The health accord was a ‘fix’ we must not repeat

Posted on April 2, 2014 in Health Policy Context – Globe Debate
Apr. 02 2014.   Jeffrey Simpson

Puffs of wistfulness, interspersed with premonitions of doom for Canadian health care, surrounded this week’s end of the 10-year health accord between Ottawa and the provinces. Begun in 2004, the accord formally ended on Monday.

At birth, the accord was heralded as “a fix for a generation.” The accord would accelerate “transformative change,” a favourite phrase of prime minister Paul Martin. The accord was an extremely costly flop. It did not reform medicare – if anything, it reinforced the status quo, which remains adequate but not good enough.

Anyone can make a mistake once; only a fool makes it twice. Those clamouring for another accord have learned and forgotten nothing, perhaps because their ideology prevents them from studying the facts.

The health accord pumped an additional $41-billion into the system over a decade, with the yearly transfers from Ottawa to the provinces rising at 6 per cent a year. Transfers will continue at that clip for another two years. Then, they will fall to something like 3.5 or 4 per cent, with the precise amount to depend on economic growth and inflation.

After a decade of health-care budgets rising in the range of 7 per cent (in large part, courtesy of the health accord), governments finally have wrestled this down to about 2.5 per cent. Another health accord indexed at 6 per cent would inflate the increases again. Most of it would go to wages and other benefits for health-care employees, who grabbed a disproportionate amount of the health-accord money the first time. They would try to do it again if governments poured more money into the system.

The 2004 accord created an institution called the Health Council of Canada to monitor the accord’s impact. The Harper government has now shut it down, but the council’s eighth and final bulletin concluded that improvement “has been modest and Canada’s overall performance is lagging behind that of many other high-income countries.”

The council kept surveying Canadians’ opinions, discovering that in only one province, Ontario, did even 50 per cent of respondents agree that “on the whole, the system works pretty well and only minor changes are necessary to make it work better.” That compares with 63 per cent of people in Britain who agreed with that statement. In Quebec, just 23 per cent of respondents agreed that the system “works pretty well.”

Wait times. The health accord was supposed to alleviate them, and it did for a while, for five important surgical procedures. Alas, demand went up, wiping out the improvement. Wait times for these five surgeries are roughly back to where they were a decade ago.

According to the Health Council, wait times for next-day appointments for a family doctor are the worst “among all countries surveyed, with no improvement since 2004.” For people having to wait more than four hours to be seen in emergency wards, the council reported that “Canada ranked the worst internationally and has not improved since 2004.”

Visits to emergency departments, sometimes caused by lack of availability of family doctors or after-hours clinics, were “highest among the countries surveyed.” After-hours medical care “is difficult for 62 per cent of Canadians.” Overall, the council reported, “Canada has improved only slightly since 2004. In contrast, the United Kingdom has managed to cut this problem in half over the same time period.”

Canadians have a somewhat more positive view of their health-care system than they did in 2004. And they do rate the quality of care they personally received highly. The bugbear remains timely access.

The political assertion that heaps of additional money, properly targeted, would “buy change” was wrong, as the Health Council concluded with its last breath. More change is happening now because people in the system are trying to change it, rather than doing the same things for more money.

Canada spent – no, wasted – an enormous sum of money over 10 years. It must not repeat that mistake.

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