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Federal health spending has outpaced provinces, analysis shows

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OTTAWA – Despite castigation from provincial premiers over lagging federal contributions to health spending, an analysis of 20 years of health funding data shows that federal transfers have mostly outpaced increases to provincial health budgets.

In 2023, federal health transfers amounted to $47.1 billion, a 212 per cent increase over 2005, when the transfers were $15.1 billion. Total spending by all 10 provinces grew in that time to $221.9 billion up from $86.2 billion, an increase of 158 per cent.

The Canadian Press, in partnership with Humber College StoryLab, collected data on provincial health budgets and federal health transfers from 2004 to 2023 to track annual spending from the launch of the 2004 federal-provincial health accord under former Liberal prime minister Paul Martin.

The findings stand in stark contrast to the rhetoric that has punctuated federal and provincial health negotiations over the last several years, as health systems struggled in the aftermath of the COVID-19 pandemic.

Two years ago, a shortage of health workers led to emergency room closures and extreme backlogs for services across the country and premiers demanded the federal government pay a greater share of the health spending bill.

Former Manitoba premier Heather Stefanson, after a meeting with her fellow provincial leaders at the end of 2022, said health spending used to be split evenly but the federal share had slowly dwindled over time.

Governments originally envisioned that health-care costs would be divided evenly between Ottawa and provincial governments in 1959, before most provinces even had medicare. But the funding model shifted drastically in the 1970s and has changed again many times since.

Rather than slowly dropping off over the last two decades as the premiers suggested, the data shows federal transfers actually grew at a slightly faster pace than provincial health spending since the Martin health accord in 2004.

In 2005-06, federal health transfers grew 39 per cent in one year while provincial health spending grew by six per cent.

That meant the federal share of total health spending jumped to 20.7 per cent from 17.5 per cent.

Federal health-care spending was far higher during the COVID-19 pandemic because of specific transfers. Those extra funds stopped flowing in 2022-23, by which time the federal share of total provincial spending had grown just slightly to 21.2 per cent.

That reality wasn’t acknowledged when premiers were clamouring for more federal money after the pandemic, Health Minister Mark Holland said in a recent interview.

It was also not acknowledged in his recent negotiations with provinces as part of Prime Minister Justin Trudeau’s proposed $196-billion health deal, which involved signing one-on-one agreements with each province.

“I understand the position of the provinces — huge demands on them — but we have been ensuring that we’re providing the dollars that are necessary and required to help them in their health systems,” Holland said.

“Now what we need to do is to begin to transform how our system functions. We need to move from a crisis-based system where we wait until people are really sick and then we deal with it, to being upstream and avoiding illness and being engaged in prevention.”

Ontario Premier Doug Ford declined The Canadian Press’s interview request as chair of the Council of the Federation, the official organization of the premiers.

A written statement said premiers “continue to urge the federal government to provide adequate and sustainable health-care funding,” also reiterating their concerns that the agreements have an end date.

The premiers call that the “funding cliff,” fearing they can’t plan for long-term stability when federal offers all have expiration dates.

In February 2023, about 10 days after Trudeau tabled the latest health funding offer, the premiers issued a joint statement to reluctantly accept it.

“While this first step marks a positive development, the federal approach will clearly not address structural health care funding needs, nor long-term sustainability challenges we face in our health-care systems across the country,” they wrote.

Getting a clear view of who is paying the growing cost of Canada’s health care isn’t straightforward.

No government is collecting health spending data on a national scale, and federal contributions are difficult to pin down.

It’s important to know how much each government is contributing so that voters can hold them accountable, said Haizhen Mou, a professor with the University of Saskatchewan’s graduate school of public policy.

“They have certain expectations on the quality and quantity of health care they receive, however, they cannot hold either level of government accountable, because there’s no clear division of responsibility,” said Mou, who studies health funding and politics.

“There’s no clear, no transparent contribution ratio or expectation for this contribution from either government in the system so far.”

The Canadian Press and Humber College StoryLab combed through decades of provincial public accounts and federal transfers to compile the data manually.

Territories were not included because health spending records couldn’t be verified in some cases. The territories also receive additional support from the federal government to fund necessary travel and accommodations for some patients that can’t be treated near their homes.

The analysis did not account for equalization payments and other federal contributions to provincial general revenues that could ultimately be spent on health.

Nor did it look at tax points transfers, which the federal government includes when it assesses how much money it is giving the provinces for health care. That dates back to 1977, when the federal government lowered its tax rates for personal and corporate income and the provinces could increase their provincial tax rates and take that revenue instead.

In 2023, after the latest health funding offer to the premiers was made public, Ottawa said tax point transfers amounted to $25 billion. However, the provinces do not include tax point transfers when discussing the federal share of health-care spending.

Holland says he’s open to finding a way to make information about health spending more available as a way to cut through the political rhetoric.

