BC Spent $35 Billion on Health Last Year. Prevention Got a Fraction of That.

Written by Clare Koning RN PhD | May 2026

In March 2025, BC's Ministry of Health budget exceeded $35 billion – more than a third of the entire provincial budget, with $4.2 billion in new spending committed across the three-year fiscal plan. In February 2026, Budget 2026 added a further $2.77 billion to the Ministry of Health alone, the largest single allocation in a record $13.3 billion deficit year.

The spending is real. The strain is real. What is not happening fast enough is a serious reckoning with where the money goes and what it is actually buying.

The overwhelming share of health spending in BC, as in every comparable system, flows to acute care: hospitals, emergency departments, specialist services, surgical backlogs. These are not wasteful expenditures. They are the inevitable downstream cost of a population that has accumulated decades of unmanaged or under-managed chronic disease.

Globally, one in three adults suffer from multiple chronic diseases. Healthcare costs rise sharply, often exponentially, with each additional chronic condition due to increased specialist visits, emergency care, and hospitalizations. At the same time, patients face worsening quality of life, higher out-of-pocket costs, medication challenges, reduced ability to work, and greater strain on carers. This burden from multiple chronic conditions is expected to keep growing.

Spending More on the Same Model Produces More of the Same Results

Budget 2026 projects that spending on doctors alone will increase by 9.3% in 2026–27 – the largest increase within the health care budget, even as analysis from the CCPA finds that fewer British Columbians have access to a family doctor despite increased physician spending. More money into the same structural model is producing diminishing returns, because the structural model itself, reactive, acute-care-centred, disease-by-disease, is not designed to address the population health trajectory it is being asked to manage.

Doctors of BC's response to Budget 2026 was pointed: absent were any specific plans to address rural physician shortages or tackle specialist waitlists. Chronic system-wide challenges, workforce shortages, emergency department closures, rising patient complexity, are acknowledged repeatedly in official documents and addressed insufficiently in the budget lines that follow.

This is not a failure of political will alone. It is a failure of investment logic.

What Prevention Actually Returns

The evidence on prevention investment is neither new nor ambiguous. A 2025 scoping review of multimorbidity interventions found that integrated care programs for patients with multiple chronic conditions, the kind of coordinated, community-based approach that sits at the heart of BC's most effective innovations, improve perceptions of care coordination, reduce hospital and emergency admissions and readmissions, and reduce average costs per capita.

On self-management specifically, the Stanford-derived Chronic Disease Self-Management Program, the model used by Self Management BC, has demonstrated through multiple randomized controlled trials and a meta-analysis of 23 studies that it significantly improves health status, reduces emergency department visits, and lowers hospitalization rates across people with diverse chronic conditions. The program is low-cost to deliver and scalable across community settings. It exists. It works. It is chronically underfunded relative to the problem it is designed to address.

On advance care planning, an investment that reduces end-of-life crisis-driven acute care, the evidence is equally clear. An older, yet still relevant, systematic review of 113 studies found that advance care planning decreases life-sustaining treatment, increases hospice and palliative care use, and prevents hospitalization. Research on 11 high-income nations found that Advanced Care Planning (ACP) has been shown to reduce end-of-life hospitalization and costs while supporting families through surrogate decision-making and bereavement. The infrastructure to deliver this in BC, through the BC Centre for Palliative Care's province-wide training and community networks, already exists.

The Policy Reframe That Is Overdue

BC's 2025–26 Ministry of Health Service Plan explicitly identifies an aging population with complex conditions and multimorbidity as one of the central pressures on the system. It commits to innovation and long-term solutions. What it does not do, and what no BC health budget has yet done with adequate seriousness, is structurally redirect resources from managing the downstream consequences of chronic disease to preventing them.

The fiscal case for that reframe is straightforward. Every person who avoids a hospitalization through a self-management program, an advance care plan, or an early-stage dietary intervention saves the system thousands of dollars and saves themselves months of suffering. At population scale, the returns are not marginal, they are the difference between a health system that can sustain itself and one that cannot.

BC is running out of room to keep spending its way through a problem it could be preventing. The tools exist. The evidence exists. The budget decisions that follow need to catch up with both.

IHSTS works to move evidence-based prevention and self-management innovations from the margins of BC's health system to the centre of it. Learn more at www.ihsts.ca.