The expected negotiations between the federal and provincial governments on the renewal of the 2004-2014 accord were only starting to attract some attention… until the Harper government’s strategic masterpiece: The unilateral announcement of a multi-year funding framework, combined with a clear message on the respect of provincial/territorial jurisdiction. The pure “per capita” funding model could still be improved and adjusted for age, although the impact of aging on costs is relatively small (1%) when compared to other drivers. Ironically, the same provinces that, year after year, complained about Ottawa’s “interference” now want it to interfere again and demand more money, with strings attached! But the recent past has shown that money alone will not buy change and that we need to look for deeper causes and solutions to our persistent problems.
A recent proposal from the premiers for an “innovation fund” was quickly rejected by the federal government, but this matter deserves a second look, as it could be a way to illustrate what “patient-centeredness” really means.
Canada ranks 5th in the OECD on per capita (total) health care expenses. Our physicians are among the best paid in the world, when compared to the average Canadian worker. Billions of dollars have been injected in the system, with a measurable improvement in access to targeted procedures. Yet we remain at the bottom of the pack when one looks at timeliness, efficiency and “patient experience”. Historically, the system has been managed by rationing the supply of services and has responded to its own needs, rather than the patient’s, which has created a rigid environment with misplaced incentives, limited choice and little competition.
The creation of an innovation fund is the right way to go, so long as its goals are well defined. The federal government has committed to a 6% escalator until 2017, followed by increases based on the nominal growth of the economy. This represents a very large sum of money that could be levered to achieve real and long-lasting change. Most provinces have created (or are in the process of creating) a Quality Council or its equivalent. One could envisage reserving all the increased funding above inflation for such a fund, accessible to provinces that would present to their respective Quality Council (with representatives from the public and the health professions) a detailed program of utilization for the transferred money. Accountability would then be exercised at the level of the provincial legislature, avoiding the usual trappings of jurisdictional conflict. The provincial councils could meet in a renewed Canada Health Council, sharing best practices and success stories.
In the interest of patients and their families, the idea deserves a second look. The federalist nature of our country allows for diversity in innovation: An opportunity for real improvement and creative emulation, rather than counterproductive uniformity.