Mr. Chairman, the resolution before the house reads:
That It is expedient to introduce a measure to authorize contributions to be paid out of the consolidated revenue fund to provinces in respect of costs incurred by them in providing insured hospital and diagnostic services pursuant to provincial law and to agreements made in accordance with the said measure, to commence when at least six provinces, containing at least half the population of Canada, have entered into such agreements and qualified for the receipt of such contributions.
I have read this resolution into the record, sir, in order to point out that this is a measure for insuring hospital and diagnostic services. That is a point on which I wish hon. members to be quite clear. We have been aware for some time that negotiations have been proceeding between the government of the province of Ontario and the federal government to bring such a plan into effect and I am proud that Ontario has taken such a forward step to bring such an agreement to the present point where at last we can visualize a hospital insurance plan for Canada. It has been a long road since 1919 when the Hon. W. L. Mackenzie King, as leader of the Liberal party, promised health insurance for Canada. From 1919 to 1948 covers a period of 28 years since health grants were first introduced. To the health grants we gladly assented, and today we have before us the present resolution for the introduction of hospital insurance.
For the past 12 years, on behalf of the Conservative party, I have advocated measures to benefit health conditions and care for the people of Canada. All political parties in this house have been in favour of such a measure. We may not all have agreed on the general form of insurance, but one point is clear, and that is that we all appreciate the fact that the public money that is spent on legislation to combat sickness, disease and misery, will pay high dividends in health standards and happiness of the people of our nation.
Sir, I wish to quote from the closing paragraph of a book written in 1945 by Henry E. Sigerist, professor of the history of medicine in the Johns Hopkins University.
The problem of financing such health services is secondary. More difficult economic problems have been solved. We have all the money we need when we are attacked by a ruthless enemy. Disease is also an enemy. Its attack may be less spectacular but is just as pernicious as any that occurs in actual warfare, and we certainly can find
the comparatively small funds required to fight this war to a victorious end. The health and welfare of every individual is the concern of society, and human solidarity beyond the boundaries of nationality, race and creed, is a true criterion of civilization.
This is a measure for health insurance. Throughout the ages, in the attempt to combat disease and sickness, there were generally evolved special types of structures, and chief among those structures was the hospital. I bring this in because it shows how hospitals first came into being. In the early centuries of our era it was a guest house that provided shelter for the indigent and the stranger and later became a place where the indigent sick were nursed and received free medical treatment. When medical science progressed, giving rise to aseptic surgery, and to better diagnostic methods, the hospital was no longer a place of death, but the source of all medical activities sought by the rich and poor. From the few rooms that were then maintained for the sick, in the early medieval monastery, the hospital developed into the large wards of the middle ages. As the development progressed it became the highly complex institution of our present day with large and small sick rooms, solariums, operating rooms, laboratories and facilities for medical research. The modern hospital has lost the gloom of the earlier eras where every feature reminded one of the proximity of death. Today the modern hospital remains a place of suffering and disease but the accent is on life.
I have previously pointed out in this house, not later than last year, that the matter of keeping well is of the utmost importance. This particularly applies in the present agreements to the diagnostic feature. A few hundred years ago, in European history, the point of view among those interested in the healing arts was concerned with the curing of disease. At this point I wish to point out that there is a great deal of difference between curing and using preventive measures. Preventive measures were almost unknown at that time. The most they hoped for was to have physicians sufficiently versed in the understanding of disease that sick people under their care would rapidly recover.
Under conditions such as these it becomes clear that only a small proportion of the population shared in the benefits of the increasing skill of the physicians; but under present conditions, hospitals, laboratories and physicians are in close contact with new scientific equipment. Today physicians are armed with new drugs, advanced methods of treatment, and methods which would have
been considered unbelievable in the previous centuries. Today curing is not sufficient. The problem today is not only to get people well but to keep them well. If we were still to pursue the old idea of keeping people well by curing disease it would be a costly and expensive proposition from the taxpayer's point of view. We must also pay particular attention to prevention. From year to year we are making progress in the campaign to keep people well. When I spoke on this last year on the health estimates I said that one could even now visualize a period in the future when the needs for hospitals would diminish owing to the great objective of full preventive measures rather than the older concept of curing disease.
In our consideration of health measures we must note the fact that while illness creates suffering it is also an economic loss. The sick man cannot work and therefore he loses his wages. Sickness may disable a worker for long periods of time. Then, if in addition to his loss of wages he is faced with a heavy hospital bill he is placed in a position of financial hazard.
