Health Care & Social Assistance

 

People have been caring for the sick and needy for millennia. Part of the traditional graduation ceremony for new doctors involves taking an oath that was originally written by the Greek physician Hippocrates in about 400 BC. Homes that cared for people who were too poor or too sick to look after themselves were in existence in India as early as 200 BC. The oldest hospital that's still around is the Hotel Dieu in Paris, originally built in the seventh century. It was a place where sick people could be confined, so they would not mingle with the populace and spread disease.

BC's health care history is not nearly that long, but in 1878, there were at least four hospitals operating in the province: the Royal Hospital in Victoria, the Royal Columbian in New Westminster, the Nanaimo Hospital, and the Royal Cariboo in Barkerville.

A list of patients admitted or discharged from these institutions shows that they were mainly men who were treated for a variety of injuries and diseases (including amputations, infected wounds, pneumonia, fever, rheumatism, paralysis, syphilis, “softening of the brain” and even “playing sick”). Hospital stays were long; some patients spent months being treated for diseases that today would involve a short stay in hospital, if at all. Although some patients paid for their hospital care, others received free services.

The Royal Columbian hospital was built with the help of a chain gang in 1862. The cost of building the hospital ($3,396) was paid for by colonists, who were concerned about the lack of a facility in British Columbia to care for the sick and wounded. When the hospital was opened, it was exclusively for the use of men. Women, children and the “incurable and insane” were ineligible for care. By 1878, when nearly 100 people were admitted to the hospital, this condition no longer seems to have been enforced as a small number of patients were women or those who had been in hospital for years.

The Royal Cariboo was built and financed by Barkerville miners in 1863, and for years was the only hospital north of Kamloops. In 1878, 24 patients were admitted to this hospital, including the miner who “played sick”. He stayed for two days.

Public sector health care spending totalled $12.8 billion in 2005

Things have changed a lot since the late 1800s. Health care services are no longer available only to males or those whose conditions are curable. The health care system is now publicly funded, meaning that the government pays the cost of providing covered health care services, which are available to all residents.

Provincial hospital insurance was first introduced in BC in 1948 as a premium-based system. In 1965, the province began to provide public medical insurance [1] for those not covered by private plans, and three years later universal public medical insurance was implemented.

Health care is a big ticket item. It is estimated that in 2005, public spending on health care totalled $12.8 billion in BC. This includes the cost of running hospitals, paying the fees of doctors and related health care professionals, public health expenditures and the cost of drugs that are covered by the provincial government.

Private expenditures for the services of dentists, physiotherapists and other health care professionals, as well as non-prescription and some prescription drugs, cost individuals or private sector insurers another $5.5 billion in 2005.

Most British Columbians use health care services

Nine out of ten British Columbians have a regular family doctor and according to survey data, most of them visit their doctor at least once a year. In 2003, 83% of British Columbians aged 12 and over had contact with a medical doctor. Two-thirds went to see a dentist and one in seven sought treatment from alternative health care providers such as massage therapists, acupuncturists, homeopaths, naturopaths and so on. In a typical year, six or seven out of every 1,000 people are hospitalized as a result of injuries.

Even if you don't regularly use the services of a doctor, dentist, or other health care or social service workers, there's a very good chance that at some point in your life, you will. Ninety percent of seniors visit a general practitioner or family doctor at least once a year, 14% are hospitalized as for various reasons, and 15% receive home care. All of this means that the demand for health care and other support services is large and growing.

What's included in health care & social assistance?

The health care and social assistance industry includes a lot more than doctor's offices and hospitals. People of all ages and from all social groups use the services of this industry when they:

• 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 services;
• 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 and social assistance industry employed just over 10% of the province's workforce in 2005, up slightly from the percentage in 1990. However, while employment in the industry has grown marginally faster than in the economy as a whole, the industry's share of GDP has fallen to less than 7%, down from nearly 8% in the early 1990s.

The industry employs one in every ten workers

Health care and social assistance is undergoing major changes in the way services are delivered. If you follow the news, you've probably heard a lot about surgery waiting lists, hospital bed closures, overcrowded emergency rooms, funding cutbacks, and debates about how to pay for the cost of health care services.

One reason for all the discussion and debate is that 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, since older people are more likely to need medical care. The health care system is already strained. Waiting times for patients to obtain some types of tests, treatments or procedures are longer than many doctors think they should be. Most analysts recognize that in order to continue providing these services to the public, some changes will have to be made to our health care system. The debate focuses around what those changes should be, how they should be implemented, and if a publicly-funded health care system is sustainable in the long run.

At the same time, technological and other advances are making it possible for some services to be delivered more efficiently, or differently, than in the past. For example, gallbladder removal used to require a 20-centimetre-long incision, and following surgery the patient would remain in hospital for several days to recover from a painful procedure. It's now possible to remove a gallbladder using laparoscopic surgery, in which a lens connected to a video camera, and a fibre optic cable connected to a light source allow the surgeon to see inside the abdomen, and operate using thin instruments through two or more incisions that are only 5-15 millimetres long. The procedure can be done as a day surgery with the patient going home after he/she has recuperated from the effects of the anaesthetic.

