Opinion

Why we need to track health-care funding – and hire a chief accountability officer

What happens to the billions of dollars the federal government doles out to provinces and territories for health funding?

With so many Canadians facing barriers to care, many might wonder where their tax dollars actually go – and whether ongoing announcements about government reforms will make any difference.

Until the most recent funding agreements, money delivered through the Canada Health Transfer (CHT) ended up in a general pot, a no-strings-attached system. But in 2023, Ottawa announced a $46.2 billion increase in support for provinces and territories over 10 years. It includes $25 billion in bilateral funding agreements. And for the first time, access to that support requires each jurisdiction to adopt new accountability measures.

The question is whether that’s enough to ensure governments deliver on substantive reform.

Amid an ongoing health-care crisis and a looming federal election, the Canadian Medical Association (CMA) commissioned a report to find out how provinces and territories intend to spend funding from Ottawa and how they’re tracking progress. The findings: there’s a lot more work to be done – and a lot more oversight needed at a national level.

The bilateral agreements focused on four shared health priorities, each with established targets, affecting every province and territory: expanding access to family health services, including in rural and remote areas; supporting health workers and reducing backlogs; improving access to quality mental health and substance use services; and, modernizing the health-care system with standardized health data and digital tools.

There are some encouraging signs. Nine provinces and territories have established targets to expand access to family health services, including in rural and remote areas. All but two have targets in place to reduce surgical backlogs.

But the CMA’s analysis also found that provinces and territories aren’t meeting other critical targets.

To date, no provinces or territories are meeting their targets to improve access to primary care. Five don’t have targets for electronic access to health data that is necessary to empower patients, support continuity of care and reduce physicians’ administrative burden. And not one has set targets to eliminate emergency department (ED) closures, despite a third summer where this previously unheard-of situation has become a weekly news story.

To date, no provinces or territories are meeting their targets to improve access to primary care.

While the bilateral agreements are structured to require greater accountability – making provinces and territories report back on how funds were actually spent in the previous fiscal year – they are immensely complex and there is an opportunity to strengthen oversight. To support federal, provincial and territorial governments, the CMA is advocating for an accountability framework to ensure allocated funds are effectively spent and enhance Canadians’ satisfaction with the health-care system.

The CMA is calling for the creation of a Chief Health Accountability Officer to track progress on health reform nationwide and report on the efficiency of health-care spending. This role would also reflect the importance of provincial, territorial and federal collaboration – working across jurisdictions to improve transparency and expedite change.

The CMA is also advocating for additional indicators, beyond what provinces and territories have already established. These include tracking the wait times for an extended number of priority procedures; what percentage of wait times are within medically acceptable benchmarks; the number of hospital ED closures per year; improved mobility of health workers through pan-Canadian licensure; and, the percentage of health workers reporting burnout.

There is a new momentum to rebuild Canada’s ailing health-care system – one that serves patients and helps communities thrive. But we can’t fix what we don’t know. Implementing better accountability measures – ways to track what we spend and how it impacts health care –is essential in charting a new path forward.

Canadians deserve to know that their tax dollars are being spent where promised, and whether that spending is making a difference.

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2 Comments
  • Chris Bonnett says:

    Couldn’t agree more. Effective governance requires accountability, but provinces have resisted this for a long time. Apparently, they don’t want to be compared because it may not fit with their political messaging. Clearly, voters and patients deserve more.

    Just 20 years ago, the Health Council was established to monitor tens of billions in new federal spending from the 2003 Health Accord, but it was dissolved after routinely reporting that that provinces had been unwilling to provide comparable and rigorous measures to track what we got for our money. Maybe this time they will deliver…but I doubt it.

  • Adam V says:

    Agree and I would go further. We need more accountability at all levels, including hospitals (many of whom can’t properly cost services and still have huge issues with efficiency) and physicians (too many family doctors have too few opening hours so patients use walk-ins or ERs, and/ordon’t accept same-day appointments).

Authors

Joss Reimer

Contributor

CMA President Dr. Joss Reimer is a public health and maternity physician in Winnipeg. Her leadership roles include positions as chief medical officer for the Winnipeg Regional Health Authority, the medical lead and official spokesperson for Manitoba’s COVID-19 Vaccine Implementation Taskforce and the medical director of public health for Winnipeg.

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