Health Expenditure and Finance Data presented in OECD Health Data 2013 are based on:

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1 Canada Health Expenditure and Finance Data presented in OECD Health Data 2013 are based on: Joint OECD-Eurostat-WHO SHA-consistent national Locally produced national SHA collection health accounts health accounts National accounts estimates SHA Implementation Weblink Main Data Sources (most recent data year): National Health Expenditure Database (NHEX), Canadian Institute for Health Information, Notes on Data Comparability: Departures from OECD/SHA Boundaries: National health expenditure in Canada includes: - Expenditure of Canadian hospitals for care provided to non-canadians. - Revenues of Canadian hospitals from ancillary operations (gift shops, parking lots, etc.). Only profit used to subsidise patient care should be included, however. While hospital revenues from ancillary operations are reported, profit cannot easily be determined from available data. - Expenditure of in-patient facilities for alcohol/drug addiction, except for private sector expenditure after Expenditure by the private sector in some long-term residential care facilities providing mainly room and board and social services (e.g. facilities for mental retardation, emotionally disturbed children) until Items such as products for oral hygiene (e.g. dentifrice, dental floss, toothbrushes, oral antiseptics), medicated shampoos, antiperspirants, etc. National health expenditure in Canada excludes: - Expenditure on school health made by provincial ministries of education. - Expenditure by private insurers for out-of-country care provided to Canadians. - Private sector expenditure on occupational health care. - Expenditures of voluntary health associations (societies dedicated to prevention and treatment of major diseases such as arthritis, cancer, diabetes, cerebral palsy, lung, kidney, liver and heart diseases, etc.). - Expenditures by public and private insurance plans for motor vehicle insurance, for health services not covered by the public programs for health care (such as services of physiotherapists, chiropractors, etc). - Expenditure on the systematic evaluation of health care delivery or of public health programs (non bio-medical research). In Canada, this expenditure is included under Health research and development, a health-related function rather than under Health administration and insurance. Departures from OECD/SHA Classifications: - Until 1998, total expenditure on in-patient care includes expenditure on hospital out-patient care & day-care and associated ancillary services (except medical fees for these services when paid directly to physicians by the provincial medical care plans), as well as home care provided by hospitals. - Public expenditure on Offices of physicians includes payments by provincial medical care insurance plans to private practice physicians for care in hospitals and detention centres, as well as to commercial laboratories and diagnostic radiology facilities headed by physicians. - Until 1974, public expenditure on prevention and public health includes administrative expenses of government programs except the cost of administering insured health services. - Starting in 1975 and until 1987, total expenditure on all other out-patient services includes expenditures for eyeglasses and other vision products along with expenditures for the professional services of optometrists and opticians. Break in time series: Health Canada maintained the National Health Expenditure Database (NHEX) until 1995 when it was transferred to the Canadian Institute for Health Information (CIHI). - From 1992 to 1995, Health Canada conducted a methodological review to revise health expenditure estimation procedures. The methodological review examined a number of concepts, data sources and methods used to estimate health expenditures by sector of finance and by category of expenditure. The review mainly affected

2 estimates of expenditures by the private sector. Private sector data under the revised methodology incorporated information obtained from new sources for 1988 and subsequent years. Following the methodological review, expenditure amounts by the private sector from 1975 to 1987 were re-estimated using trend data. Amounts before 1975 were left unchanged. Therefore, data users should exercise caution when using the private sector expenditure data for years prior to 1988, and particularly before For this reason, lower-level aggregates before 1975 are not presented in OECD.stat for some expenditure categories. - One of the primary motivations for undertaking the methodology review was that, previously, several categories in the private sector were estimated using a residual calculation method, based on the difference between total health expenditures and public sector health expenditures. As a consequence, errors made in estimating the total were deposited in the private sector. - Following the transfer of NHEX to CIHI, estimation methods were further refined and data sources improved. Some series were revised back to 1975 to incorporate these enhancements. - Total expenditure on therapeutic appliances and other medical durables. Until 1974, the data included expenditure on eyeglasses (including glasses, parts, and contact lenses), in addition to hearing aids and other appliances and prostheses such as wheelchairs, trusses, walkers and artificial limbs. From 1975 until 1987, expenditures on eyeglasses and contact lenses were no longer included here but instead were included with expenditure for the services of optometrists and dispensing opticians under the category All other out-patient services. This reflects data sources which tended to report expenditure on vision care as a lump sum. In Canada, optometrists dispense eyeglasses and contact lenses in addition to providing professional services. Since 1988, spending by private insurers on prescription eye-ware and other eye care goods, reported separately from spending on eye care services is included under Total expenditure on therapeutic appliances and other medical durables. - Out-of-pocket spending on prescription eye-ware and other eye care goods, reported separately from spending on eye care services in the Survey of Household Spending since 1996, is also included under Total expenditure on therapeutic appliances and other medical durables starting in 1988 (spending from 1988 to 1995 was estimated using trend data). - Until 1998, expenditure on in-patient care includes total current expenditure of hospitals (for in-patient care, day care, out-patient