Health Care & Social Assistance

 

Provincial hospital insurance has been available in BC since 1984, when it was introduced as a premium-based system. In 1965, the province began to provide public medical insurance⁶ for those not covered by private plans, and three years later universal public medical insurance was implemented.

The health care system is now publicly funded and available to all residents of the province. Although visits to dentists, chiropractors, and some other types of health professionals are not covered, many people have private medical insurance that pays for some of these services.

Most British Columbians use health care services...

Eighty-seven percent of British Columbians have a regular family doctor and according to survey data, most of them visit their doctor at least once a year. In 2005, an estimated 83% of British Columbians aged 12 and over had contacted a medical doctor during the past 12 months. Sixty-five percent had seen a dentist, while 16% sought treatment from alternative health care providers such as massage therapists, acupuncturists, homeopaths, and naturopaths. Almost one-quarter of those aged 15 or over in 2005 reported having received some type of hospital care during the last year.

...but 13% of British Columbians do not have a regular doctor

A growing number of BC residents do not have a regular doctor. Between 2001 and 2007, the percentage of British Columbians aged 15 and over who did not have a regular doctor increased from 9% to 13%.

Survey results from 2001⁷ suggest that just over half (55%) of the people who did not have a doctor at that time either did not want or did not seek the services of a physician. Another 36% indicated that physician availability was the issue, with the rest of them citing other reasons for not having a regular doctor.

Per capita spending on health care services and products was $5,147 in 2008

The cost of providing health care services is rising and, with an ageing population, it's likely that the demand for these services will increase even more in the future. Health care use increases with age-nine out of 10 seniors visit a general practitioner or family doctor at least once a year, 14% are hospitalized for various reasons, and 15% receive home care.

Health care is a big ticket item. In 2008, total spending on health-related goods and services in BC reached $22.6 billion, or $5,147 per person. Public sector expenditures totalled $15.6 billion ($3,570 per person). This includes the cost of running hospitals and residential care facilities; paying the fees of doctors and related health care professionals; public health expenditures; administering the health insurance program; the cost of drugs paid for by Pharmacare; other expenses such as home care, medical supplies and ambulance services; and capital expenditures including the construction of hospitals and equipment purchases.

Nearly three-quarters ($2,925 per person) of these public sector expenditures are used to provide health care services supplied by hospitals, other institutions, and health care professionals. Payments to dentists, physiotherapists and other health care professionals, as well as purchases of non-prescription and prescription drugs cost individuals or private sector insurers another $6.9 billion ($1,577 per person) in 2008. Private sector spending on health services was $4.1 billion ($933 per person), while $2.4 billion ($543 per person) was spent on prescription and over-the-counter drugs.

Spending on both public and private sector health care services has more than doubled since 1990

Some of these expenditures are for goods and services that are not provided by the health care & social assistance industry. For example, public health and administration of the health insurance plan is a function of the provincial government, while drugs are purchased from retailers.

What's included in health care & social assistance?

The services of the health care & social assistance industry are used by people who:

• Get immunized at school or in a public health clinic;
• Go to a lab for x-rays or tests;
• Adopt a child;
• Send their children to day-care or nursery schools;
• Are counselled by a psychologist;
• Receive assistance from a social worker;
• Call or visit a crisis intervention centre;
• Receive home care or meals-on-wheels;
• Consult a herbalist or naturopath;
• Visit a chiropractor, physiotherapist or podiatrist;
• Have their eyes checked by an optometrist;
• See a doctor or dentist;
• Are cared for in a nursing home; or
• Receive treatment at a hospital.

It's difficult to separate the social assistance component from health care, because many of the services provided are interrelated. For example, nursing homes and homes for the aged provide health care as well as a variety of social services to their residents.

Similarly, psychologists and social workers are involved in the treatment of individuals in hospitals and in other health care institutions, but they also provide social services that are unrelated to health care. Home care workers provide basic nursing services, but also prepare meals, clean, or do shopping for those who are unable to get out on their own.

What's happened since 1990?

