Expenditures on Mental Health and Addictions for Canadian Provinces in 2003 and 2004

Article excerpt

Objective: To measure total public and private expenditures on mental health in each province.

Method: Data for expenditures on mental health services were collected in the following categories: physician expenditures (general and psychiatrist fees for service and alternative funding), inpatient hospital (psychiatric and general), outpatient hospital, community mental health, pharmaceuticals, and substance abuse. Data for 2 years, 2003 and 2004, were collected from the Canadian Institute for Health Information (hospital inpatient and fees for service physicians), the individual provinces (pharmaceuticals, alternative physician payments, hospital outpatient, and community), and the Canadian Centre on Substance Abuse. Totals were expressed in terms of per capita and as a percentage of total provincial health spending.

Results: Total spending on mental health was $6.6 billion, of which $5.5 billion was from public sources. Nationally, the largest portion of expenditures was for hospitals, followed by community mental health expenses and pharmaceuticals. This varied by province. Public mental health spending was 6% of total public spending on health, while total mental health spending was 5% of total health spending.

Conclusions: Canadian public mental health spending is lower than most developed countries, and a little below the minimum acceptable amount (5%) stated by the European Mental Health Economics Network.

Can J Psychiatry 2008;53(5):306-313

Clinical Implications

* Public spending on mental health in Canada was 5% of all public spending on health care, a rate below most comparable countries.

* There are considerable variations between provinces in hospital and community care, and there is room for additional movements to community care.

* There is a considerable variation in per capita private drug costs between provinces, indicating a considerable private burden on younger psychiatric patients.

Limitations

* There is no accurate information on the number of days of inpatient psychiatric care during a given year.

* Information on the use of psychiatric drugs is not sufficiently refined.

* Data on outpatient (for example, emergency room) care seem considerable, but are only available for one province.

Key Words: mental health, expenditures, costs

Abbreviations used in this article

ALC alternative level of care

CIHI Canadian Institute for Health Information

CIHIPDW Canadian Institute for Health Information per diem weight

CMG case mix grouping

CMHC community mental health centre

CNS central nervous system

CWC cost per weighted case

DAD discharge abstract database

EBIC economic burden of mental illness

FFS fee for service

PDW per diem weight

RIW resource intensity weight

Total mental health expenditures are an important indicator of a society's commitment of resources to mental illness. According to a European mental health committee report, a rate of mental health expenditures to total health expenditures of less than 5% represents an unfair allocation of resources to mental health. According to Health Canada's EBIC report, Canada spent 5.6% of its direct health resources on mental health in 1998.' However, this estimate only included resources (for mental and general health) for which billing and clinical codes were available (general hospital discharges, FFS billings, and prescription drug sales for provincial drug plans). A more recent and complete analysis for Alberta by Block et al2 indicated a rate of 8.4% (excluding prescription drugs) of all provincial health department expenses. Given the importance paid to mental health in recent government3 and private4 reports, it is timely to directly estimate how much is spent on mental health in Canada. The purpose of this paper is to estimate provincial expenditures for mental health in 2003 and 2004. …