care, ancillary services, etc.), as well as expenditure of nursing and residential care facilities. Starting in 1999, it includes hospital expenditure specifically for in-patient care (curative, rehabilitative and long-term), expenditure of nursing and residential care facilities (based on a revised method of estimation of private sector expenditure) and payments by provincial medical care insurance plans to private practice physicians for services provided to in-patients in hospitals and detention centres. Since 1999, total current expenditure of hospitals is broken down into the following functions using the Cost Per Weighted Case (CPWC) methodology developed by CIHI: 1. In-patient curative care 2. In-patient rehabilitative care 3. In-patient long-term nursing care 4. Day cases of curative care 5. Day cases of rehabilitative care 6. Out-patient curative care 7. Out-patient rehabilitative care 8. Services of curative home care 9. Clinical laboratory 10. Diagnostic imaging 11. Patient transport and emergency rescue 12. Medical goods dispensed to out-patient 13. Prevention of non-communicable diseases 14. Education and training of health workers 15. Research and development in health 16. Food, hygiene and drinking water control 17. Environmental health 18. Pastoral care 19. Social work - Since 1999, only expenditure on in-patient care (curative, rehabilitative and long-term) is included under inpatient care. Hospital expenditures on other functions of care are distributed to the appropriate categories. Since 1999, current expenditure of hospitals excludes expenditures on health related functions (education & training; research & development; food, hygiene and drinking water control; environmental health), as well as expenditures on pastoral care and social work. See Variables with Specific Notes on Sources and Methods below.

3 - Until 1998, private expenditure of nursing and residential care facilities includes all expenditures by the private sector on the following six types of facilities: homes for the aged, institutions for persons with physical disabilities, developmental delays, psychiatric disabilities, alcohol and drug problems, and for emotionally disturbed children. Starting in 1999, it includes only expenditures by the private sector on residents who require personal care for a minimum of 1.5 hour a day with medical and professional nursing supervision in the following three types of facilities: homes for the aged, institutions for persons with physical disabilities and institutions for persons with psychiatric disabilities. - Until 1998, expenditure on out-patient care includes all payments to physicians, dentists and other health practitioners (optometrists, chiropractors, physiotherapists, etc.) in private practice. Starting in 1999, it excludes fee-for-services payments by provincial medical care insurance plans to private practice physicians for in-patient care, day care, home care, ancillary services to health care (clinical laboratory & diagnostic imaging). It includes, for the first time, expenditure for out-patient care in hospitals (financed out of the hospital budget). It continues to include all payments to dentists and other health practitioners in private practice. - Until 1998, expenditure on ancillary services to health care only includes expenditure of public programs for patient transport and emergency rescue. Starting in 1999, it also includes expenditure by hospitals for patient transport and for clinical laboratory & diagnostic imaging (for out-patient), as well as fee-for-service payments by provincial medical care insurance plans to private practice physicians for clinical laboratory and diagnostic imaging. - Until 1998, expenditure on medical goods dispensed to out-patients only includes expenditure on medical goods dispensed outside hospitals. Starting in 1999, it also includes expenditure on medical goods dispensed by hospitals to out-patients. - Until 1998, expenditure on prevention and public health services only includes expenditure on public programs for prevention and public health. Since 1999, it also includes expenditure by hospitals on prevention and public health services. - Until 1998, expenditure on home care only includes expenditure of public programs for home care. Starting in 1999, it also includes expenditure for home care provided by hospitals. See also Note on general comparability of health expenditure and finance data. Variables with Specific Notes in Sources and Methods: 1) HEALTH EXPENDITURE Total expenditure on health Source: Canadian Institute for Health Information, Ottawa, National Health Expenditure Database. - Forecasts for 2011 and data is actual and have been revised. - Health expenditure is defined as expenditure for which the primary objective is to improve or prevent the deterioration of health status. It includes expenditure for hospital care, care in other health-related residential institutions, home care, ambulance services, physicians' services, dentists' services, vision care, other health professionals' services; prescribed and non-prescribed drugs, hearing aids, health appliances and other prostheses; the administration of prepayment plans, public health, capital expenditure, occupational health and voluntary health organisations. Health research and the training of health workers that includes concomitant care of patients have been excluded, in accordance with the International Classification of Health Accounts (ICHA), as they are health-related functions. - The Canadian data appears to include a larger array of long-term care institutions than in several other countries. A frequently-used criterion consists classifying as health "joint" products in which medical and related expenditure is half or more of the total value, as social services and welfare the products where this content is below half. - See Notes on Data Comparability for departures from OECD/SHA Boundaries and Classifications. Collection National Health Expenditure estimates are compiled based on information from the following sources: Provincial Government Sector Provincial Public Accounts and Main Estimates. Provincial Departments of Health Annual Reports and Statistical Supplements where available. Annual Reports of various foundations, agencies and commissions. Special tabulations and specific information from various provincial departments reporting health expenditures. Federal Transfers are Part of Provincial Government. EPF, CHST - Federal-Provincial Relations Division, Federal Department of Finance. CAP - Cost Shared Programs Division, Human Resources and Development Canada.

