It has been pointed out more than once during the current provincial election campaign that health-care in Nova Scotia is far from fixed, with growing numbers without access to primary care, along with other failings such as over-crowded emergency departments and longer wait times for elective surgeries. 

But Tim Houston has lived up to one commitment – spending big. As he told party faithful last year, when it comes to health care “we need more. And we need to go faster. As for the cost, whatever it takes.”

That “whatever it takes” approach has moved Nova Scotia into second place among provinces in per capita spending on health care, thanks to a country-leading 23.2 percent increase since Houston’s PCs took over in 2021. 

That information comes from the Canadian Institute for Health information (CIHI) which earlier this month released the 2024 edition of National health expenditure trends.  The report forecasts Nova Scotia per capita spending on health at almost $7,000 this year, topped only by Newfoundland and Labrador

Increase in per-capita health spending by province 2021-24 (descending order)

Province2021 $ per capita2024 $ per capitaIncrease 2021-24
Nova Scotia$5,678$6,99523.2%
Prince Edward Island$5,482$6,65421.4%
Newfoundland&Labrador$6,914$8,27219.6%
British Columbia$5,480$6,46418.0%
New Brunswick$5,001$5,60012.0%
Saskatchewan$5,615$6.0758.2%
Manitoba$5,419$5,8257.5%
Alberta$5,645$6,0166.6%
Ontario$5,217$5,3101.8%
Quebec$5,965$6,0030.6%

Source: CIHI nhex-series-D4-2024

Although the numbers for 2024 are forecasts, CIHI points out they are based on 2024 provincial budget estimates and are reviewed by provincial officials before they are published – so the provincial government could not easily disavow data that reveals something it would rather keep hidden. This could be important if the Legislative Assembly being elected next week decides to re-constitute the Standing Committee on Health. 

Committee members may want to delve a little more deeply into some of the other expenditure trends where Nova Scotia stands out. For example, hospital spending:

  • Between 2021 and 2024 per capita spending on hospitals increased by 42.8 percent in Nova Scotia. The next highest increase was Newfoundland and Labrador, with a 29.1 percent increase;
  • At $3,223 per capita, Nova Scotia spends 66 per cent more on hospitals than the lowest-spending province, Ontario at $1,935.  

One explanation for high hospital spending is that Nova Scotia puts less than seven other provinces into community-based physicians and other health care professionals – and spends significantly less on public health than any other province. In 2024, Nova Scotia is forecast to spend only $149 per capita on public health, down almost 20 percent from 2021 when COVID expenditures provided a temporary boost to public health spending. 

Admin tops public health

By putting only 2.1 percent of the overall budget into public health in 2024, the Houston government continues with chronic underinvestment, a practice that according to an article in the Canadian Journal of Public Health “could have serious consequences for a province with a population frequently recognized as being among the least healthy in the country, coupled with observable health inequities within the population.”

In fairness, it should be noted that at $149 per capita, spending on public health in 2024 would be almost double what it was pre-COVID. However, it still appears absurdly low when compared with provinces such as PEI ($758 per capita), Alberta ($698) and British Columbia ($513). The only province that even comes close to matching Nova Scotia’s low level of spending is Quebec, forecasting $233 per capita spending on public health for 2024.

A couple of other findings in the 2024 CIHI data should also receive attention. Firstly, there is administration, defined as “expenditures related to the cost of providing health insurance programs by the government and private health insurance companies, and all costs to operate health departments.” At $74.57 per capita, Nova Scotia is the highest in the country, just ahead of B.C. and Quebec. And that cost of nearly $75 is up 36.4% since 2021. 

Finally, there are pharmaceutical drug costs. Nova Scotians have among the highest drug bills in the country – $1,343 per head – but the provincial government picks up only 24.9% of the tab, lower than six other provinces. In addition to Nova Scotia, out-of-pocket drug costs averaging $1,000 or more per capita also prevail in New Brunswick and Newfoundland and Labrador, making one wonder why leaders in Atlantic Canada have not been more vocal in calling for a comprehensive national pharmacare plan.

Overall, the 2024 National health expenditure trends data provide proof that the Premier meant it when he pledged to spend “whatever it takes.” But any fool can spend, the goal is to spend wisely and there’s nothing in the latest expenditure numbers to show that’s been happening in Nova Scotia.

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