Patients who are 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 receive a daily visit 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 can't be left alone while their caregiver (often their spouse or other family member) is away from home.

Some of these services are being 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 has also stepped in to provide 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 might otherwise have to leave their homes. This means that some of the employment in the health care and 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?

Health-related occupations are the most common

Nearly half of the people working in this industry are in health-related occupations. Within this group, nurses make up the biggest share of the total, followed closely by dental assistants, nursing aides and orderlies. 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.

One in five (21%) people are employed as early childhood educators, community and social service workers, counsellors, social workers and in other similar occupations. Business, finance and administrative occupations make up 14% of the workforce while 11% work in sales and service occupations. These include cooks, home care workers, food service workers and cleaners.

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

Health care and social assistance was the province's second biggest employer in 2005, with 217,400 people holding jobs in this industry.

Just over half of the people working in the industry are employed at hospitals or in medical offices

Hospitals employ just over a third (34%) of the people working in this industry. 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 22% 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 17% of the people working in this industry.

The average hourly wage rate in health care and social assistance was $21.87 in 2005, and workers typically spent 34 hours a week on the job. Hospital employees earned an average of $25 per hour, while workers in the offices of medical and other health care professionals ($21) and at nursing and residential care facilities ($20) earned roughly the same as the industry average. However, wages in the social assistance industry were considerably lower, about $18 per hour. Among other things, this reflects differences in the type of work done, and the amount of training that's 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 ten years or more obtaining the qualifications required to do their job.

What are the characteristics of the workforce?

One in four people who work in BC's health care and social assistance industry are employed part-time. This is similar to the average for all service industries, but somewhat higher than in the economy as a whole, where one in every five people works part-time.

Fifty-nine percent of the people who work in this industry have union coverage. That's nearly double the average (33%) for the province as a whole.

Most workers in the health care and social assistance industry are women. They make up 81% of the workforce, more than in any other industry. This percentage has remained quite consistent since 1990.

The unemployment rate in health care and social assistance is extremely low, averaging 2.8% during the fifteen year period ending in 2005. By comparison, the average for all industries was three times higher, at 8.4%.

Only 15% of the workers in this industry are self-employed. However, 31% of the people who work in the offices of doctors, dentists and other health care professionals are their own bosses. That's up from 23% in 1990. Twenty-eight percent of the people who work in the social assistance industry are self-employed.

Many health care and social assistance workers are employed at hospitals and other institutions where there are a large number of employees. One in three people in this industry work at a job site where there are at least 100 employees, and 16% work at an institution with at least 500 co-workers. That's more than double the provincial average for large employers. At the other end of the scale, 36% of the people in this industry work with fewer than 20 people.

One in three people are employed at an establishment with at least 100 workers

Where are the jobs located?

Nine out of every ten jobs in this industry are in the Lower Mainland, Vancouver Island/Coast and Thompson/Okanagan regions

 

Generally speaking you'd expect the jobs in this industry to be allocated by region in roughly the same proportion as the population as a whole. While that is basically true, there are some variations. For example, both Thompson/Okanagan and Vancouver Island/Coast account for a bigger share of total employment in this industry than their share of the provincial workforce. On the other hand, the Mainland/Southwest's share is slightly smaller than its share of the total workforce in BC.

Major treatment facilities 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 of some types of specialized equipment and there is better access to specialist care. With a larger population base, it's more likely that physicians and other health care professionals will have the training needed to treat some types of conditions that are not commonly encountered. The location of the province's medical school at UBC in Vancouver also means that some types of health care services may only be available in the Lower Mainland region.

Larger 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. Treatment facilities located in Thompson/Okanagan provide specialized services to residents of other regions who do not have access to similar care closer to home. For example, the BC Cancer Agency has facilities in the Lower Mainland, Victoria and Kelowna. Cancer patients from other parts of the province who require some types of treatment must travel to one of these facilities to obtain the care they need.

Since health care needs tend to increase with age, it is very likely that the demand for these services will be somewhat greater in areas where there are more older people, such as on the Island and in Thompson/Okanagan, where there are some big retirement communities. 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 2014?

The need for health care and social assistance doesn't vary a lot with the state of the economy. People get sick or use social services such as day cares whether the economy is growing or contracting. 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. However, it's expected that there will be some productivity gains, and the industry's share of total GDP is expected to rise to 9% by 2014.

Most analysts anticipate that the demand for health care will increase over time. The ageing of the population is expected to continue to put pressure on the health care system. Statistics indicate that a significant percentage of total lifetime healthcare costs occur 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.

From this, you might conclude that health care is one sector where the need for workers is more likely to increase than to decline. That is probably true. Like education, health care and social assistance services will always be in demand.

The industry's share of total GDP is forecast to increase to 9% by 2014

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[1] To cover the cost of treatment by a doctor, not just hospital care.