Prime Minister Justin Trudeau has announced the federal government is nearing an agreement with the provinces to provide additional funding for health care. The prime minister says he expects a deal to be reached this month.
Trudeau’s statement comes as something of a surprise. His health minister, Jean-Yves Duclos, recently walked out of a meeting with his provincial counterparts, saying no arrangement could be made. Nevertheless, any progress is welcome.
That said, however, what we know so far about the pending deal is far from reassuring.
Duclos, as he did in his meeting with the premiers, has made the creation of a national health database a condition of any deal. This is very nearly the last priority at present.
Our health-care system is awash in data.
What we lack are commitments to defined and agreed-upon outcomes.
In 2004, then-prime minister Paul Martin took an important step in the right direction when he negotiated a 10-year, $41-billion deal with the premiers. The funds were offered in exchange for an agreement to reduce wait times for four specified procedures, hip and knee surgery, cataract removal and radiation therapy for cancer.
Unfortunately, and we might say almost predictably, the deal came up short because the provinces failed to deliver. In 2019, 15 years after the agreement was signed, and later refreshed, only 75 per cent of hip replacements and 70 per cent of knee replacements were conducted within the agreed-on wait times.
Those numbers have since deteriorated further due to the COVID outbreak.
We say “almost predictably” because there were no penalties in the agreement for failure to deliver. The provinces got the money whether they met their targets or not.
Duclos should put aside his pursuit of a national database — a years-long project — and set two conditions for additional funding.
First, he should specify improvements in areas generally agreed to be in need of urgent attention.
These include timely access to medical imaging scans and screening tests such as colonoscopies, pap smears and mammograms. Appropriate wait times should be set for essential surgeries, and for accelerating entry by foreign-trained doctors and nurses.
Second, learning from Martin’s error, Duclos should make whatever money is offered conditional on performance.
We’ve focused primarily on just one aspect of a new health-care funding deal — the need for defined outcome targets and penalties for non-compliance. Certainly other matters are also on the table.
But there is an essential reality to face in any effort to reform our national health-care system. Medicare is now more than 50 years old and still operates, in the main, along the same worn-down, outdated lines as ever.
The almost glacial rate of reform speaks volumes to the limited powers of provincial politicians to effect change by themselves.
Organized foot-dragging within the health-care system, frequently by professions anxious to retain their autonomy, has stymied repeated attempts at reform. That’s one reason it took B.C. Health Minister Adrian Dix five years to grant pharmacies the right to renew routine prescriptions, the simplest of expedients.
The best means to overcome such resistance is to bring a new actor to the table. Provincial health ministers might find their hand is strengthened if they can show that Ottawa will cut funding if reforms are not made.
The 1985 Canada Health Act brought an end to physician extra-billing by threatening exactly that consequence.
Opinion polls show conclusively that voters don’t believe simply providing more money will correct the problem. It’s up to Duclos to stop shadow boxing with the provinces and lay out, in clear and precise terms, the improvements we need to see.
Then back that up with a credible threat to withdraw funding if the targets aren’t met.
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