4 Contributions to the Governments of the Northwest and Yukon Territories - Public Accounts of Canada, Department of Indian Affairs and Northern Development. Health Resource Fund - Health Canada. Federal Direct Sector. Public Accounts of Canada. Special tabulations/information from: Health Canada. Department of Veterans Affairs. Department of National Defense. Solicitor General of Canada. Social Security Funds Sector Special tabulations on medical aid spending provided by the provincial/territorial Workers Compensation Boards. Annual Reports of provincial/territorial Workers Compensation Boards. Annual Report of the Régie de l assurance-maladie du Québec. Municipal Government. Special tabulation purchased from the Public Institutions Division of Statistics Canada. Special tabulations from the Residential Care Facilities survey administered by the Health Statistics Division of Statistics Canada. Private Sector Private Insurance Component The not-for-profit portion is captured from special tabulations provided by the not-for-profit Insurance Companies. The commercial portion is captured by a special tabulation provided by the Canadian Life and Health Insurance Association (CLHIA). Consumer Component (out-of-pocket). Survey of Household Spending, Statistics Canada (formerly the Family Expenditures Survey (FAMEX)), except for the following categories Hospitals - (adjusted income from patient services) Annual Return of Health Care Facilities Part 2, fielded by Statistics Canada to 1994/95, and the Canadian MIS Database (CMDB) administered by CIHI (starting in 1995/96). Other Institutions - Residential Care Facilities Survey fielded by Statistics Canada. Over-the-Counter Drugs and Personal Health Supplies - Market Review of Selected Drug Categories at Retail, a special tabulation purchased from Nielsen Company Canada. Other Components (private sector) Hospitals - (adjusted income from non-patient services) Annual Return of Health Care Facilities, Part 2 fielded by Statistics Canada to 1994/95 and the Canadian MIS Database (CMDB) administered by CIHI (starting in 1995/96). Capital Expenditures - special tabulation purchased from the Investment and Capital Stock Division of Statistics Canada Health Research - The Association of Canadian Medical Colleges, Canadian Medical Education Statistics, Expenditure for Biomedical and Health Care Research of Canadian Faculties of Medicine by source of funds. Total current expenditure on health - Current expenditure on health in Canada also includes the NHEX category SU: Unspecified Health Service ($463 million in 2012). - All expenditures for Unspecified Health Service are public. They represent government expenditure reported in public accounts or special reports of federal departments, which cannot be distributed between personal health care and collective health. Total investment on medical facilities - Capital expenditures pertain to hospitals and nursing homes and are counted in full at the time the expenditure are made (full-cost accounting). They include the cost of procuring, constructing and installing new facilities and machinery and equipment, whether for replacement of worn or obsolete assets, or as additions to existing assets. Capitalised costs such as feasibility studies, architectural, legal, installation and engineering fees, as well as capitalised interest charges on loans with which capital projects are financed are also included. Construction expenditure excludes the purchase price of land but include outlays for land servicing and site preparation. - Capital expenditure by the private sector and provincial & municipal governments are from the Capital and Repair Expenditures Survey conducted annually by the Investment, Science and Technology Division of

5 Statistics Canada. Capital expenditures by the federal government are from national public accounts and reports of federal government departments. Public expenditure on health - Forecasts for 2011 and Public expenditure consists of expenditure by the federal, provincial/territorial and local governments, as well as the workers' compensation boards and the Quebec Drug Insurance Fund. Except for non-prescription drugs and personal health supplies, public expenditure covers all categories of expenditure included in total expenditure. - The Workers Compensation Boards (WCB) schemes and the Quebec Drug Insurance Fund appear to be the only schemes in Canada that correspond to the definition of social security schemes. - Workers Compensation Boards operate under provincial and territorial statute and are considered agencies of the provincial/territorial governments. They are financed by employers who pay a percentage of their total payroll depending on the accident experience of each category of employer. - The Quebec Drug Insurance Fund, introduced by the government of Quebec on January 1, 1997, is financed by the mandatory payment of premium. The Fund covers residents not otherwise insured by the provincial drug program (for seniors, social assistance recipients, etc.) or by private health insurance generally offered through employment. Departures from OECD/SHA Boundaries and Classifications - Some provinces (e.g. Quebec, Manitoba, Saskatchewan, British Columbia) have mandatory motor vehicle insurance programs that provide coverage for personal injury as a result of a motor vehicle accident. Expenditures incurred by these public motor vehicle insurance programs, for health services not already covered by the public programs for health care (such as services of physiotherapists, chiropractors, etc), are not compiled in the Canadian National Health Expenditure Database (NHEX) and therefore not included in the submissions to the OECD. - Public expenditure on health excludes expenditures on school health by Ministries of education. - Public