The health care & social assistance industry employed nearly 11% of the province's workforce in 2008, a slightly larger share than in 1990, when just under 10% of the province's workers were employed in this industry. However, its share of GDP has fallen to less than 7%, down from about 8% in the early 1990s.

The industry's share of employment has remained stable at about 11%, but its share of total GDP has fallen to just under 7%

Technological advances are making it possible to deliver some services more efficiently

During the last 20 years, there have been many changes in how this industry operates. Technological and other advances are making it possible for some health care services to be delivered more efficiently. For example, increasing use of laparoscopic surgery allows more procedures to be performed without overnight hospital stays.

Hospital stays are shorter, and more people are being cared for at home

Patients admitted to hospital are sent home at a much earlier stage in their recovery than they used to be. Instead of getting round-the-clock supervision in hospital, they may be cared for by family members or, if necessary, receive daily visits at home from a nurse or other health care worker.

Rather than institutionalizing elderly people (or those with disabilities) when they can no longer care for themselves, there is a growing emphasis on providing home care, meals-on-wheels, and similar services that allow people to remain at home for as long as possible. Day care services are not only available for young children, but also for older people who cannot be left alone while their caregiver (often a spouse or other family member) is away from home.

Some of these services are provided by private agencies, or in smaller community-based facilities, rather than in large public institutions, and many of the people doing these jobs are employed on a part-time basis.

The private sector also now provides services to the elderly that were previously only available in institutions. Many seniors' housing complexes offer meals, laundry, housekeeping, and medical services to people who otherwise might not be able to live independently. This means that some of the employment in the health care & social assistance sector is likely to shift away from institutions and into smaller facilities, private businesses, or non-profit agencies.

What are the most common occupations?

Just over half of the people working in this industry are in health-related occupations. Within this group, nurses make up the largest share of the total, followed closely by nurse's aides and orderlies, registered nursing assistants, and dental assistants. Medical, dental and other health technicians, as well as doctors, dentists, pharmacists and other health care professionals are other types of occupations included in this group.

Sixteen percent are employed as early childhood educators, community and social service workers, counsellors, social workers and in other similar occupations. Business, finance & administrative occupations also make up 16% of the workforce, while 10% work in sales & service occupations. These include cooks, home care workers, food service workers, and cleaners.

Just over half of the jobs are in health-related occupations

How many people work in health care & social assistance, and how much do they earn?

Health care & social assistance was the province's second largest employer in 2008, with 245,600 people working in this industry in 2008. Thirty-seven percent are employed by hospitals. Doctors' and surgeons' offices, medical labs, and offices of other health practitioners such as chiropractors, optometrists, and physiotherapists provide jobs for 27% of the workforce.

Another 21% work at agencies and organizations providing social assistance services: home care, community centres, foster care, day care centres, welfare organizations, shelters, support groups, crisis centres, food banks, and so on. Nursing homes and other residential care facilities employ 15% of the people working in this industry.

Two out of three people working in the industry are employed at hospitals or in medical offices

Wages are typically about two dollars an hour higher than the average for all industries in the province

In 2008, the average hourly wage rate in health care & social assistance was $23.55, and workers typically spent 34 hours a week on the job. Hospital employees earned an average wage of $26.94 per hour, considerably more than the wages of workers in the offices of medical & other health care professionals ($22.34) and at nursing & residential care facilities ($20.55). Wages in the social assistance industry averaged $20.02 per hour.

Among other things, the lower wage rates in social assistance reflect differences in the types of occupations and the amount of training required to qualify to work in this industry. For example, day care workers usually have significantly less formal training than health care professionals, who can spend 10 years or more obtaining the qualifications required to do their job.

What are the characteristics of the workforce?

Part-time employment is relatively common in this industry. One in four people working in the industry is employed part time. This is slightly higher than the average for all service industries (23%). For the economy as a whole, just 20% of workers are employed part time.

Fifty-eight percent of the people who work in this industry have union coverage. That's nearly double the average (31%) for the province as a whole.