“I think anything that provides transparency and allows us to get to talking about the material, consequential things that we have to be doing, as opposed to debating over dollar values, I think is helpful,” he said.

The new health deals call on provinces to improve the collection of national health data, but makes no specific mention of tracking federal and provincial spending.

The one thing that is clear is that health care spending is growing.

Per capita, Canada’s transfers for health grew six times faster than population growth, amounting to $1,115 per person in 2023, up from $427 per person in 2005. Those figures have not been adjusted for inflation.

Among the provinces, per capita spending grew at massively different rates, with Newfoundland’s budget soaring 19 times faster than its population, while spending in Nova Scotia and Alberta grew less than two times as fast as the population.

This report by The Canadian Press was first published Sept. 2, 2024.



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As sports betting addiction takes hold in Brazil, the government moves to crack down

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SAO PAULO (AP) — “King” doesn’t disclose his real name. Even clients of his Sao Paulo newsstand have to call him by his moniker. The Brazilian online sports gambling addict lowered his profile after a loan shark threatened to put bullets in his head if he didn’t pay up.

Broke and embarrassed, King sought treatment and support earlier this year.

“I was once addicted to slot machines, but then sports betting was so easy that I changed. I got carried away all the time,” he told The Associated Press.

King’s story is that of many vulnerable Brazilians in recent years. The country has become the third-biggest market in the world for sports betting, following the U.S. and the U.K., a report by data analysis company Comscore said last year. But unlike those countries, rampant advertising and sponsorship have been coupled with an unregulated market. The government is now — belatedly, some say — striving to get a handle on the epidemic.

On a recent evening, King’s Gamblers Anonymous meeting took place in an improvised classroom inside a church, with coffee and cookies to keep everyone awake, and supportive messages scrawled onto the blackboard. One that’s become ubiquitous in Brazil and beyond: “Only for today I will avoid the first bet.”

King and other attendees, all Christian, started a prayer and the meeting began.

King said his financial problems arose from his addiction to online sports betting, chiefly on soccer.

“I miss the adrenaline rush when I don’t bet,” he said before the gathering. “I have managed to stop for a couple of months, but I know that if I do it once again, even a small bet, it will all come back.”

Driven by the pandemic

The COVID-19 pandemic was a key driver for Brazilians embracing sports betting. King said he transformed almost every sale during that time into a bet. His hook was the non-stop advertising on TV, radio, social media as well as sponsorship of local soccer teams’ jerseys. He asked for bank loans to pay his gambling debts and then, to cover those, went to the moneylender. His total debt now amounts to 85,000 reais ($15,000) — impossible to pay off with his monthly income of 8,000 reais.

Digging oneself out of debt in Brazil is especially daunting with its sky-high interest rates. Loans from Brazilian banks could add interest of almost 8% per month to the borrowed sum, and from loan sharks could be even more.

Four Gamblers Anonymous meetings attended by the AP in October featured discussions about difficulties paying down debts, forcing working-class members to postpone housing payments and cancel family vacations.

Some members of impoverished Brazilian families have used welfare money for betting instead of paying for groceries and housing, official data suggests. In August, beneficiaries of Brazil’s flagship program Bolsa Familia spent 3 billion reais ($530 million) on sports betting, according to a report from the central bank. That was more than 20% of the program’s total outlay in the month.

A host of gambling related problems

Sports betting was made legal in 2018 in a bill signed by former President Michel Temer. The subsequent turmoil has recently been setting off alarm bells, with addicts venting on social media and media reports of people losing huge sums.

On Oct. 1, the economy ministry prevented more than 2,000 betting companies from operating in Brazil for having failed to provide all the required documents. Soccer-loving President Luiz Inácio Lula da Silva said in an interview on Oct. 17 that he will shut down the entire market in Brazil if his administration’s new regulations — presented at the end of July— fail to work. And Brazil’s Senate on Oct. 25 opened an investigation into betting companies, focusing on crime and addiction.

“There’s tax evasion, money laundering of organized crime, the use of influencers to trick people into betting. These companies need to be audited,” Sen. Soraya Thronicke, who proposed the inquiry, told journalists in Brasilia.

Sérgio Peixoto, a ride-sharing app driver in Rio, is one of many lower-middle-income Brazilians who have reduced their spending due to sports betting debt. Peixoto’s debt currently amounts to 25,000 reais ($4,400). His monthly income is four times less than that.

“It stopped being a game, it wasn’t fun. I just wanted to get the money back, so I lost even more,” said Peixoto, 26. “I could have invested that money. It would surely have given me more benefits.

Pressure to bet

Pressure on people to gamble is everywhere. Current and former soccer players, including Vinicius Júnior, Ronaldo Nazário and Roberto Rivellino, are among the poster boys for local and foreign brands. All but one of the top-tier soccer clubs have betting companies among their main sponsors, with their name and logo emblazoned on their kits. There have been cases of kids and teenagers setting up accounts using their parents’ personal information and money, multiple local media outlets have reported.