expenditure on health includes all public sector expenditures in inpatient facilities for alcohol/drug addiction. - Public expenditure on health excludes expenditures on the systematic evaluation of health care delivery or of public health programs. In the Canadian Health Accounts, these expenditures are included under Health research and development, a health-related function. Public investment on medical facilities - Until 1974, information on capital investment by the public sector is exclusively from public accounts and government reports. Starting in 1975, information on capital investment by the private sector and provincial & municipal governments is from a survey conducted by the Investment and Capital Stock Division at Statistics Canada. Capital expenditure by the federal government is still obtained from national public accounts. Since 1975, capital expenditure is categorized as private or public based on ownership of the facility in which the investment is made. Private expenditure on health Private Insurance Component: - The not-for-profit portion is captured from special tabulations provided by the not-for-profit Insurance Companies. - The commercial portion is captured by a special tabulation provided by the Canadian Life and Health Insurance Association (CLHIA). Consumer Component (out-of-pocket): - Survey of Household Spending, Statistics Canada (formerly the Family Expenditures Survey (FAMEX)), except for the following categories: - Hospitals - (adjusted income from patient services) Annual Return of Health Care Facilities Part 2, fielded by Statistics Canada to 1994/95, and the Canadian MIS Database (CMDB) administered by CIHI (starting in 1995/96). - Other Institutions - Residential Care Facilities Survey fielded by Statistics Canada. - Over-the-Counter Drugs and Personal Health Supplies - Market Review of Selected Drug Categories at Retail, a special tabulation purchased from AC Nielsen Canada. Other Components (private sector): - Hospitals - (adjusted income from non-patient services) Annual Return of Health Care Facilities, Part 2 fielded by Statistics Canada to 1994/95 and the Canadian MIS Database (CMDB) administered by CIHI (starting in 1995/96).

6 - Capital Expenditures - special tabulation purchased from the Investment and Capital Stock Division of Statistics Canada. - Health Research - The Association of Canadian Medical Colleges, Canadian Medical Education Statistics, Expenditure for Biomedical and Health Care Research of Canadian Faculties of Medicine by source of funds. Departures from OECD/SHA Boundaries and Classifications: Private expenditure on health as published in Canada includes: - Expenditure in Canadian hospitals for care to non-canadians. - Non-patient revenues earned by hospitals from ancillary operations (parking lots, gift shops, etc.). Only profit used to subsidise patient care should be included. However, while hospital revenues from ancillary operations are reported, profit cannot easily be determined from available data. - All private sector expenditures in in-patient facilities for alcohol/drug addiction and in some long term residential care facilities providing mainly room and board and social services (e.g. facilities for mental retardation, emotionally disturbed children) until Such items as products for oral hygiene (e.g. dentifrice, dental floss, toothbrushes, oral antiseptics), medicated shampoos, antiperspirants, etc. Private expenditure on health as published in Canada excludes: - Expenditures incurred by private insurance enterprises for motor vehicle insurance, for health services not already covered by the public programs for health care (such as services of physiotherapists, chiropractors, etc). - Expenditure by private insurance enterprises for out-of-country care rendered to Canadians. - Expenditure of voluntary health associations (societies dedicated to prevention and treatment of major diseases such as arthritis, cancer, cystic fibrosis, cerebral palsy, epilepsy, multiple sclerosis, diabetes, lung, kidney, liver and heart diseases, AIDS, etc). - Expenditure on occupational health care. Private investment on medical facilities - Starting in 1975, information on capital investment by the private sector and provincial & municipal governments is from a survey conducted by the Investment and Capital Stock Division at Statistics Canada. Capital expenditure is categorized as private or public based on ownership of the facility in which the investment is made. Total expenditure on personal health care - The sum of expenditure on in-patient care (hospitals and other institutions), home care, ambulatory care, prescribed and non-prescribed drugs sold in retail outlets, personal health supplies, and therapeutic appliances. - Total expenditure on personal health care does not include the NHEX category SU: Unspecified Health Service which are expenditures by the public sector. However, an unknown proportion would be for personal health care. See Total current expenditure on health. - Since 1999, excludes the following expenditures in hospitals: health-related functions, pastoral care, social work and prevention and public health. Public expenditure on personal health care - Public expenditure on personal health care does not include the NHEX category SU: Unspecified Health Service which are expenditures by the public sector. However, an unknown proportion would be for personal health care. See Total current expenditure on health. - Since 1999, excludes the following expenditures in hospitals: health-related functions, pastoral care, social work and prevention and public health. Total expenditure on collective health care - Total and Public expenditure on collective health care does not include the NHEX category SU: Unspecified Health Service which are expenditures by the public