Our governments will inevitably need to ask financially secure boomers to contribute more in proportion to the health care costs their generation will create.Cole Burston/The Canadian Press
Medical care is the biggest thing our provincial taxes buy. That makes it all the more frustrating that so many Canadians still struggle to get timely care, even as provincial medical budgets reach record levels.
I recently published a new study, Medical Budgets in an Aging Canada, which reveals much of this disconnect — but not all of it. Both the explained and unexplained gaps merit more attention from governments and medical associations.
The study begins with a striking observation. Since 1976, Canada’s population has grown by about 75 per cent, while the number of physicians has increased nearly 200 per cent. That seems paradoxical in a country consumed by the idea of a “doctor shortage.”
I expected that paradox to unravel once we recognized that wait times reflect not only a larger population, but an older one. In 1976, one in 10 Canadians was over age 64. Now it’s one in five. This matters because a typical 65-year-old uses as much medical care as four people under the age of 50 combined. As boomers age, rising pressure on the system was entirely predictable.
My latest research quantifies that pressure. While the population grew by about 75 per cent, the demographic-adjusted demand for medical care rose by 135 per cent − nearly twice as fast. Put differently, the shift from 10 to 20 per cent of the population over age 64 is equivalent to adding nearly 19 million extra patients under age 50 lining up for care.
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This surge in demand, without matching revenue, is now a major reason why most provinces run deficits. If provinces still had the demographics they did when boomers were young, all but B.C. would be posting sizable surpluses today – without changing a single tax rate or spending line. Instead, we are filling fiscal holes created by predictable aging-related medical needs.
Governments saw this demographic crunch coming. In the 1990s, Ottawa raised Canada Pension Plan premiums by 68 per cent to prepare for boomers’ retirement. But the medical-care side of the equation was never fixed. Provinces didn’t modernize revenues to match the predictable rise in age-related medical spending.
This leaves our governments with unfinished business. They must renew a frank conversation about funding medical care in an aging society – one that will inevitably require asking financially secure boomers to contribute more in proportion to the costs their generation will create.
But that conversation keeps getting crowded out by the doctor-shortage misdiagnosis. Canada has many more doctors by comparison with past demand. Even after adjusting for population aging, the physician work force has grown faster than the demographic-driven need for care.
Part of the explanation lies in how medical work has changed. Physician head count has surged, but total physician hours have grown more slowly. Doctors today work fewer weekly and annual hours than in the 1970s. This reflects expectations for better work-life balance, and a rising share of doctors in dual-earner households.
Staffing incentives also pull physicians away from community-based medicine. Hospital roles often offer higher pay, and involve less administrative burden. Hospital managers like this arrangement because physicians bill the province directly, while hospitals must pay nurses out of their own budgets. The result is a siphoning of physician labour away from general practice – the front door of the system.
As medical care consumes a growing share of provincial budgets, governments also have less room to invest in the building blocks for a healthy society – housing, child care, education, income supports and a stable planet. Research shows these areas matter more for long-term health than medical care itself. Yet provincial budgets now allocate more to treating illness than to preventing it, the opposite of the pattern in the 1970s. When we underinvest in what keeps people well, more people end up needing medical care, adding pressure to a system strained by population aging.
Imagine a concert where organizers triple the number of ticket booths; but each booth is open fewer hours than it used to be. That’s Canada’s medical system. We’ve added doctors faster than age-adjusted demand has grown, but physicians aren’t working the same number of hours they once did. And since governments haven’t invested urgently in preventing illness, more people keep joining the line.
Sustaining universal access to care will require governments to face the demographic reality driving medical demand; update revenues so financially secure boomers contribute in line with their costs; overhaul staffing incentives; and reinvest in the social and ecological foundations of health. That’s the real path to timely care –not repeating the oversimplified claim of a doctor shortage.
Dr. Paul Kershaw is a policy professor at UBC and founder of Generation Squeeze, Canada’s leading voice for generational fairness. You can follow Gen Squeeze on X, Facebook, Bluesky, and Instagram, as well as subscribe to Paul’s Hard Truths podcast.