As healthcare overhaul looms, battlelines drawn

Posted on August 25, 2016 in Health Delivery System

TheStar.com – Business – Ottawa is getting ready to overhaul Canada’s $219-billion healthcare industry this fall. Expect resistance from the provinces.
Aug. 25, 2016.   By DAVID OLIVE, Business Columnist

Preparations are underway for a milestone summit this fall that could be a defining moment for Canadian quality of life in the 21st century.

Ottawa appears determined to overhaul Canada’s $219-billion healthcare industry. It is keen to use the once-in-a-decade expiry of the Health Accord as the opportunity for reform. The Health Accord is the means by which Ottawa injects funds into Medicare with health-care transfers to the provinces and territories, and renegotiation of a new accord has consumed several months.

At this historic moment, the feds are prepared to be the prime architect of change, if balky provinces and territories put up their usual stubborn resistance to it.

Provinces and territories have consistently demanded more money from Ottawa with no strings attached. They denounce specific uses of the funds as a federal intrusion on their bailiwicks.

But as Dr. Jane Philpott, the federal health minister, said earlier this week, “There has never been a major development in the history of health care in Canada where the federal government was not there.”

Indeed.

For instance, there would be no Medicare – the national achievement of which Canadians are proudest – had Ottawa not unilaterally imposed it across the country in the 1960s. Ontario was among the holdouts, until its then premier discovered that Ontarians wanted what the feds were offering.

Today, the feds have that same advantage of popular support for reform.

A Canadian Medical Association (CMA) poll that mirrors the results of other polls shows Canadians are strongly supportive of major healthcare reforms in mental-health services (83 per cent), more affordable prescription drugs (80 per cent), palliative care (80 per cent) and home care (79 per cent), among other health services.

Dr. Philpott is an ardent champion of “targeted funding,” to ensure that federal money gets spent on the Grits’ priorities of improved home care, palliative care and mental health treatment.

By contrast, the sub-governments share the view of Quebec Premier Philippe Couillard, that “We are totally opposed to targeted funding.” Give us the money, let us decide how to spend it.

Dr. Philpott’s valid grievance is that the $41 billion Ottawa transferred to sub-governments during the previous 2004-2014 Health Accord, which expired two years ago, did not bring health-care reform. “We didn’t buy change,” as the minister puts it. This time, Ottawa wants to see results for its money.

In a remarkable speech to the CMA this week, Dr. Philpott’s indicted the sub-governments for their routine violations of the Canada Health Act, which has undercut “a fair and just society.” She condemned the system as plodding and uncoordinated, an assessment few Canadians would disagree with.

And acceding to the sub-government’s rote demands – an increase in federal funds with no strings attached – holds exactly zero chance of forcing reform. After all, the health minister noted, there are many countries that spend less than Canada on healthcare, yet boast better health outcomes.

Examples: Britain, Italy, Spain, Norway, Israel and Ireland, among others.

The sub-governments should have seen this confrontation coming. A Harper government also frustrated with lack of health-care reform slashed the increase in federal health transfers from 6 per cent to 3 per cent in a bid to force better spending decisions on provinces and territories.

It will be a struggle for the sub-governments to marshal a convincing argument against Dr. Philpott’s insistence that Ottawa must have a role in moving Canadian healthcare from “from the middle of the pack to out in front.”

Here’s what the traditional hands-off, no-strings-attached status quo has gotten us:

– The World Health Organization (WHO), an arm of the U.N., ranks Canada a dismal 30th in quality of health care, trailing Colombia, Cyprus and Morocco. (France and Italy rank 1st and 2nd, respectively.)

– Total Canadian health-care spending has more than doubled, to $219 billion, over the past 15 years, with no comparable across-the-board improvement in quality of health of Canadians. And as a percentage of GDP, Canadian healthcare spending has jumped from 8.3 to 10.3 in that period.

– Absenteeism, most of it health related, costs the Canadian economy an estimated $16.6 billion a year. Poor health also contributes to voluntary turnover, which on average is 7.3 per cent and in the retail sector is almost 21 per cent.

– Wait times, on average, are actually worse than 20 years ago. Twenty-nine per cent of Canadian patients must wait more than two months to see a specialist. The percentage of patients subjected to that anxiety is much smaller in the U.S. (6 per cent), Britain (7 per cent), Germany (10 per cent) and France and Australia (18 per cent each).

– The basic principles of the Canada Health Act are routinely violated, degrading quality and accessibility of care from coast to coast.

In a letter to Dr. Philpott earlier this year, the Canadian Health Coalition (CHC) noted that rogue behaviour:

“In the past year alone, the provinces have failed several times to abide by the Canada Health Act,” the CHC wrote. “Bill 20 in Quebec forces patients to pay for medically necessary treatment. Bill 179 will lead to the opening of private MRI clinics in Saskatchewan, and allow those who can pay to jump the queue ahead of others.” [That’s “two-tier” healthcare, which Canadians have rejected in more than one election.]

“In Ontario, we’ve found multiple cases of extra-billing and user charges, especially for cataract patients. In British Columbia, private clinics are charging illegal membership fees and user fees, and are double billing patients and the provincial healthcare system.”

What the country needs is a holistic approach to health, as Dr. Philpott suggested this week in offering as one of several solutions a serious look at the “socio-economic” factors affecting health.

The logical conclusion is that governments must at least think about embracing universal daycare, pharmacare and denticare, which certain successful European societies have long ago done. Quebec has done so in daycare, of course – still a prime candidate for a national rollout more than a decade after then PM Paul Martin first suggested it.

The feds will have to put their money where their social-engineering ambitions are, covering something close to half of sub-government healthcare spending, long ago slashed to the current 20 per cent or so.

For as long as the provinces and territories are shouldering most of the financial burden for health care – the biggest item by far in every sub-government’s budget – premiers are going to be huffy about how their healthcare budgets are devised.

It’s time we stopped benchmarking ourselves against the U.S. (ranked 38th by WHO), which has bred a complacent satisfaction with our healthcare system, when reality urges a long-delayed renaissance.

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