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NUCCA News - Help coming for medicare as politicians ponder Romanow report
DENNIS BUECKERT Friday, December 27, 2002
Roy Romanow, head of the royal commission on health care, speaks during a news conference in Ottawa last month. (CP/Jonathan Hayward)
OTTAWA (CP) - First ministers are to meet early next year to talk about health care reform, and Ottawa has something that will catch provincial attention: cash. Expectations are high after the Romanow report, which called for $15 billion in new money over the next three years. The federal government hasn't announced a dollar figure but it's expected to be substantial. "I think everyone's very much seized of the fact that Canadians want their health care system fixed," Health Minister Anne McLellan said in an interview. "Their major concern is around accessibility - access, for example, to a family doctor when they need it, access to surgery when they need it. They want timely access to a high-quality system." McLellan indicated the government will require greater accountability as part of a new deal for health. "We have made it plain that we want to be flexible but on the other hand we have to make sure that new taxpayer dollars will actually deliver the change that Canadians want to see in their system." Romanow's report has clearly been a hit with the public. A poll by Ekos Research found that many Canadians named him, unprompted, as someone who would make a good prime minister. Despite not being a candidate, he tied for second place with Industry Minister Allan Rock and Finance Minister John Manley, both of whom are expected to seek retiring Prime Minister Jean Chretien's job. But many recommendations in Romanow's report grate on the nerves of provincial politicians. He resoundingly endorsed the current universal, single-payer system, saying there's no evidence to suggest a private, for-profit system would be more efficient. He came out against user fees and recommended expanding the system to cover home care and some prescription drugs. He said there's no point in pouring money into the system unless it buys "transformative change." The most controversial recommendation in provincial government eyes was his call for greater accountability in how the provinces spend federal health money. Under the current Canada Health and Social Transfer (CHST), introduced in 1996, money for health is lumped with funds for higher education and social assistance, with no strings attached. Health is a provincial responsibility under the constitution, and provinces defend their turf jealously. They like the flexibility of the CHST but want more federal money. Romanow said Ottawa should specify how much of the money it gives provinces would be specifically for health. McLellan says she's considering that idea. "That would certainly enhance the transparency around the number of dollars the government of Canada transfers to provinces and territories for health care. "Then of course one tracks through the public accounts of the provinces how much money in total they're spending on their health care system." That's an apparent shift in her position. In October, before the report was tabled, McLellan said she saw no need to change the current funding mechanism. Some provinces - notably Quebec and Alberta - say Ottawa has no right to put conditions on health money, not even the requirement to explain where the money went. They say they account for health spending to their legislatures, and nothing further is needed. Accountability was a major sticking point when McLellan met her provincial colleagues in early December. The ministers came out of the meeting talking vaguely about flexibility and didn't even issue a final communique. That didn't discourage McLellan. "Federal-provincial-territorial meetings have a certain rhythm to them," she said. "It's not surprising the provinces and territories would go to this first meeting after Mr. Romanow's report and say, 'We want unconditional funding.' "And it's not surprising that I would say, 'Look, I hope we all agree that what we need to do is to make sure that our new resources put into the system get us the change that everyone, including Commissioner Romanow, has talked about as being needed."' Pressure for greater accountability has risen in part because of controversy over what happened to the last big federal investment in health. Under a September 2000 agreement Ottawa gave the provinces $21.1 billion over five years, plus special funds for primary health care and new technology. It was later determined that much of the money intended for advanced medical equipment bought equipment such as lawn mowers. "Too many Canadians are saying, 'Those were our tax dollars, what did that actually get us in terms of a better health system?"' McLellan says. Implicit in the idea of accountability is that Ottawa could penalize provinces that don't follow the principles of the Canada Health Act, which sets the rules for medicare. That's not a new idea; Ottawa has in the past used its cheque book to influence health policy, cutting transfer payments to provinces that violate the act. Former health minister Diane Marleau fined several provinces for practices such as permitting doctors to extra-bill. But Ottawa seemed to back off on enforcement efforts at about the same time it made deep cuts to transfer payments and created the CHST. Allan Rock declined to intervene even in cases critics saw as clear violations. For example, he didn't punish provinces for permitting private, for-profit MRI clinics. The only fines he imposed were on Nova Scotia for allowing user fees at abortion clinics. Some health activists cite the hands-off approach as evidence the Liberals like the idea of a two-tier health system despite public statements to the contrary. Recent news reports indicate Ottawa has declined to act in several cases where its own inspectors found apparent violations. But McLellan says she's committed to defending medicare. "If it is possible to resolve disputes through discussion and consultation . . . that is a much better way to go and sometimes that does take time. "Think about this: Is that better than withholding dollars that are not going into front-line health delivery? All you're doing is depriving the people of that province of the amount of money we're withholding." McLellan says reform has already begun, but so far it has been ad hoc and incremental. New resources will help but they won't be a cure-all. "When we talk about transformation there is no one magic bullet. It is a long, arduous, complicated process because this is a large, dynamic, complicated system." She plays down the risk that reform will get lost in jurisdictional battles. "Canadians should be reassured that their health ministers, federal, provincial, territorial, their first ministers, are all committed to ensuring that we have a sustainable, publicly financed, high-quality, timely health-care system." Colleen Fuller, a B.C. health policy consultant and researcher, says she's optimistic that Romanow's report will be acted upon. She said Romanow set out a clear strategy for saving medicare from "the greedy marketplace." And she sees greater accountability as essential to that strategy. "The provinces are now saying that they don't want that cash tied to any obligation on their part . . . and this is ridiculous." - Highlights of two major reports released in 2000 on Canada's health system: October Senate report chaired by Michael Kirby: - Raise $5 billion annually for health care system, preferably through a health-care premium. Premiums would range from $183 for low-income people to $1,460 for wealthy. - A role for private sector in health care. - Guarantee maximum waiting times and make government pay for treatment elsewhere if waiting time exceeded. - Home-care program for recovering patients, funded 50-50 with provinces. - Federal government contribute substantially to cost of home care for the dying. - Expand medicare to help people facing catastrophic prescription drug costs. - Pay doctors annual flat rate per patient rather than fee for service; give hospitals fees for services rather than lump sum. - November royal commission report in November chaired by former Saskatchewan premier Roy Romanow: - Expand medicare with federal cash infusion of $15 billion through 2005-06, including $1.5 billion dollars over two years to improve care for rural areas; $1.5 billion over two years to shorten wait times for diagnostic services; $2.5 billion over two years for primary care. - Endorsed universal not-for-profit system. - Co-ordinate waiting lists to reduce wait times. - Start building national home care program. - Financial help for people who need expensive drugs. - More accountability from provinces on how they spend federal money. - Ottawa pay minimum of 25 per cent of insured health services. - Electronic database of personal health records. - Examine drug patents with a view to reducing costs. - Create Health Council of Canada to set benchmarks for care and ways to measure performance. |
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