sector. However, an unknown proportion would be for collective health care. See Total current expenditure on health. - Since 1999, includes expenditure on prevention and public health in hospitals. Expenditure on prevention and public health (total, public, private) - Expenditures for items such as measures to prevent the spread of communicable disease, food and drug safety, health inspections, health promotion activities, community mental health programs and public health nursing. Until 1974 also includes all costs for the infrastructure to operate health department with the exception of insurance programs. General administrative expenses of government health departments, other than for insured health services, are therefore included here until This departs from the OECD guidelines of including these expenses under Expenditure on health administration and health insurance. Work has been done recently to identify general administrative expenses separately from expenditures on public health for the years 1975 to

7 2012 and this distinction is now reflected in the published Canadian data. Since 1975, the expenditure on provision and administration of public health programs excludes the cost of general administration of departments of health. - Since 1999, includes expenditure on prevention and public health in hospitals. Total expenditure on health administration and insurance - Until 1974, only the administrative cost of providing insured health services (prepayment administration) by either governments or private health insurance firms is included. Since 1975, general administrative expenses of government health departments, other than for insured health services. For private health insurance firms, prepayment administration is usually the difference between premiums received and claims paid. For insurance plans offering administrative services only, the amount reported is the payment for administrative services. Public: - Until 1974, the data mostly represent administrative expenses by provincial governments for the provision of insured health services (expenses by the federal government are quite small). Until 1974, the cost of general administration of departments of health are not included here, but is treated as a part of public health. Since 1975, the data include both the administrative expenses for the provision of insured health services and the cost of general administration of departments of health. Private: - For private health insurance firms, pre-payment administration is usually the difference between premiums received and claims paid. For insurance plans offering administrative services only, the amount reported is the payment for administrative services. Total expenditure on health research and development - Represent expenditure for research activities intended to improve the health status of the population, or to increase efficiency in the delivery of preventive and therapeutic services. This comprises the production and dissemination of health statistics. This departs from the OECD guidelines of including the production and dissemination of technical documentation and statistics on health under Health administration and insurance. The data exclude expenditure for research carried out and funded by hospitals until 1998 and by drug or health care appliances companies in the course of product development in all years. This expenditure is included respectively under the categories Hospitals until 1998, and under Pharmaceutical Goods and Therapeutic Appliances in all years. - Starting in 1999, expenditure on health research & development in hospitals is included. Public expenditure on health research & development - The data represents expenditure by federal and provincial governments for research activities intended to improve the health status of the population, or to increase efficiency in the delivery of preventive and therapeutic services. Starting in 1999, includes public expenditure on health research & development in hospitals. Expenditure on medical services (total, public, private) - Includes a portion of the NHEX category RO: Other Spending pertaining to medical services ($804 million in 2012). The NHEX category RO: Other Spending represents out-of-pocket expenditure and private insurers expenditure that cannot be allocated to discrete types of care. The NHEX category RO: Other Spending is broken down between Medical Services and Medical Goods, but cannot be broken down further. From 1985 to 1987, total expenditure on medical services includes all expenditures by the private sector on eyeglasses and other vision products as no breakdown of private sector spending between eye care goods and eye care services was available. - Starting in 1988, however, spending by private insurers on prescription eye-ware and other eye care goods, shown separately from spending on eye care services in reports from private insurers is reported under Expenditure on medical goods and excluded from Expenditure on medical services. While out-of-pocket spending on prescription eye-ware and other eye care goods is reported separately from spending on eye care services in the Survey of Household Spending only starting in 1996, it is also excluded from expenditure on medical services since 1988, as estimates were made for the years 1988 to 1995 using trend data. See Expenditure on medical goods. - Note: Expenditure on medical services does not include the NHEX category SU: Unspecified Health Service, which are expenditures by the public sector. However, an unknown proportion would be for medical services. See Total current expenditure on health. Since 1999, the following expenditures in hospitals are excluded: health-related functions, pastoral care, social work, prevention and public health, and medical goods dispensed to out-patients.