Brazil’s economy ministry estimates that Brazil’s sports betting market had $21 billion in transactions last year, a 71% increase compared with the first year of the pandemic, 2020.

The ministry’s newly presented regulations include facial recognition systems for gamblers to bet, the identification of a single bank account for transactions involving sports betting, new protections against hackers and the government-authorized domain, bet.br, which will host all betting sites that are legal in Brazil. Once they are in place, come January, between 100 and 150 betting companies will continue to operate in the South American nation.

The changes in Brazil have prompted some companies to take preemptive action. A report by Yield Sec, a technical intelligence platform for online marketplaces, said several betting companies voluntarily restricted their operations in different places after the latest editions of the European Championships and Copa America in the hopes of presenting “the best possible license application face to the Brazilian authorities.”

Magnho José Santos de Sousa, the president of the Legal Gambling Institute, a betting think tank, said Brazil is currently “invaded by illegal websites that have licenses in Malta, Curação, Gibraltar and the United Kingdom.”

De Sousa expressed hope that the new regulations for advertising, responsible gambling and qualification of sports betting companies will transform the country’s deregulated arena into a more serious one that doesn’t exploit the vulnerable.

“The whole operation could turn from water into wine,” he said.

Gamblers Anonymous in high demand

Meantime, the demand for Gamblers Anonymous meetings in Sao Paulo has grown so much in recent years that the weekly gathering, in place since the 1990s, was no longer enough. Many groups have added a second day in the week to help new people recover, mostly sports bettors.

Earlier in October, a group on Sao Paulo’s northern edge admitted a man who was struggling with sports betting and card games. The 13 other people in the room stressed that he wasn’t alone.

“Welcome,” one long-time attendee said, in a greeting that has become a regular for the group. “Today, you are the most important person here.”

___

Dumphreys reported from Rio de Janeiro.



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Saskatchewan’s Jason Ackerman improves to 6-0 at mixed curling nationals

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SAINT CATHARINES, Ont. – Saskatchewan’s Jason Ackerman remained undefeated on Wednesday with a 7-4 win over Newfoundland and Labrador’s Trent Skanes at the Canadian mixed curling championship.

After going down 3-1 through four ends, Ackerman (6-0) outscored Skanes (3-3) 6-1 the rest of the way, including three points in the seventh end.

Alberta’s Kurt Alan Balderston also earned a win, defeating New Brunswick’s Charlie Sullivan 9-2 in another matchup in the final draw.

The win improved Balderston’s record to 4-2 and sits in third in Pool B.

The top four teams from each pool will play four more games against the survivors from the other pool. The remaining three teams from the pool will play three more seeding games to help set the rankings for next year’s event.

The championship final is scheduled for Saturday.

This report by The Canadian Press was first published Nov. 6, 2024.

The Canadian Press. All rights reserved.



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Oilers fall 4-2 to Golden Knights in McDavid’s return from injury

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EDMONTON – Noah Hanifin had a pair of goals as the Vegas Golden Knights won their first road game of the season, coming from behind to shock the Edmonton Oilers 4-2 on Wednesday.

Jack Eichel had a goal and two assists and Mark Stone also scored for the Golden Knights (9-3-1), who have won two in a row and six of their last seven. The Knights entered the game 0-3-1 on the road this year.

Brett Kulak and Zach Hyman replied for the Oilers (6-7-1), who have lost two straight despite getting captain Connor McDavid back from injury earlier than expected for the game.

Adin Hill made 27 saves for Vegas, while Stuart Skinner managed 31 stops for Edmonton.

Takeaways

Golden Knights: With an assist on the Knights’ second goal, William Karlsson has recorded at least a point in all five games he has played this season (two goals, four assists).

Oilers: McDavid was a surprise starter for the Oilers, coming back just nine days after suffering an ankle injury in Columbus and initially being expected to miss two to three weeks. The star forward came into the contest with 11 points (three goals, eight assists) during a six-game point streak versus the Golden Knights, but was held pointless on the night.

Key moment

With just 48.4 seconds left to play, the Golden Knights won a race to the corner and Ivan Barbashev was able to send it out to a hard-charging Hanifin, who sent a shot glove-side that beat Skinner for his second goal of the third period and third of the season.

Key stat

It was Hyman’s third goal in the last four games after the veteran forward went scoreless in his first 10 games this season following a 54-goal campaign last year. Hyman now has five goals in his last six games against Vegas.

Up next

Golden Knights: Head to Seattle to face the Kraken on Friday.

Oilers: Travel to Vancouver on a quick one-game trip to clash with the Canucks on Saturday.

This report by The Canadian Press was first published Nov. 6, 2024.

The Canadian Press. All rights reserved.



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