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$4.9 Billion Decrease in Health Care Expenditure in Ontario

Key Message

A considerable reduction in health care expenditure over a 10-year period has been achieved through changes in health behaviours (smoking, alcohol, diet and physical activity). 


Manuel DG et al. (2016). A $4.9 Billion Decrease in Health Care Expenditure: The Ten-Year Impact of Changing Smoking, Alcohol, Diet and Physical Activity on Health Care Use in Ontario. ISBN: 978-1-926850-67-2 (Online). Toronto, ON: Institute for Clinical Evaluative Sciences. 168 pp.


Smoking, unhealthy alcohol consumption, poor diet and physical inactivity play an important role in overall health. Previously, our research team at the Institute for Clinical Evaluative Sciences (ICES) examined the impact of these four health behaviours on hospitalization costs. The 900,000 Days in Hospital reportdemonstrated that 32%of hospital bed-days between 2001 and 2012 were attributable to these behaviours. Ontariopolicymakersandpublichealthpractitioners are interested in the broader impact of health behaviours on health care use—the focus of this report. This study is in response to requestsa to provide further insights into the health care system and both the potential economic and health equity impacts of preventive strategies.



This study shows that a considerable reduction in health care expenditure in Ontario has been achieved through changes in health behaviours. The premium derived from improved health behaviours equates to a 1.9% reduction in health care expenditure over the 10-year period from2004 to 2013. At first glance, a 1.9% improvement may seem small; however, given themagnitudeof theprovince’shealthcareexpenditure, it amounts to a not-insignificant $4.9 billion. We are not aware of other health interventions or strategies that have led to as large a reduction in expenditure as those reported in this study. In total, we found that 22%of Ontario’s health care costs could be attributed to health behaviours. This equates to more than $89.4 billion over the 10-year period from 2004 to 2013.

Socioeconomic position contributed 15%, or $60.7 billon, to the province’s health care costs. Taken together, health behaviours and socioeconomic position contributed to a burden of $134 billion in health care costs. These calculations are likely conservative or underestimated due to study limitations (for examples, refer to earlier comments related to the assessment of healthy eating and the exclusion of data on youth alcohol use). The large remaining burden from health behaviours and social inequalities suggests that there are significant opportunities to further reduce health care expenditures through population health strategies. This study confirms our previous analyses, which showed that health behaviours are an important contributor to poor health. 

Benefit Statements / Outcomes

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  • Leisure Information Network (LIN)
  • Alberta Recreation and Parks Association

On Behalf Of:

  • Canadian Parks and Recreation Association (CPRAA)

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