Julie Smyth

Healthcare panelists ask: has the federal government abandoned its role?

May 11, 2012

Ottawa – The health care debate has evolved since the publication of The Canada We Want in 2020, prompting a lively debate at the Chateau Laurier last night.

A panel of distinguished speakers, all contributors to Canada 2020’s book, examined a range of health care issues and discussed the implications of the federal government’s recent announcement of a funding deal for provinces.

In December 2011, Finance Minister Jim Flaherty surprised Canadians with the news that the provinces will receive continued 6% annual increases in transfers until 2017, after which transfers will be set at the rate of nominal GDP growth with a guaranteed base of 3% per year.

At last night’s event, Paying for the Healthcare We Want, a crowd of 300 listened to expert opinions about the challenges facing Canada’s complex health care system. There was debate about whether the recent health care deal means the federal government has abandoned its role.

Mark Stabile, Director of the School of Public Policy and Governance at the University of Toronto, said it was a “pretty generous deal on the table” but he said the government has backed off its responsibility to some extent.

“I would not want this to be a long-term role for the federal government. But there can be an ongoing back and forth. In the long run, I hope there will be a much larger role for the federal government.”

He said it has opened up a national conversation about the issue.

Francesca Grosso, Principal at the consulting firm Grosso McCarthy and a former Director of Policy to the Ontario Minister of Health and Long Term Care, said she did not think the federal government has abandoned its responsibilities, citing the many national health care agencies.

“I think the federal government has a tremendous role in health care.”

She also spoke about one of the major problems facing provinces such as Ontario: the vast amount of money going into complex groups of organizations, leading to duplication of services. She said it is not always the best use of dollars, pointing out that some patients leaving hospital and receiving homecare are assessed as many as three different times.

The Canada 2020 event was a timely one, coming just days after Ontario’s Health Minister announced it is cutting a number of doctors’ fees. The announcement led to debate, both in the media and at the event last night, about the medical fee structure and the self-employed status of doctors in Canada.

Michael Decter, a Harvard-trained economist and leading Canadian expert on health systems, spoke about the history and context surrounding the health care debate. He talked about the focus on wait times in the 2004 health care accord, a deal designed to be a 10-year road map, and how the provinces and the federal government “had their direction shaped more by public opinion.” He said the emphasis on wait times led to some reductions but “it masked the larger issue that we really hadn’t come to terms with, which we now have to face.”

That issue: Canada has built a system based on dealing with acute care yet, with an ageing population, we are facing more chronic diseases. Decter, who served as Deputy Minister of Health for Ontario and is the Founding Chair of the Health Council of Canada, argued Canada needs to focus on homecare and chronic disease, as well as more community and patient-centred care.

Decter and Grosso, who worked together on the Health Council of Canada and co-authored the 2006 book Navigating Canada’s Health Care: A User Guide to the Canadian Health Care System, were in agreement that the federal government will lead in very narrow areas. Decter referred to the mental health commission started by the Harper government.

Decter described the Canada Health Act as “a wonderful shield and sword” and spoke about how he would like to see more variations in care. He talked about how in the Northwest Territories many nurse practitioners do the same work as doctors, yet there is resistance to this alternative arrangement in other parts of the country.

There are going to be some difficult conversations going forward, especially as the population ages, noted Decter. Canada has a universal system but, he said, many people feel that should mean we all get the same services. “A universal system should be based on need. So you should get the service you need, not the same service as everyone else.”

The discussion delved into whether the new funding formula will push the provinces to become more innovative.

Philippe Couillard, who practiced medicine for 17 years and is Strategic Advisor at SECOR Group, said there needs to be more sharing of innovative ideas across the country. Couillard, also a former Minister of Health in Quebec and chair of the Health Research Foundation of Canada, said provinces are slow to share best practices and he suggested the federal government could play a role in this area.

There was discussion about the private delivery of publicly-funded services and the risks – both in terms of cost and quality – in expanding into areas beyond simple medical procedures.

The panel also took questions from the audience and through Twitter. One question dealt with the ongoing challenge of doctor shortages, while another focussed on the dismal state of health among the aboriginal community (panel members suggested the bigger underlying problems are the lack of education and job prospects among young people, as well as the poor housing – and that this is where the money should be directed). The issue of a national pharmacare plan also came up in discussion, as well in a question from the audience. There were no quick solutions offered on this subject.

Susan Smith, Co-founder of Canada 2020, encouraged the audience to participate in the health care debate by going to the Canada 2020 website to share comments and views.

Last night’s event was the fifth discussion based on the Canada 2020 book. Each panel discussion covered a different issue.

Smith also announced that Canada 2020’s next event will be on September 26. The guest speaker will be Dr. Eric Topol, a renowned professor of genomics in California who Smith noted has been named one of the “12 rock stars of science.” His much anticipated talk will be titled “The Digital Revolution: How it will create better healthcare.”

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