8 Public expenditure on in-patient long-term nursing care: Includes expenditure by the public sector for care in homes for the aged, institutions for persons with physical disabilities, developmental delays, psychiatric disabilities, alcohol and drug problems, and for emotionally disturbed children. Starting in 1975, data on federal and provincial/territorial expenditure are from public accounts. It was assumed that all payments made to the above type of facilities by Health Ministries were for health services. However, some provinces have a combined health and social services ministry and some of the payments might have been for social services. Data on federal and provincial/territorial expenditure before 1975 are from the Canada Assistance Plan. - The data includes payments by Workers' Compensation Boards. - Since 1999, also includes public expenditure on in-patient long-term nursing care in hospitals. Private expenditure on in-patient long-term nursing care Until 1998, includes all expenditures by the private sector on the following six types of facilities: homes for the aged, institutions for persons with physical disabilities, developmental delays, psychiatric disabilities, alcohol and drug problems, and for emotionally disturbed children. Starting in 1999, it includes only expenditures by the private sector on residents who require personal care for a minimum of 1.5 hour a day with medical and professional nursing supervision in the following three types of facilities: homes for the aged, institutions for persons with physical disabilities and institutions for persons with psychiatric disabilities. Starting in 1999, it also includes private expenditure on in-patient long-term nursing care in hospitals. Expenditure on in-patient care (total, public, private) Total: Until 1998, expenditure on in-patient care includes total current expenditure of hospitals (for in-patient care, day care, out-patient care, ancillary services, etc.), as well as expenditure of nursing and residential care facilities. Starting in 1999, it includes hospital expenditure specifically for in-patient care (curative, rehabilitative and long-term), expenditure of nursing and residential care facilities (based on a revised method of estimation of private sector expenditure) and payments by provincial medical care insurance plans to private practice physicians for services provided to in-patients in hospitals and detention centres. Public: Until 1998, public expenditure on in-patient care includes public expenditure on hospitals (for in-patient care, day care, out-patient care, ancillary services, etc.), as well as public expenditure on nursing and residential care facilities. Starting in 1999, it includes public expenditure on hospitals specifically for in-patient care (curative, rehabilitative and long-term), public expenditure on nursing and residential care facilities and payments by provincial medical care insurance plans to private practice physicians for services provided to in-patients in hospitals and detention centres. Public expenditure on nursing and residential dare facilities includes expenditure by the public sector for care in homes for the aged, institutions for persons with physical disabilities, developmental delays, psychiatric disabilities, alcohol and drug problems, and for emotionally disturbed children. Starting in 1975, data on federal and provincial/territorial expenditure are from public accounts. It was assumed that all payments made to the above type of facilities by Health Ministries were for health services. However, some provinces have a combined health and social services ministry and some of the payments might have been for social services. Private: Until 1998, private expenditure on in-patient care includes private expenditure of hospitals (for in-patient care, day care, out-patient care, ancillary services, etc.), as well as private expenditure of nursing and residential care facilities. Starting in 1999, it includes private expenditure on hospitals specifically for in-patient care (curative, rehabilitative and long-term) and private expenditure on nursing and residential care facilities based on a revised method of estimation of private sector expenditure as described below. Until 1998, private expenditure on nursing and residential care facilities includes all expenditures by the private sector on the following six types of facilities: homes for the aged, institutions for persons with physical disabilities, developmental delays, psychiatric disabilities, alcohol and drug problems, and for emotionally disturbed children. Starting in 1999, it includes only expenditures by the private sector on residents who require personal care for a minimum of 1.5 hour a day with medical and professional nursing supervision in the following three types of facilities: homes for the aged, institutions for persons with physical disabilities and institutions for persons with psychiatric disabilities. Expenditure on day care

9 - Although Canada is able to report expenditure on day-care separately, the majority of countries are not able to do so. Therefore, to make the expenditure data more comparable across countries, day-care expenditure for Canada has been included in total, public and private out-patient expenditure. - For reference, Total expenditure on day-care in 2012 was $6081million. Expenditure on out-patient care (total, public, private) Total: Until 1998, the sum of current outlays on the services of physicians, dentists and other health professionals in private practice (chiropractors, optometrists, podiatrists, osteopaths, naturopaths, nurses, denturologists, and physiotherapists). Gross expenditure includes overhead expenses of private practice where applicable, such as the wages of employees, rents, utilities, car expenses and premiums for malpractice insurance. They exclude wages of government public health workers and of employees of hospitals and other institutions whose earnings are included in the expenses of the entities employing them. Until 1998,expenditure on services supplied by the out-patient department of hospitals are not included here, with the exception of fees paid directly to physicians by the provincial medical care insurance plans for hospital services. Salaries of physicians serving in the armed forces and prisons are included here. Break in series in Starting in 1975 and until 1987, the data also includes all private sector expenditures on eyeglasses and contact lenses since the private sector statistics did not distinguish between goods and services for eye care. Break in series in Since 1988, spending by private insurers and out-of-pocket spending on prescription eye-ware and other eye care goods, reported separately from spending on eye care services reports from private insurers and in the Survey of Household Spending, is excluded