Federal health role is about more than money
Posted on January 10, 2012 in Health Policy Context
Source: Toronto Star — Authors: Will Falk
TheStar.com – opinion/editorialopinion
Jan. 10, 2012. Will Falk
Jim Flaherty’s surprise health announcement last month was clear, principled and financially generous: 6 per cent through 2016-17, and then to 2024 increases at nominal GDP growth, but never below 3 per cent, even if economic growth lags. This provides known long-term funding and is more than provinces could have reasonably expected from the 2014 first ministers’ meeting.
The principle behind the federal generosity is clear. Prime Minister Stephen Harper is taking Ottawa out of the health-care debate and ending the national discussion of health and health-care system issues that began with the original federal funding in the 1966 Medical Care Act and continued up to the 2004 wait times accord.
But is this a good thing for Canada? Does a national debate not serve a purpose in the 21st century? There are at least seven areas that require national policy leadership and federal attention:
• Transparent reporting on health quality and access. From 2000 to 2006, Canadians had a crisis in declining quality and access to care. The federal government responded with national wait time standards and organizations that made reporting of results consistent across Canada. Harper and his first health minister, Tony Clement, strongly supported these initiatives. In April 2007, the PM said: “When a government makes an investment in the health of people, it’s making an investment in the country’s future. The patient wait times guarantees we have negotiated with the provinces and territories mark yet another step forward in our government’s commitment to building a stronger, safer, better Canada for all of us.”
• Delocalization and virtualization of health-care delivery. Today, a woman with a possible breast tumour in Newfoundland or Manitoba may well have her pathology read in Toronto. Telemedicine is revolutionizing the way patients are cared for and will continue to do so through the next two decades. Interprovincial care delivery is expanding and longer term international markets may represent an opportunity for growth and job creation. Exporting health-care excellence is a national opportunity.
• Health human resources: credentialing and immigration. Health provider credentials have become interprovincial and are internationalizing. Health worker immigration has become critical to Canadian health systems. Immigration is a federal responsibility.
• Aboriginal health system improvement. The federal government runs its own $2 billion-plus health system for First Nations and Inuit Canadians. It has poor quality and access results. It is the responsibility of Harper and Health Minister Leona Aglukkaq to focus time and resources to fix Canada’s aboriginal health system — in the same way that provinces have the responsibility to improve their health systems. This is best done in concert with provinces and territories.
• New technology approver and regulator. Harper has shown leadership in seeking to create one federal regulator for financial institutions. The same arguments of efficiency and national standards hold true for new drug and technology regulation and funding approval. Canada has a strong basis for a national system given existing Health Canada assets, the proliferation of new targeted therapeutics, and various other innovations coming from our health-care providers.
• Health promotion and disease prevention. 2014 marks the 40th anniversary of theLalonde report, which helped establish Canada as a world leader in health promotion and disease prevention. Health Canada has done good work in this area for decades in areas such as smoking cessation, anti-tobacco campaigns, drug abuse prevention, driver safety and public health. Thoughtful condition-based programs on obesity and diabetes, for example, should be discussed. An obesity prevention program and tax system along the lines of earlier smoking cessation efforts could be considered nationally.
• Epidemic preparation. Canada was not prepared for the SARS epidemics of the past decade. In a pandemic situation, provincial responses alone are inadequate. Future epidemics will require further cooperation among different levels of government and an ongoing national dialogue.
Harper’s government did make one very important point in the December announcement: that system delivery reform in the short and medium term rests with the provinces. The provinces have the tools to transform — not just cut back — their systems. Provinces should not delay transformation for another discussion.
But moving forward with provincial reforms does not mean ending national leadership. A robust discussion in 2014 around the issues outlined above could provide a national consensus on what a 21st century health system for Canadians looks like.
Will Falk, executive fellow in residence at the Mowat Centre for Policy Innovation, advised both the Harper and Martin governments on health policy.
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