%): Ontario vs. rest of Canada

Revenues Relative to GDP (%)

Program Expenses Per Capita

There is a clear and persistent imbalance between revenue and expenditures, which is not sustainable in the long run. The question is whether the solution should involve a reduction in spending or an increase in revenue, or a combination of the two, or a movement in the same direction with one dominating. For example, one could increase expenditures sustainably so long as revenues rose sufficiently quickly to yield a net reduction in the deficit. A comparison of Ontario with other provinces and territories reveals that Ontario is an outlier, consistently having the lowest or second lowest expenditures as a share of GDP. Notably, the only province that has lower program expenditure/GDP ratios are Alberta and Saskatchewan, and those lower ratios are entirely due to those provinces having a much higher per capita GDP than Ontario – about 32% higher for Alberta and about 15% higher for Saskatchewan. Alberta and Saskatchewan spend more per capita on programs than Ontario, as the next graph below shows.

The reason for the jump in the debt/GDP ratio is the large and increasing deficits. The deficits are projected to decline for many jurisdictions in 2021-22, but they remain large and as a consequence, the debt/GDP ratio (above) was projected to increase in 2021-22 in spite of the drop in the deficits.

Recent data from RBC and Statistics Canada confirm a marked trend towards rising provincial and federal deficits. There was a sharp projected jump in the debt/GDP ratio for 2020-21, with the ratio projected to deteriorate in a number of provinces, including Ontario. Ontario leads all provinces and territories in debt/GDP by a large margin, with the exception of Newfoundland. Figures from 2020-21 onwards (bolded) are projected.

Ontario’s 2021 budget confirmed a jump in the program spending and in deficits for 2020-21, the year of the pandemic, although spending and deficits are projected to decline in 2021-22. Over the period 2011-12 to 2021-22, total spending (program spending plus interest payments) has always exceeded revenues, so there has always a deficit. In many years, program spending alone exceeded revenues.

Age-Adjusted Per Capita Health Spending

Health as a percentage of program spending

Percentage of patients who reported that their primary family or friend caregiver expressed continued feelings of distress, anger or depression over a six-month period.

Percentage of home care patients who strongly agreed that they felt involved in developing their home care plan

Median number of days that new patients of home care waited from request for home care services or discharge from hospital to their first home visit, from hospital or from home, Ontario

Percentage of patients who rated their home care coordination and service provider(s) as excellent, very good, good, fair or poor.

Emergency department visits by home care clients in 30 days after leaving hospital

Percentage of home care patients who were satisfied with their care from both care coordinators and service providers