Universal care
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* Jon Gerrard

*   © 2004 Canadian Medical Association or its licensors

Noralou Roos and associates1 report mean per capita physician and hospital expenditures for Winnipeg residents for 1999–2000. Although they do not supply overall mean expenditures, the means for the middle socio-economic quintile ($286/person for physician costs and $333/person for hospital costs) are probably close to the overall means.

Data from the Canadian Institute for Health Information (CIHI)2 suggest that Roos and associates omitted a significant proportion of physician and hospital expenditures from their calculations. According to CIHI data for Manitoba,2 public expenditures for physicians were $382/person in 1999 and $420/person in 2000; for hospitals these figures were $895/person in 1999 and $944/person in 2000.2 Total public health expenditures for the province were $2380/person in 1999 and $2621/person in 2000. Overall, it appears from this comparison that Roos and associates1 included only about a quarter of all public health expenditures in their analysis.

Given evidence from other comparisons of funding and patterns of health care use among regional health authorities,3,4 it is unlikely that the costs for Winnipeg reported by Roos and associates1 were that much lower than those for the rest of Manitoba (as in the CIHI data); hence, other reasons for the higher values reported by CIHI are more likely. For example, the analysis by Roos and associates might not have captured salary costs for physicians on salary, and it appears that the majority of hospital costs were not included.1 

The fact that Roos and associates incorporated only a minority of public health care costs in their calculations does not necessarily reduce the validity of their conclusions, which were based on comparisons among socioeconomic groups and among groups of individuals with different levels of use of health care services. Nevertheless, some caution is needed in the interpretation of their results.

**Jon Gerrard** MLA, River Heights Leader, Manitoba Liberal Party Winnipeg, Man.

## References

1.  1. Roos NP, Forget E, Walld R, MacWilliam L. Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says “no.” CMAJ 2004;170(2):209-14.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzAvMi8yMDkiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTcwLzEwLzE1MTkuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. National health expenditure trends 1975–2002. Ottawa: Canadian Institute for Health Information; 2002.
    
    

3.  3. Manitoba Health annual report 2002-2003. Winnipeg: Manitoba Health; 2003. p. 88-91. 
    
    

4.  4. Martens PJ, Fransoo R, Burland E, Jebemani L, Burchill C, Black C, et al. The Manitoba RHA indicators atlas: population-based comparison of health and health care use. Winnipeg: Manitoba Centre for Health Policy; 2003.