from total expenditure on out-patient care. Break in series in Starting in 1999, the outlay on the services of private practice physicians excludes fee-for-service payments by provincial medical care insurance plans for in-patient care, day care, home care, ancillary services to health care (clinical laboratory and diagnostic imaging). Total expenditure on out-patient care includes, for the first time, expenditure on out-patient care paid out of the hospital budget (reported under HC.1.3.9). It continues to include all payments to dentists (reported under HC.1.3.2) and other health practitioners in private practice (reported under HC.1.3.9). Until 1998, expenditure on physician services ($11,805 million in 1998) was entirely reported under basic medical and diagnostic services (HC.1.3.1, HC.2.3) as it could not be broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). Starting in 1999, the major portion ($6,819 million in 1999) of expenditure on physician services, representing fee-for-service payments by provincial medical care insurance plans, is broken down between basic medical and diagnostic services and specialist services. However, payments made by provincial medical care insurance plans according to alternative modes of remuneration (i.e., other than fee-for-service), while included in expenditure on out-patient care (HC.1.3, HC.2.3), are not broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). Break in series in Starting in 2003, some payments made to physicians by provincial medical care insurance plans, according to alternative modes of remuneration (i.e., other than fee-for-service), are broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). However, there remains a portion of payments to physicians that could not be broken down. The alternative payments for specialist services may include payments in some provinces for clinical laboratory and diagnostic imaging. In Nova Scotia, alternative payments for clinical laboratory and diagnostic imaging could be identified as such and were included under HC.4 Ancillary services, rather than under out-patient care (HC.1.3, HC.2.3). Public: Until 1998, the data are the publicly financed portion of expenditure on the services of physicians, dentists and other health professionals in private practice (chiropractors, optometrists, podiatrists, osteopaths, naturopaths, private duty nurses, dentists, and physiotherapists). The remuneration of health professionals on payrolls of hospitals, public health agencies and the like is not included here but is counted with the category concerned. The data exclude expenditure on services supplied by the out-patient department of hospitals, with the exception of fees paid directly to physicians by the provincial medical insurance plans for hospital out-patient services. Salaries of physicians and dentists serving in the armed forces and prisons are included here. Break in series. Starting in 1999, the public spending on the services of physicians in private practice excludes fee-for-services payments by provincial medical care insurance plans for in-patient care, day care, home care, and clinical laboratory and diagnostic imaging that can be identified as such in the National Physician Database or in annual reports of provincial medical care insurance plans. Public expenditure on outpatient care includes, for the first time, expenditure on out-patient care financed out of the hospital budget (reported under HC.1.3.9). It continues to include all public payments to dentists (reported under HC.1.3.2) and other health practitioners in private practice (reported under HC.1.3.9). Until 1998, expenditure on physician services by the public sector was entirely reported under basic medical and diagnostic services (HC.1.3.1,

10 HC.2.3) as it could not be broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). Starting in 1999, fee-for-service payments by provincial medical care insurance plans to physicians are broken down between basic medical and diagnostic services and specialist services. However, payments made by provincial medical care insurance plans according to alternative modes of remuneration (i.e., other than fee-for-service), while included in expenditure on out-patient care (HC.1.3, HC.2.3), are not broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). Break in series in Starting in 2003, some payments made to physicians by provincial medical care insurance plans, according to alternative modes of remuneration (i.e., other than fee-for-service), are broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). However, there remains a portion of payments to physicians that could not be broken down ($2,306 million in 2003). The alternative payments for specialist services may include payments in some provinces for clinical laboratory and diagnostic imaging. In Nova Scotia, alternative payments for clinical laboratory and diagnostic imaging could be identified as such and were included under HC.4 Ancillary services, rather than under outpatient care (HC.1.3, HC.2.3). Expenditure on physician services (total and public) - a constituent of out-patient care Total: - The largest component of total expenditure on physician services (a constituent of out-patient care) is professional fees paid by provincial medical care insurance plans to physicians in private practice. Among other components are salaries and other forms of contractual professional incomes received by private practice physicians, fee payments made by workers' compensation boards, direct expenditure on physicians' services by federal agencies, private-sector payments for services not covered by provincial plans and amounts extra-billed by physicians in the years preceding the prohibition of extra-billing in the mid-eighties. Until 1998, includes all fee-for-service payments made directly by provincial medical care insurance plans to private practice physicians for all types of care, including care in hospitals (in-patient care, day care, out-patient care, etc.). In all years, excludes the remuneration of physicians who are on payrolls of hospitals, public health agencies, and the like. Includes the professional remuneration of physicians serving in the armed forces and prisons. Until 1998, expenditure on physician services ($11,805 million in 1998) is entirely reported under basic medical and diagnostic services (HC.1.3.1, HC.2.3) as it could not be broken down between expenditure on basic medical and diagnostic services (HC.1.3.1, HC.2.3) and expenditure on specialist services (HC.1.3.3). Break in series in Starting in 1999, excludes fee-for-services payments by provincial medical care insurance plans for in-patient care, day care, home care, and clinical laboratory & diagnostic imaging that can be identified as such in the National Physician Database or in annual reports of provincial medical