Fifty-eight percent of workers have union coverage, nearly double the average for all industries

Most workers in the health care & social assistance industry are women. They make up 81% of the workforce, more than in any other industry (the average for all industries is 47%, and women make up 54% of all service sector workers). This percentage has remained quite consistent since 1990.

There is not much seasonal variation in employment. However, temporary work is quite common in health care & social assistance. Almost 14% of the people working in this industry were hired on a temporary basis in 2008.

The unemployment rate in health care & social assistance is extremely low, averaging 2.6% between 1990 and 2008. By comparison, the average for all industries was three times higher, at 7.8%.

Unemployment rates are about one-third of the provincial average

The low incidence of unemployment is largely due to the nature of the services provided by this industry. The need for some types of social services may increase during economic downturns, but most of the industry does not go through upturns and downturns that are driven by general economic conditions. Instead, the need for health care & social assistance services is more likely to be influenced by factors such as the size and age structure of the population, and the general health of people living in the province.

Only 15% of the workers in this industry are self-employed, less than the 19% average for all industries in the province. However, 36% of the people who work in the offices of doctors, dentists, and other health care professionals are their own bosses. That is up from 23% in 1990.

At the same time, self-employment in social assistance services has become less common than it used to be. Twenty-two percent of workers in social assistance were self-employed in 2008, down from 31% in 1990. One reason for the decline may be that social assistance includes home care, home-making, day care, and similar services. Homecare services, in particular, are being used more frequently than they were in the past. These services are normally provided by social service organizations and agencies rather than by self-employed individuals.

Many health care & social assistance workers are employed at hospitals and other institutions where there are a large number of employees. One in five works at an institution with more than 500 employees. That's more than double the provincial average. Another 17% have jobs at establishments with 100-500 employees. At the other end of the scale, 36% of the people in this industry work with fewer than 20 people.

About a fifth of the workforce is employed at an establishment with more than 500 workers

Where are the jobs located?

Thompson-Okanagan, Vancouver Island/Coast and, to a lesser extent, Cariboo, account for a bigger share of total employment in this industry than their share of the provincial workforce. However, Mainland/Southwest's share is lower than its share of the total workforce in BC.

This distribution of employment may be partly due to the age structure of the population. Health care needs tend to increase with age, so it is very likely that the demand for these services is somewhat greater in areas where there are more seniors, such as Thompson-Okanagan and Vancouver Island.

Nine out of 10 jobs in this industry are in Mainland/Southwest, Vancouver Island/Coast and Thompson-Okanagan

Major treatment facilities and some types of specialists are most often located in larger centres such as Vancouver and Victoria, where the population is big enough to support the high costs associated with the purchase and operation the facilities and equipment they need to treat their patients.

The main campus of the province's medical school is at UBC in Vancouver, although satellite medical schools have recently been established at universities in Victoria and Prince George.

Regional hospitals and other health care institutions typically provide services to the local population as well as to people coming from rural areas or smaller centres.

For example, the BC Cancer Agency has facilities in the Lower Mainland, Victoria and Kelowna, and plans are underway to build a new treatment centre in Prince George that will serve residents of northern BC.

At present, cancer patients can only obtain some types of treatment in Kelowna, Victoria, or the Lower Mainland. The children's hospital is located in Vancouver, which also has a hospital specializing in maternity care. At the same time, the demand for some types of social services may be greater in rural and remote areas than in other parts of the province.

What's the outlook to 2017?

The need for health care & social assistance doesn't vary a lot with the state of the economy. People become sick or use social services such as day care whether the economy is growing or contracting.

The industry's share of total GDP is forecast to increase only marginally by 2017

As the population continues to grow, employment in this industry is expected to increase a little faster than the average for all industries in the province during the next few years. The industry's share of total GDP is expected to increase to just over 7%.

The ageing of the population is also expected to continue to put pressure on the health care system. Statistics indicate that a significant percentage of total lifetime healthcare costs are incurred in the last year of a person's life. As people age, they are also more likely to require social services such as home-making or meal services.