Federal health spending without accountability
The 2004 Health Accord agreed to a total transfer of $41 billion of federal money to the provinces and territories for health care over a ten year period. This transfer ends in 2014 when the accord expires.
The legacy of the Health Accord is mixed. There have been improvements in wait times for some operations and diagnostic tests, but no progress in developing a national plan for pharmaceutical coverage, and virtually no reporting about how the federal investment was used and what it achieved.
What are some lessons learned from the Health Accord about the federal role in health care that Canadians should be aware of when heading to the polls on May 2?
Last week, Part 1 of this series covered whether the 2003/2004 Health Accord provided the ‘fix for a generation’. This week we are asking about the legacy of the Health Accord, and what the federal government can and should commit to in the next round of negotiations with the provinces and territories.
As part of the Health Accord, the federal government committed to a $5.5 billion total fund over 10 years for reducing wait times, and a $16 billion for primary care, home care and catastrophic drug coverage. The 2003 Health Accord committed to publicly report on the progress of the main areas of the Accord. However this commitment was softened in the 2004 Health Accord, which contained a statement that nothing in the Health Accord takes away the jurisdiction of provincial and territorial governments over the delivery of health care.
Little Accountability for Federal Health Dollars
The Health Council of Canada was established in 2003 to act as a public watchdog to monitor the progress of the Health Accord commitments. Cathy Fooks, who served as the first Executive Director of the Health Council of Canada, says that the Council ”was not as independent as it needed to be to do the job that it set out to do.” Moreover, the type of information that the council was supposed to measure and report on was not readily available. Danielle Martin, a family doctor and past Council member says “the Council didn’t have the capacity to do what it was meant to do. No one can force provinces to give up information, and much of the data we needed was information that the provinces did not even have”. While the Health Council of Canada still exists, its main focus is on providing policy reports and describing best practices which can lead to health care reform, rather than measuring and monitoring annually on the 2003/2004 Health Accord goals.
The 2004 Accord did not include any mechanism for holding the provinces accountable for how the federal transfers are spent. Some may argue that this is appropriate in our political system – the federal government’s role in health care funding is to simply collect taxes and transfer funds to the provinces and territories, subject to the conditions outlined in the Canada Health Act. After all, a province like New Brunswick has different health care priorities than Ontario, and who knows those priorities better than the local region? On the other hand, many Canadians find it troubling that health care standards differ so much from one province to another. For example, certain expensive prescription drugs are paid for by some provincial governments but not others. The issue of the federal government’s role in ensuring similar access and quality of health care across the country has not been an area of focus of any of the federal parties in this election.
What does the future hold, and what should you ask the federal parties during this election?
If the CHT is to be more than a simple transfer of federal funds to the provinces and territories, the federal party leaders must indicate what their health care priorities are, what improvements in health care they expect the CHT will lead to, what new accountability measures they will implement, and how they will ensure that the provinces and territories will comply.
Jeff Turnbull, president of the Canadian Medical Association argues that Canadians need to speak out now and press political leaders for a plan and vision to create a health care system that delivers better value. Turnbull says that today’s health care system still has “huge inefficiencies, silos, lacks patient-centredness and integration, and has no overarching vision for the direction it should go.” Turnbull says that transforming the system will require a willingness to “tackle issues of meaningful change in health rather than throw money at the health care system.” Turnbull suggests that a transformed system of care would align to national standards, set by Canadians from across the country, and could include major changes such as expanding the scope of traditional Medicare from hospital-based care to long-term care and home care, to meet the changing health care needs of the population.
In the campaign leading up to the May 2 election, the Liberal, Conservative and NDP leaders have all committed to an annual six percent increase in the CHT after 2014, although they have all been unclear about how long they will continue to increase funds at this rate. Mark Stabile, director of the School of Public Policy & Governance at the University of Toronto questions whether annual 6% increases are feasible in the current economic climate. Stabile says that “a serious conversation needs to happen about where this money will come from, and that it’s impossible to maintain the 6% funding increase without raising federal revenues through taxes.”
This table outlines the increases to the CHT based upon the Health Accord.
Despite claims that health care is a provincial matter, the presence of federal legislation and the large sums of money transferred from the federal government to the provinces and territories clearly illustrates that there is a federal role in Canadian health care. With the Health Accord set to expire in 2014, possibly during the life of the parliament that is elected on May 2, now is the time for federal leaders to make their positions on health care clear. How much will they increase health care transfers by, for how long, and what will they demand in return?