care insurance plans. Starting in 1999, the major portion ($6,819 million in 1999) of expenditure on physician services, representing fee-for-service payments by provincial medical insurance plans, could be broken down between expenditure on basic medical and diagnostic services (HC.1.3.1, HC.2.3) and expenditure on specialist services (HC.1.3.3). However, the remaining portion ($1,898 million in 1999) could not be broken down and is not included under these two categories. However, it is included under expenditure on out-patient care (HC.1.3, HC.2.3). Break in series in Starting in 2003, some payments made to physicians by provincial medical care insurance plans, according to alternative modes of remuneration (i.e., other than fee-for-service), are broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). However, there remains a portion of payments to physicians that could not be broken down. The alternative payments for specialist services may include payments in some provinces for clinical laboratory and diagnostic imaging. In Nova Scotia, alternative payments for clinical laboratory and diagnostic imaging could be identified as such and were included under HC.4 Ancillary services, rather than under out-patient care (HC.1.3, HC.2.3). Public: The largest expense component is professional fees paid by provincial medical care insurance plans to physicians in private practice. Until 1998, includes all fee-for-service payments made directly by provincial medical care insurance plans to private practice physicians for all types of care, including care in hospitals (inpatient care, day care, out-patient care, etc.). In all years, excludes the remuneration of physicians who are on payrolls of hospitals, public health agencies, and the like. Includes the professional remuneration of physicians serving in the armed forces and prisons. Break in series in Starting in 1999, excludes fee-for-services payments by provincial medical care insurance plans for in-patient care, day care, home care, and clinical laboratory and diagnostic imaging that can be identified as such in the National Physician Database or in annual reports of provincial medical care insurance plans. Starting in 1999, fee-for-service payments to physicians by provincial medical insurance plans

11 are broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) specialist services (HC.1.3.3). Break in series in Starting in 2003, some payments made to physicians by provincial medical care insurance plans, according to alternative modes of remuneration (i.e., other than fee-for-service), are broken down between basic medical and diagnostic services (HC.1.3.1, HC.2.3) and specialist services (HC.1.3.3). However, there remains a portion of payments to physicians that could not be broken down. The alternative payments for specialist services may include payments in some provinces for clinical laboratory and diagnostic imaging. In Nova Scotia, alternative payments for clinical laboratory and diagnostic imaging could be identified as such and were included under HC.4 Ancillary services, rather than under out-patient care (HC.1.3, HC.2.3). Expenditure on dental services (total and public) - Expenditure for dental services includes expenditure on services of dentists, dental assistants, dental hygienists and dentists. It includes the cost of dental prostheses, including false teeth and laboratory charges for crowns and other dental appliances. - Data submitted by private insurers do not allow for the exclusion of dental prostheses from dental services. Includes the cost of dental X-rays. Expenditure on home health care (total, public, private) Total: - The data represents expenditure on care rendered to patients in their homes by physicians, nurses and other health practitioners. Includes only public expenditure, except for the private sector share of home care provided by hospitals after Until 1998, when home care is provided by a hospital, the cost is included under the category "Hospitals", and not here. Public: - The data represents expenditure by the federal and provincial governments, and workers compensation boards. Includes payments made by governments to the Victoria Order of Nurses. Until 1998, when home care is provided by a hospital, the cost is included under the category "Hospitals", and not here. Until 1998, excludes fee-for-service payments made by provincial medical care insurance plans for home care provided by private practice physicians. Private: - Expenditure for home care not provided by a hospital is not included here as it is not identified separately from other health service expenditures in reports from private insurers and in the Survey of Household Spending conducted by Statistics Canada. Private expenditure for home care is, however, captured under the aggregate category Expenditure on Medical Services. Break in series in Since 1999, includes expenditure on home care provided by hospitals in all provinces and fee-for-service payments made by provincial medical care insurance plans in Nova Scotia, Quebec and British Columbia for home care provided by private practice physicians. Expenditure on ancillary services - Until 1998, the data represents public expenditure for transportation in an especially-equipped surface vehicle or by a designated air ambulance to or from facilities for the purposes of receiving health care. Private expenditure for patient transport is not included here as it is not identified separately from other health service expenditures in reports from private insurers and in the Survey of Household Spending conducted by Statistics Canada. Private expenditure for patient transport is, however, captured under the aggregate category Expenditure on Medical Services. Break in series in Since 1999, the expenditure on ancillary services also includes expenditures on hospital laboratory and diagnostic imaging services associated with out-patient care and day care in hospitals, as well as patient transport financed out of the hospital budget. Also since 1999, the expenditure includes fee-forservice payments made by provincial medical care insurance plans to private practice physicians for clinical laboratory and diagnostic imaging. Break in series in Since 2003, includes alternative payments (i.e., other than fee-for-service) to physicians by the medical care insurance plan of Nova Scotia for clinical laboratory and diagnostic imaging. Expenditure on medical goods (total, public, private) - Includes a portion of the NHEX category RO: Other Spending pertaining to medical goods ($784 million in 2012). The NHEX category RO: Other Spending represents out-of-pocket expenditure and private insurers expenditure that cannot be allocated to discrete types of care. The NHEX category RO: Other Spending is broken down between Medical Services and Medical Goods, but cannot be broken down further.