While many diseases can be prevented, many can be cured in the initial stages by early treatment. This is the point where diagnostic methods and hospital care become very important, and the phrase "diagnostic methods" assumes importance in relation to the resolution. But the hospital, which plays an increasing part in all aspects of medical care, has been forced to raise its costs considerably. Medical supplies, drugs and appliances are not only more expensive but are needed in rapidly growing quantities.
At this point I should like to remind hon. members that while new treatments are often expensive the duration of stay in hospital has been markedly cut down and earlier cures effected by their application. Nevertheless, new drugs, new methods and the cost of hospitalization present a financial burden with which the average citizen finds it difficult to cope.
Some medical care is obtainable collectively through public funds but most of it
Net Operating Expense of Public General
must be paid for by the individual at a time when he is undergoing the financial handicap of sickness. It may be difficult to estimate the risk of sickness for the individual but it can be estimated for large groups and therefore in order to spread the risk among a number of people the principle of insurance must be applied.
Few hon. members of this house can be unaware of the burden which falls on the shoulders of the individual faced with heavy hospital bills. Not only must we consider the financial position of the individual but we must also consider the financial position of the hospitals and the municipalities.
Boards of management of hospitals during the past decade have been engaged in a constant struggle to maintain their institutions in a period of rising costs and yet keep down the cost of bed and room accommodation to the patients. But in the main hospital costs have been steadily rising, and this of necessity has caused increasing financial burdens on the patients.
The point has been reached now where the average citizen cannot afford to pay for hospitalization in the event that he or the members of his family incur severe sickness. The cost of patient day care, and the increase in the number of days of care provided, has meant an increase in the total expenditure on hospital care by our people.
For the information of the house I wish to present the following statement of the province of Ontario contained in their proposals for hospital care insurance of January 1957. These figures are necessary for a clear understanding of the problem. Hospital operating deficits in 1954, after provincial grants, amounted to approximately $10 million. This was substantially reduced by income from endowments, donations and almost $3 million in deficit payments by municipalities.
At the risk of burdening the house-and I do realize that figures become tiresome-I wish to read the following table covering the period 1947 to 1954 which I think assists us to appreciate the true situation:
Total Adult and Cost per Increase in Cost per Patient DayChildren Patient Patient Over PreviousDays Day Year4,663,568 $ 7.46 -4,811,276 8.61 15%5,023,544 9.43 10%5,252,566 10.38 10%5,510,301 11.94 16%5,857,258 12.89 8%6,140,929 13.47 4%6,534,306 14.64 9%
Between 1947 and 1954 the latest year for which figures are available the net operating costs of public general (A,B,C,) hospitals nearly tripled, total adult and children days of care increased by 40 per cent and per diem costs nearly doubled. The average increase in per diem costs over the previous year during the period 1945-1954 amounted to about 10 per cent. In these eight years such increases have ranged from a low of 4 per cent to a high of 16 per cent in a single year.
Now having considered capital costs, sir, let us consider sources of revenue. Referring again to the province of Ontario statistics, I quote from the proposals of the Ontario government as a source of information:
As the deficits referred to indicated, hospital revenue failed to keep pace with rising costs, even though, in the period 1947-1954 the revenues of all hospitals in Ontario increased from $38.9 million to $99.8 million in 1954. While this represented a total
Income from Patients
Income from Municipalities for treatment of patients
Ontario government maintenance grants, etc. ..
Property donations, etc
Grants from municipalities
There was a surplus in 1947 of $1,154,180 and there was a residual deficit in 1954 of $3,567,541.
Now, having considered revenues and costs, I come to a point of what is apparently disagreement in the discussion to date between the Ontario and federal governments. It would appear that the federal government does not agree that depreciation charges and interest on capital debt should be allowed as part of the formula for their contribution to the costs of hospital care. The Canadian Hospital Association has requested the federal government to reconsider the allowable expense in hospital services to include depreciation on buildings and fixed equipment and interest on capital loans. Under present conditions if no allowance is made for this purpose hospitals will be again in the position where they will have to seek funds for rebuilding or replacing equipment. I would point out that public campaigns for this purpose will be increasingly more difficult in the future. I quote from the Canadian Hospital Accounting Manual:
Depreciation of hospital buildings and equipment should be recognized as an element of hospital
increase of 157 per cent, income from patients increased by 161 per cent and payments from the Ontario government increased 394 per cent.
