In 2014, the current federal-provincial Health Accord expires. The Accord, agreed upon by the First Ministers in 2003, set targets for structural changes for access, quality and sustainability, and put in place increases to federal cash transfers to fund the system. The following year, the First Ministers announced further reforms in ‘A 10-Year Plan to Strengthen Health Care”. This Plan targeted key areas for system reform; among them, wait times, aboriginal health, medical equipment, prevention, promotion and public health, primary health care and a National Pharmaceutical Strategy. As you would expect, with renewal of the Accord looming, there has been a lot of discussion about where we are, where we’re going, and what needs to change. A comprehensive review has been promised by government, and Senate Social Affairs committee hearings are underway. The Harper government has already committed to continue Canada Health transfers at a rate of $30 Billion annually, with an “escalator” of 6% per year until 2017, and a slightly lesser “escalator” from 2018 onward.
Most Canadians would agree that our Universal Health Care system is one of the things that defines us as a nation. Consequently, changes to the Canada Health Act and the system it supports are slow and hotly contested. Health Care in Canada is a sacred cow and is seen as a birth right. However, most Canadians would also express frustration with access to a primary care physician accepting new patients. Or a specialist. Or diagnostic testing. Or a new hip. The Health Council of Canada recently released its Progress Report for 2012, highlighting achievements by governments toward the commitments set out by the 2003 Health Accord. The report gives credit for many of the modest targets that have been hit, but says that governments have failed to attain the broader accomplishments, and questions whether the progress that has been made is enough to move health care forward.
The Wait Time Alliance, a watchdog organization reporting on progress toward the reform goals set out by the 2004 First Minister’s Plan to Strengthen Healthcare focuses their feedback on the priority areas identified by government: Diagnostic imaging, hip and knee replacement, radiation for cancer patients, cataract surgery and cardiac bypass surgery. Their 2012 report indicates that after many years of progress toward wait time reductions, results this year show a worsening in performance. They express concern that focus has been placed on procedures for which wait times are published, but progress is lacking in procedures where provincial reporting is not a requirement, like chronic pain, gastroenterology and psychiatry. They also express frustration in the significant variations in wait times between provinces and have called for efforts to close the gap.
If we look at other industrialized nations, we outpace the healthcare spend (with the exception of the US) but are not exceeding their access or efficiencies. Switzerland’s health care system, for example, is 10.8% of GDP compared to Canada’s 11.6% in 2010. Their approach is a mixture of public and private competition, multiple insurers and deductibles for patients.
A white paper by the MacDonald-Laurier Institute compares the Canadian system with those of a number of other developed countries. “First, Do No Harm: How the Canada Health Act Obstructs Reform and Innovation” by Jason Clemens and Nadeem Esmail points out that all other countries with Universal Health Care systems in place allow parallel private health care programs to function, where patients share in the costs of the healthcare services they consume and have the option to purchase private healthcare outside of the public system. The authors call for a number of changes to the Canada Health Act including a removal on the ban on extra billing and user charges while protecting low income families; a shift in responsibility from the federal to provincial governments for health care delivery; freedom for the provinces to experiment in determining how health care plans operate and are regulated, including for-profit models; and a removal of the “uniform terms and conditions” reference from the Canada Health Act’s principle of universality in order to open up the possibility of experimentation by the provincial governments. The authors suggest that these reforms “will create the environment for improved universal health care, but also protect the core principles of Medicare”. But how will Canadians react to reform?
A recent Ipsos-Reid poll shows that given a choice between private and public healthcare systems, 80% of Canadians prefer the not-for-profit model delivered by the public sector. But, throw a third option into the mix, where a mixed model of a public option as well as the choice to pay for private sector-delivered services exists, and 53% of Canadians choose the mixed model. Are Canadians growing tired of navigating through our limping system, or at throwing more and more public money at healthcare without seeing improvement in access or delivery?
What is clear is that healthcare in Canada cannot possibly remain sustainable at these ever increasing funding levels in the long term, and that Canadians’ demands for timely access to care given this spend will get increasingly louder should improvements not be visible in the short term. Though we love our healthcare, that love is not unconditional.