Income from municipalities for the treatment of patients, increased 70 per cent while deficit payments by municipalities increased 353 per cent. In 1947 Ontario government payments amounted to 5.6 per cent of total revenue; these payments increased to 10.8 per cent in 1954. The Ontario government maintenance grants, et cetera rose from $2.2 million to $10.8 million over this period.
The biggest increases in payments during the period 1947-1954 were made by the Ontario government and by the municipalities to cover deficits. Notwithstanding these sharp increases and other increases in revenues which were received by general hospitals over the period, the residual deficit in 1954 came to $3.6 million.
The trend in costs and revenues are shown as follows-this includes public general hospitals, Red Cross outposts, chronic care and convalescent hospitals, selected years 1947-1954.
The following interesting table shows the expenditures and revenues in the period 1947 to 1954:
1947 1954 Percentage Increase 1954-1947$37,747,989 $103,375,770 17438,902,169 99,808,229 15728,727,518 74,879,897 161(73.8%) (75.0%) 4,578,450 7,765,727 70(11.8%) (7.8%) 2,183,623 10,792,861 394(5.6%) (10.8%) 2,795,545 3,577,374 28(7.2%) (3.6%) 617,034 2,792,370 (1.6%) (2.8%)
expense. The depreciation and value of buildings and equipment represents a real cost of hospital service even though such assets may originally have been donated to the hospital.
Representatives of the federal government accepted this principle in 1951 but not in 1957. In all reason it would appear only just that depreciation on buildings, equipment and the interest on capital loans should be recognized in a national hospital insurance plan.
It must be clearly recognized that health is under the jurisdiction of the provinces. However, a review of the present hospital situation would not be complete without a review of the present mental health situation in Canada. This has been another point of discussion in regard to present negotiations between the province of Ontario and the government of Canada. The federal government has not recognized mental patients in the present agreements under discussion. It does agree to the inclusion of these mental patients while in general hospitals. The problem of mentally ill patients is one of our greatest problems. Owing to advanced methods of treatment it must be pointed out that the length of stay in hospital has been steadily
cut down in the past 20 years, enabling the hospital to care for more patients. However, to make full progress there must be general recognition of the fact that mental illness is a form of disease comparable to any other disease which affects the human body. In 1934 patients discharged from mental hospitals had a stay of 5.4 months in comparison with 1954 when the stay was 1.8 months. The point to be noted is that in 1954 three patients could be treated in the bed required to accommodate one patient in 1934. Mental health clinics, private physicians and out-patient departments of general hospitals are giving an increasing amount of treatment for this disease. But the fact remains that the 1954 statistics indicate there were over 68,000 patients in mental institutions in Canada. This number exceeds by 10,000 the number of patients in public hospitals.
While the health grants have assisted in this matter, I cannot but feel that this is one of our foremost problems in the field of national health and should receive further consideration in these agreements in order that it can be dealt with more adequately. This fact must be recognized. According to the statistics of the Canada Year Book, of the 68,157 patients on the books of mental institutions at the end of 1954, 62,323 were in hospital. This is 87 per cent more than the 33,290 reported in hospital at the end of 1932.
The minister has argued that to recognize mental patients in hospitals would under this scheme increase the costs and help defeat the objective of insurance. Nevertheless, even if the care of these patients remains the duty of the provinces consideration should be given in the discussions for further available funds to enable the provinces to carry out a program of hospitalization and treatment to cut down the incidence of this disease.
It would be impossible in the time allotted for debate to fully discuss all that is entailed in this resolution. The resolution is to introduce enabling legislation to deal with the proposed hospital insurance. We regard the whole matter as of the most vital importance. This party is of the opinion that such a plan should be available to any or all the provinces. Under the present proposed legislation it will be necessary to have six provinces or a majority. Statistics show the necessity of a hospital insurance plan. If it is necessary now, let us put a plan into operation as soon as it can be done in an orderly way. Every month of delay is another month when we permit these discrepancies to exist.
As a resident of Ontario I am proud that the government of Ontario has taken this forward step. We of the Conservative party
have long advocated a step of this kind. We support this resolution but we believe that the plan should be available to any and all provinces which enter into such agreement and qualify for the receipt of such contributions. Therefore I move, seconded by the hon. member for Middlesex East:
That the resolution be reported to the house with the proviso that the words after "when" in the fifth line of the resolution to the word "entered" in the sixth line of the resolution be deleted and the following substituted therefor:
"(a) when any province of Canada has
(b) that the word 'agreements' in the fourth line and sixth lines of the resolution be changed to 'agreement' ",
Topic: AUTHORIZATION OF PAYMENTS FROM CONSOLIDATED REVENUE FUND